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Are there risks to having anesthesia?
Although all types of anesthesia involve some risk, major side effects and complications from anesthesia are uncommon. Patients often ask "What is the risk of having anesthesia?" Unfortunately, there is no quick and easy answer to that question. There are personal risk factors to consider such as the patient's age, weight, or the patient's medical condition and history. The number of potential complications that have been known to occur during anesthesia is vast; it is impractical to aspire to discuss each of them fully. In our practice at CAA, every patient is evaluated by an anesthesiologist before surgery. Usually this occurs before the patient comes to the operating room, but sometimes, such as with emergency surgery, the patient may not meet an anesthesiologist until he or she actually arrives in the operating room holding area. During this evaluation the anesthesiologist reviews the patient's medical information and makes note of those factors that may become important during surgery. After this evaluation, the anesthesiologist is in a position to discuss the risk profile of that particular patient.
Some anesthetic medicines may cause an allergic or abnormal reaction in the patient, but these instances are rare. If you suspect you may have such a problem, you should tell both the surgeon and the anesthesiologist well before the surgery so that testing may be arranged, as necessary. Death or serious injury due solely to anesthesia is quite rare and is usually related to complications from the surgery.
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What if I wake up during the operation?
Many patients ask about the possibility of waking up in the middle of an operation. Although this is a very rare occurence, there have been instances when it has occurred. In anesthesiology, we refer to this as "awareness." When awareness does occur, it is usually just prior to the anesthetic taking effect or as the patient is emerging from anesthesia. In very rare instances it may occur during the surgery itself. Should the patient have any concerns regarding awareness, address them with the anesthesiologist during the pre-operative visit.
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Can anesthesia cause nerve damage?
For purposes of discussion, the nervous system is divided into two parts. The Central Nervous System consists of the brain and spinal cord. The Peripheral Nervous System comprises basically everything else, i.e., all of the nerves that travel to the various parts of the body after exiting from the spinal cord. Nervous tissues are extremely sensitive and vulnerable structures. Occasionally in the period of time surrounding surgery or childbirth, patients exhibit signs of nerve damage. Sometimes the cause of their symptoms seems obvious, but in many instances it is obscure.
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Will the anesthesia make me sick?
Many patients fear nausea and vomiting after anesthesia and surgery. Fortunately today, nausea after anesthesia is much less common than it once was. Nevertheless, it is still a problem. One of the problems with predicting its occurrence and taking steps to prevent it is that it appears that many different factors influence its incidence. It appears to be the final common pathway for a variety of different disturbances. Think of all the non-anesthetic situations where nausea shows up and you will appreciate how many different things can result in nausea. One thing for certain is that it is not so simple as to be the result of using any one drug. Many studies have attempted to elucidate the factors involved in producing post-op nausea and several factors seem to influence the probability of having it. Factors such as the type of surgery (irrespective of the type of anesthesia), sex, age, and obesity all alter the chances of getting sick after anesthesia.
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Will I get a headache after a spinal or an epidural?
The brain and spinal cord are bathed by a fluid known as cerebrospinal fluid, or CSF. This fluid is contained by a membranous structure, the principal member of which is the Dura Mater, usually referred to as simply the dura. Several procedures in medicine involve puncture of the dura: diagnostic lumbar puncture ("spinal tap"), myelogram, spinal anesthesia, and others. Additionally, a small percentage of epidural anesthetics result in an unintentional dural puncture. Once dural puncture has occurred, the stage is set for the production of a syndrome known as a post-dural puncture headache, or PDH. Not everyone who has a dural puncture, however, develops the headache. Many factors influence the development of headache, including sex, pregnancy, age, and the size and type of needle used. The production of the headache seems to be caused by the leakage of spinal fluid through the puncture site, with a lowering of the CSF pressure. Typical characteristics of PDH include its postural nature, it being worse in the upright position than when lying down, and its temporal relationship to the dural puncture. A small percentage of patients with PDH will also experience disturbances of their vision or hearing.
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Can anesthesia cause breathing problems after surgery?
Some patients experience breathing problems after surgery. This can result from pulmonary aspiration, atelectasis and pneumonia, residual muscle weakness, or may result from pre-existing lung disease such as asthma or emphysema.
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What are the dental complications of anesthesia
During most general anesthetics, and potentially in any regional or local anesthetic, an endotracheal tube may be inserted through the vocal cords into the trachea, or windpipe. This procedure, an essential one for protecting and maintaining the airway during anesthesia, is called intubation. It is performed using an instrument called a laryngoscope; laryngoscopy (the use of the laryngoscope to intubate) poses a risk to teeth. The jaw and facial structures of some normal, healthy individuals may make intubation difficult. In individuals with unhealthy teeth or gums or frontal caps or bridges there is an increased risk of tooth damage. We understand that no one expects tooth damage when having surgery on some other organ system, but this type of damage is a risk during surgery and anesthesia even with experienced personnel.
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What are the risks of Spinal Anesthesia
Headache: The most frequent complication of spinal anesthesia is known as a spinal headache. Today's spinal needles are specially designed to help prevent this complication, and only a small percentage of patients develop it.
Back Pain: Most persons experience back pain at some point in their life, and it can have many causes and precipitating factors. Just laying in bed for a few days after surgery can cause back pain, regardless of the type of anesthesia chosen. Some patients assume that when they develop chronic low back pain later in life that it is because they were given a spinal anesthetic when they were younger. However, when well-designed medical studies have examined the issue, spinal anesthesia has not emerged as an important cause of chronic low back pain.
Nerve damage: There have been rare cases of nervous system damage leading to deficits in sensation or strength following anesthesia of all types, including spinal anesthesia; fortunately, many of these resolve spontaneously. The causes may differ among cases.
Failed Anesthesia: Occasionally, the spinal anesthetic may fail to provide adequate anesthesia for the surgical procedure. Sometimes this occurs because the surgery continues for longer than anticipated, outlasting the anesthetic. In other cases, the spread of anesthesia may be nonuniform, resulting in a "patchy block." Sometimes a surgeon can supplement by injecting a local anesthetic; in other cases a general anesthetic becomes necessary.
Total Spinal Anesthesia: Various techniques exist for controlling the spread of spinal anesthesia. Occasionally the spread of the anesthetic extends to a higher level than expected. If the spinal level gets too high, then there may be enough muscle weakness to result in inadequate breathing. This is usually managed with endotracheal intubation and assisted breathing until the effect has worn off.
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Complications of Brachial Plexus Block
Possible complications differ in their likelihood with the different approaches, but include:
Collapse of the lung on the same side. The tip of the lung is very near to the brachial plexus, and there have been cases where the needle punctured the membrane lining the lung, resulting in collapse. If the lung collapses far enough, re-expansion by means of a surgically placed chest tube may be required. This is not a frequent complication of brachial plexus block.
Inadequate or "patchy" block. When anesthetic solutions are injected near the brachial plexus, they normally spread uniformly to anesthetize the entire plexus. On occasion, however, the spread is not uniform and incomplete numbness is achieved. If the surgeon cannot compensate for this by adding a small amount of local anesthesia, a general anesthetic is usually required to complete the operation.
Phrenic nerve block. More often seen with interscalene and to a lesser degree with supraclavicular block, this happens when enough anesthetic solution spreads upwards from the plexus to anesthetize the phrenic nerve, which controls the half diaphragm on the side of the block. Blockade of this nerve causes weakness of this important breathing muscle until the anesthetic wears off. However, in normal persons with adequate lung reserves, it is usually well tolerated. Patients with advanced lung disease might tolerate it poorly enough to require assistance with the breathing, and possibly endotracheal intubation with breathing assistance, until the effects have dissipated.
Axillary hematoma. Some approaches to axillary block involve finding the plexus by first locating, with the needle, an artery that lies immediately next to the plexus. Small amounts of blood that escape from the needle hole in the artery can form a blood clot, or hematoma, beneath the skin. This can show up as a discoloration similar to a bruise in the armpit and can cause a little soreness for a few days. This is usually no more than a temporary nuisance, and resolves spontaneously.
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What are the risks of Local Anesthetic Medicines?
While local anesthetics are widely and successfully used to provide pain relief, they are not without potential problems. In addition to the numbing effect they have on nerves, they also have actions on the brain and heart. If too much local anesthetic enters the circulation, it can cause a convulsion or a disturbance of heart rhythm. For this reason there are limits concerning how much local anesthetic medication is safe to administer. In addition, epinephrine (adrenaline) is often added to the local anesthetic solution because it constricts blood vessels, thus reducing blood flow to the area, thus the slowing absorption and lowering the blood levels of the local anesthetic drug. Many patients think themselves to be allergic to local anesthetics because of the way the epinephrine makes them feel (anxious, apprehensive, heart racing). However, such symptoms are not signs of a true drug allergy but rather just the actions of small amounts of epinephrine that have gotten into their systems; local anesthetic drugs can safely be used in these patients.If the area of the body that is being anesthetized is small enough, a local anesthetic technique can be used. However, if a larger area is being targeted, then regional or general anesthesia should be chosen.
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