There are many ways to skin a cat and the same applies for anesthesia and surgery. Most of the techniques we use today have been around for a long time but it is amazing how creative many practitioners have become by using a combination of tried and tested techniques to make the surgery more efficient, keep the patient safe and allow for a seamless emergence and recovery.
The most common choice today remains the general anesthetic. In this situation, the patient is given medications through an IV and an airway to keep them asleep so the surgery can continue uninterrupted. A general anesthetic has multiple components that may be active depending on the circumstances of the surgery. A key feature is sedation, the patient becomes sleepy. A second feature is loss of awareness. You certainly do not want to remember when they are making an incision in your abdomen. In addition, it is important you be relaxed. Your muscles will relax as you become sedated but often surgeons want the muscles specifically relaxed or paralyzed to make their job easier. Finally, it is essential that pain is controlled even when you are asleep. Of course, as a patient you will appreciate if this pain control continues into the postoperative period and you awaken with little or no pain. During the episode of general anesthesia, the patient remains asleep (sedated, relaxed, unaware and without pain). The way this is accomplished is part of the “Art of Anesthesia.” A good anesthesia provider does this balancing act quite well.
A second choice for anesthesia is a “MAC.” The technical term is Monitored Anesthesia Care. It indicates the AP is present to monitor the patient’s condition and vital signs. Over the years this has evolved into a situation where the AP is present to monitor but in addition is actively involved in sedating the patient. This helps the surgery go quicker for the lucky person under the knife. Due to surgical demands this technique has resulted in a pattern where the sedation has led to a state unrecognizable from general anesthesia. There is nothing wrong with this as long as you have a qualified AP in your room with you.
Regional Anesthesia has become very popular. This type of anesthesia works well for most surgery involving the extremities. Regional techniques are also used to complement anesthesia for abdominal and chest surgery. Prior to surgery your surgeon and/or AP will talk to you about this option and discuss the details. If you agree you will be taken to a procedure room and a nerve block or epidural will be administered. Needless to say, you will be monitored and sedated before this is performed. Today most APs use a combination of ultrasound and nerve stimulators allowing them to be more exact and effective in accomplishing the procedure. Usually within 5 minutes of injecting the medication your extremity will become numb and limp. With these effects, the surgery can be completed without the need of a general anesthetic. If this does happen it is important to point out that your AP will be with you and provide a MAC anesthetic. With this combination, you will feel no pain, sleep lightly through the procedure but wake up quickly when done and be completely pain free postoperatively.