Going to Sleep

To begin your surgery, you will go through a process known as induction of anesthesia. If you and your anesthesia professional have elected to use general anesthesia there are certain steps that will take place. The first thing you will notice is that your caretaker will get busy placing all the important monitoring devices. These will include an EKG to monitor your heart electrical activity, and automatic blood pressure cuff that will check your blood pressure every 5 minutes, an oximeter to check your oxygen levels continuously and BIS monitor to measure EEG activity for awareness. If your case requires an arterial line or central line it will be attached to a machine that will do all the monitoring.

Once the monitoring devices are working properly the anesthetist will begin the process. One essential ingredient is oxygen to be administered by mask to prevent any dangerous drops in your oxygen levels as you go off to sleep and your breathing is blunted. During these moments, the anesthetist will encourage you to breathe deeply and think of where you would want to go for your next vacation. At this moment, they will inject medications in your intravenous line. These medications are fast acting sedating agents which often burn at the injection site but will get you off to sleep in seconds.

As you go off to sleep the anesthesia provider will tape your eyes closed to prevent any abrasions of the eye.  They may also put a lubricant in your eyes to keep them moist.  Once they are satisfied you are completely asleep and relaxed in the case of most general anesthetics they will put a small plastic tube in your throat to assist your breathing.  This will be secured carefully so it does not become dislodged during the case.  Any tube that falls out during the case can be very problematic for everyone, most importantly the patient.

Today there is a newer device which is called commonly an LMA (Laryngeal Mask Airway).  This is a tube with a balloon attached to splint the airway open allowing the patient to breathe on their own but still be asleep.  This is being used more and more today.  Some people like the idea of not putting a tube past the vocal cords and there tends to be less coughing when the patient wakes up.

If you are having a regional anesthetic as with a nerve block, then your induction will be different.  By the time, you get in the room your arm or leg will be numb from the anesthetic.  Often you will notice they are limp, and you will be unable to control them.  You must carefully support your extremity so you do not get hurt.  Once you are carefully placed on the operating room table you will be given oxygen by an oxygen cannula and medications are usually given for sedation. Some people prefer to be completely awake.  The medication will make you sleepy and very likely make you forget everything that happens in the room.  The same monitoring devices used for a general anesthetic will be used for your safety.  You will usually wake up very quickly and be ready to go home faster than you expect.