General Anesthesia: The Sleep-wake anesthesia

General Anesthesia (GA) is a type of anesthesia in which your anesthesiologist will put you to sleep, by injecting certain medicines in your veins or asking you to breathe gases from a mask. You will fall asleep before the procedure starts and will remain unconscious throughout the duration of the procedure. After your procedure is over, your anesthesiologist will wake you up.

Once you are under general anesthesia, you can undergo any procedure on any part of your body, without feeling any pain or having any awareness of the procedure.

Which surgeries can be done under GA?

Since GA puts the brain to sleep, any surgery on any part of the body can be done under GA. However, most surgeries below the umbilicus are done under regional anesthesia like spinal or epidural anesthesia (see Spinal Anesthesia (SA), unless there are any contraindications to regional anesthesia. Other minor surgeries or surgeries on small body parts like fingers or toes are usually done under local anesthesia.

GA is appropriate for following types of surgeries:

Surgeries above the umbilicus For example, surgeries on the brain (neurosurgeries), chest (thoracotomies), upper extremities, upper abdomen.
Prolonged surgeries
Surgeries requiring complete immobilization
Surgeries in very anxious or noncooperative patients
Surgeries in patients with central nervous system impairment like head injuries, narcotic overdose, excessive alcohol consumption
Surgeries where spinal anesthesia may be risky or contraindicated

Preparation for GA

If you are having an elective surgery under GA:

You need to be empty stomach for 8-10 hours before your procedure. If you have your surgery in the morning, you can have your last meal in the night by 10 pm and to come empty stomach in the morning.
You will be given certain medications to acidity and anxiety to be taken on the night before surgery and in the morning of surgery.
You will be asked to stop taking any blood thinners or aspirin 5-7 days before your surgery, depending the particular drug being used.
You will be asked to continue taking certain drugs without interruption till the morning of your surgery like medicines for your blood pressure, thyroid disorders, asthma, epilepsy etc.
You may be asked to omit certain drugs on the morning of your surgery, like medicines for diabetes.
In the hospital, you will be seen by an anesthesiologist which will take a detailed history, do a thorough physical examination and go through all your investigations. This is called Pre-anesthetic checkup and is done to check your fitness for surgery. It may be done a few days before surgery or on the day of your surgery, depending on the type of surgery (whether major or minor), presence of any previous medical conditions and the hospital policies.
Your anesthesiologist will also explain the procedure of general anesthesia and answer all your questions regarding the same.
After this, you will be sent to operation theatre.

How much time does it take for giving GA?

Most people imagine operation theatres (OT) to be areas with dim lighting, stressful atmosphere and intense hustle and bustle, and hence the fear of OT. But actually it is not like that.

When you are in the operation theatre, you may feel that you are lying on the operating table while nothing is being done. This is because your anesthesiologist will be going through the anesthesia checklists or preparing for your GA and the surgical team will be preparing their surgical table. During this time, an Intravenous line will be set up and you will be administered certain medications to prepare you for your anesthesia and surgery. This is called Premedication.

Once everything is ready, your anesthesiologist will inform you that GA is being administered As soon as the medicines are given in your vein, it takes just 10-30 seconds for you to fall asleep. You will actually fall asleep before you can count from 1 to 10!

What are the side effects of GA?

With the advent of newer drugs and techniques over time, general anesthesia nowadays is extremely safe and there are very few side effects. Most of these are minor complaints and usually abate on their own.

Some side effects after GA may include:

Nausea and vomiting: Certain drugs use in GA are known to cause nausea and/or vomiting. Some patients may be more prone than others to have nausea or vomiting with these drugs. Nowadays, antacids (drugs that prevent acidity) and antiemetics (drugs that prevent nausea and vomiting), are routinely administered prophylactically before every surgery, which limits postoperative nausea and vomiting to a large extent. Moreover, newer anesthetic drugs have much less side effects than the older ones.
Sore throat or hoarseness: During GA, a pipe is inserted in your throat to breathe you while you are under anesthesia. After surgery, some patients feel soreness or irritation in the throat or their voice may sound hoarse. This happens due to the local irritation caused by the presence of the tube during your surgery and it usually subsides on it’s own. If it still persists beyond a few hours or is troublesome, simple warm saline gargles help.
Persistent drowsiness: Earlier, patients used to remain drowsy for many hours after their surgery, in the recovery room and the attendants would keep waiting for their patient to wake up. But nowadays, the anesthesia drugs are extremely short acting and your anesthesiologist will wake you up right on the operation table, even after prolonged surgeries. So the postoperative persistent drowsiness is rare nowadays. However, some diseases like hypothyroidism or an innate sensitivity of the patient to anesthetic drugs, may cause some patients to remain drowsy in the postoperative room. Even if such drowsiness is there, it rarely persists beyond 1-2 hours and recovers on it’s own.
Respiratory or cardiovascular problems: Once you are under GA, you will stop breathing and the anesthesiologist will insert a tube in your throat to breathe you with a a ventilator. This may incur problems like a difficult airway, chest infection, soreness in throat or injury to airway structures. Similarly, the anesthetic drugs in GA affect your blood pressure and heart rate which have to be kept continuously under control by your anesthesiologist, until you wake up. However, significant problems causing risk to life are rare.
Awareness under anesthesia: In GA, the anesthesiologist puts your brain to sleep so that your do not feel pain or have any awareness. But certain cases have been reported where the patients complained of awareness of the procedure while under anesthesia. Again, this is also extremely are, especially nowadays with improved anesthetic drugs and awareness monitoring techniques.
Allergic reactions: Mild allergic reactions to drugs may be seen in some patients. Serious allergic reactions are extremely uncommon. Even if they happen, your anesthesiologist is there to look after you. You are in safe hands!
Other symptoms: Like dry mouth or shivering. These are temporary and resolve on their own.

Is GA risky?

GA is generally safe in most cases. However, there may be increased risk in patients with associated medical conditions like:

Patients with heart disease
Patients with liver or kidney disease
Patients with respiratory conditions like asthma, emphysema etc.
Patients with high blood pressure or diabetes
Extremes of age like old age, infancy etc.
Patients who are overweight or obese
People who smoke or consume alcohol

How long does it take to wake up after GA?

In the earlier days of anesthesia, it was usual for patients to remain unconscious or sedated for many hours after the procedure.
But nowadays, with improved anesthesia techniques and newer drugs, almost all patients are woken up on the operation table by the anesthesiologist, irrespective of the duration of the surgery.
In some cases, the patients may remain sedated for some time after surgery due to medical conditions like hypothyroidism, kidney disease, liver disease or due to physiological changes like old age. In all these conditions, the elimination of anesthetic drugs by the body gets delayed and the patient may remain sedated for some time in the postoperative period. However, even in these conditions, most patients will be fully wake in 1-2 hours.

Will I feel pain after I wake up from GA?

Gone are the days when patients used to wake up from GA screaming with pain and then someone would come and inject an intramuscular injection on the buttock.
Nowadays, many good painkillers are available, which are administered to you in your veins before you wake up from GA. Since these pain killers are already in your body before you wake up, you will wake absolutely comfortable and pain-free in most cases.
It is possible that you may feel mild discomfort, mild pain, or throbbing at the operative site. This is due to increased blood flow to the operative site, and is usually not troublesome. In case, you feel that the pain is bothersome, you can request your anesthesiologist for additional pain relief.

Carry home message

General Anesthesia puts you to sleep for some time and surgery on part of the body can be done under GA. GA is especially indicated for long duration surgeries, surgeries on uncooperative patients, patients with impaired consciousness due to head injury or dug overdose. In the absence of other medical conditions, GA carries low risk of complications. So stay safe and do not worry! Trust your anesthesiologist.

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