Anesthesia is always presumed to be the state of being asleep while you are having surgery, and since the advent of modern general anesthesia in the 1840s, that is more or less how it has been. But now, with the advent of new anesthetic techniques, as well as the presence of new drugs, it is not always necessary to have then patients completely asleep in order to have their surgery.
For a lot of operations, it really isn't an option to be asleep or not, such as open heart surgery or a liver transplant. But amazingly, just about every operation you can think of has been done without general anesthesia. Brain surgery, gallbladder removal, total knee and hip replacement, breast implants, facelifts, hysteroscopy - all have been done with minimal sedation, to the satisfaction of everyone involved. Just for the sake of sorting out then debate of being under general anesthesia or not, I thought I'd go through the pros and cons of general anesthesia versus being awake in some form.
Pros of general anesthesia:
1. It's a lot easier and quicker from the patient perspective. This is obvious. You go in the OR, get some drugs to relax you, and then all of a sudden, you're in the recovery room and your surgery is done. There is a lot to be said for that. Along those lines,
2. The chances of you moving during the surgery are slim to none. It may not matter to you because you won't remember it anyway, but if you're fidgeting around during the surgery, it is difficult for your surgeon and in some cases can be dangerous.
3. No drug induced confessions. The medicines used to keep people sleepy during conscious sedation make some people very chatty. Sometimes during that state of mind, people will say things that maybe they shouldn't. If you're the type of person who is a talkative drunk, for example, opt for the general anesthesia route.
4. You are much less likely to remember anything. I guess you can never guarantee anything, but the chances of remembering anything while under general anesthesia are very small.
Cons of general anesthesia:
1. It's a little more dangerous. General anesthesia involves significantly depressing your level of consciousness. With that comes decreasing your blood pressure and your breathing. Any time you decrease these parameters, the chances of something bad happening go up a little bit. now the chances of something bad happening to a healthy person undergoing a "routine" general anesthetic are very small, but not impossible. Every general anesthetic involves some degree of risk.
2. In all likelihood you'll be in more pain afterwards. During the general anesthetic you get medications to keep you motionless and comfortable. When the surgery is done, those medicines are discontinued, and you wake up. The trouble is that the pain relief properties of those medicines stops too. When you get conscious sedation, the surgeon almost always has to give local anesthetic into the area where the surgery is taking place, and so you wake up a little more comfortable.
3. Nausea. Vomiting. The gases used to keep you asleep during a general anesthetic have, as one of their common side effects, the tendency to make people puke. On one hand, a lot of people, if they get sick, do so in the recovery room and don't remember it. But a lot more get sick hours afterward, or even in the next day or two after surgery. Besides making the patient feel miserable, vomiting, if it happens often and/or vigorously enough, can affect the success of the surgery, causing wounds to open up or bleed in the worst case scenario.
4. Grogginess. In theory, most young healthy people will metabolize the inhaled gases and IV narcotics from a general anesthetic within 6 hours after the anesthetic is finished, but everyone is different. Some people can feel out of it for a day after anesthesia, or even longer. A lot of people don't like that "drugged up" feeling.
5. Loss of control. What's good for one person stinks for another. Many people like the idea of being taken to a happy place for an hour or two while some surgeon does stuff to them and they don't even have to know that any of it even happened. Others can't stand the idea of not knowing what's going on, not being in total control of the situation. Know anyone like that? Are you someone like that? If the words "control freak" have ever been used to describe you, this aspect of general anesthesia will not appeal to you at all.
6. You receive more drugs. If you're having conscious sedation, you get either a nerve block from the anesthesiologist or local anesthetic from the surgeon, and then the anesthesiologist gives you a small amount of sedative through the IV, not enough to make you completely asleep, but enough to make you feel relaxed and comfortable. General anesthesia involves a lot. There's a sedative, narcotics, anesthetic gas, muscle relaxants, etc. More drugs = more side effects.
Next blog I'll go through conscious sedation - what exactly it means, and its pros and cons.
No comments:
Post a Comment