10 Things You Should Know About Anesthesia

It’s hard to imagine, but not so long ago, people used to go through surgery wide awake! Back then, the only types of surgeries were short ones. It was so painful to have surgery that people could only tolerate it for a few minutes. That made it impossible for surgeons to do many surgeries we take for granted today. 

In 1846, a Boston dentist introduced anesthesia, and everything changed: People could have surgery and not feel any pain. Anesthesia has evolved since then, with new drugs and monitors making anesthesia safer than ever.

If you’re having anesthesia, here are 10 things you should know about how it works. 

1) There’s more than one type of anesthesia

There are four main types of anesthesia: 

1) General anesthesia: People who receive general anesthesia are made unconscious through inhaled gases, medications given in the vein, or a mixture of both. This means they will not feel pain or remember the surgery. Often, they need a breathing tube to help them breathe during surgery.

2) Regional anesthesia: People who receive regional anesthesia get medications injected to block specific nerves so they don’t feel pain over a large area of their body. One type of regional anesthesia is an epidural, which many women receive during childbirth. 

3) Sedation: People who receive sedation get a medicine that makes them enter a sleep-like state in which they don’t feel pain or remember their surgery. 

4) Local anesthesia: People who receive local anesthesia have a medicine injected or applied to a certain part of their body that makes it numb. One example of local anesthesia is novacaine, which dentists use when they fill cavities. 

Sometimes, sedation is used with local or regional anesthesia. Which type of anesthesia you get depends on what kind of surgery or procedure you are having as well as your medical history. 

2) Sedation is used for more than just surgery

Sedation is a type of anesthesia that provides pain relief and lets you fall asleep without making you unconscious. With sedation, you still breathe on your own and you can move. The medical team can vary the amount of medication they give in real time so that you stay comfortable. 

Sedation is used for shorter surgical procedures, but it’s also used for certain medical procedures, like endoscopies and colonoscopies. Some people also prefer to have sedation for things like biopsies and dental surgery. 

For children, sedation can help relieve not just pain but also fear and anxiety during procedures. Kids can get sedation if they need stitches, a broken bone set, or even a long imaging study like an MRI. 

3) General anesthesia is safer than you think

Some people ask for local anesthesia thinking it’s safer than general anesthesia. It would seem obvious that a minor procedure using local anesthesia would be safer than a major procedure using general anesthesia. But this has never been proven.  

Studies show that safety outcomes of local anesthesia and general anesthesia are often equal. 

All types of anesthesia carry risk, including the risk of death. But this is very uncommon. The death rate from anesthesia is 0.4 out of every 100,000 surgeries for people without underlying medical conditions. To put this in perspective, you are 27.5 times more likely to die in a car accident than die from anesthesia. 

4) The scary complications are extremely uncommon

One of the scariest complications of anesthesia is anesthesia awareness, meaning you become conscious during surgery. While this can happen, studies show that it is very rare, even with general anesthesia. 

Many operating rooms have special machines that monitor brain waves and that alert the anesthesia team if you are waking up. Your team will be able to adjust your anesthesia so you don’t regain consciousness.  

5) Certain types of anesthesia are safer for some people than others

Everyone wants the safest type of anesthesia available. It’s true that there are risks with all types of anesthesia. But what matters isn’t the medication but the person. Anesthetics that are safe for one person may be dangerous for another. 

For example, regional anesthesia might be safer than general anesthesia for a person who has a neck tumor. But the exact opposite is true for someone with a certain type of heart condition called aortic stenosis. 

Your anesthesiology team will work with you to determine the safest option for you. 

6) General anesthesia might affect children’s brain development

The FDA is working with anesthesia researchers to study the long-term effects of general anesthesia on how children learn. The results of these studies are not yet clear. 

Many surgeries and procedures cannot be delayed because they are lifesaving. In these cases, the child must get general anesthesia. In situations where a procedure or surgery can wait, some experts recommend waiting until children are 3 years old to have general anesthesia. This is especially true in cases where surgery is expected to last longer than an hour. 

7) There’s no such thing as the strongest anesthesia

Many people jokingly (or seriously) ask for the strongest stuff when they’re going to have surgery or a procedure. But there’s more than one type of strong when it comes to anesthetics. 

Each type of medication used in anesthesia has its own unique function. A medicine may be strong in one way but not in another. For example, one medicine can be great for pain relief but do nothing to make someone less anxious during surgery. Another medicine might make someone so relaxed that they could sleep during surgery but not afford any pain relief. 

8) The no-eating-or-drinking-after-midnight rule has changed 

People receiving general anesthesia and sedation were once told they couldn’t have anything to eat or drink after midnight on the day of their procedure. For those who had procedures scheduled late in the day, this meant a long day of hunger and thirst on top of the stress of the procedure.

There is a good reason for the rule. Getting anesthesia lowers or removes your body’s reflexes. That means during the procedure you could choke on anything you've eaten recently. 

But research shows this risk is only high for about 6 to 8 hours after eating. The recommendations now say it’s OK to have a light meal until 8 hours before a procedure. You can also drink clear water until 2 hours before a procedure. It’s OK to give babies breast milk until 4 hours before a procedure and formula until 6 hours before a procedure.

9) You still can’t drive or operate machinery after anesthesia

If you need general anesthesia or sedation, you’ll be told you can’t drive or operate heavy machinery for 24 to 48 hours following your procedure. This is because the medicines used for these types of anesthesia cause sleepiness and decreased response times. 

There are clinical trials looking to see if this rule should be changed, especially for people who are getting short periods of sedation. 

10) You should be prepared for side effects 

Although anesthesia is relatively safe, the medications do cause side effects. You might not feel great after anesthesia, but fortunately side effects wear off after a few hours. 

The most common side effects of sedation and general anesthesia are:

• Sore throat

• Nausea and vomiting

• Confusion

• Muscle aches

• Itching

• Chills and shivering 

 After a spinal or epidural anesthetic, you might have:

• Headaches

• Backaches

• Trouble going to the bathroom 

Your healthcare team might give you medication to help with the side effects. Many people prefer to rest quietly for a few hours while the side effects resolve. 

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Written by:

Ronald W. Dworkin, MD, PhD

Ronald W. Dworkin, MD, is a board-certified anesthesiologist who has been practicing anesthesiology in a community hospital for 30 years. He has taught in the honors program at George Washington University for over 10 years and works as a senior fellow at the Hudson Institute.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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