Issue 8 Stories
Physicians Perspective

Anesthesia: Keeping You Safe, Comfortable and Unaware During Surgery

My first experience with anesthesia occurred the day before my last semester as an undergraduate at the University of Illinois Urbana-Champaign. While driving back to school, my mother and I were involved in a high-speed, head-on car collision in which I suffered a broken hip, knee and ankle. I was airlifted to Loyola University Hospital and brought to the emergency room.

In a fair amount of pain, I was given ketamine, a drug used to start anesthesia, as the doctors and nurses attempted to relocate my hip. Prior to receiving the drug, a calm female voice explained what I was going to be given.

I remember asking, “Will I scream?”

“You might,” said the voice, “but you won’t remember.”

It’s true—I don’t remember whether I screamed or not, but I do remember being afraid.

A Common Concern

I’m writing this article for anyone interested enough to read it, but I especially want to address readers who may be facing surgery, as well as those who may be avoiding surgery due to certain concerns I often hear from my patients.

If you’re like many people, the idea of being “put under” anesthesia might make you a bit anxious. But rest assured (pun intended!) that anesthesiologists have worked very hard over the years to make anesthesia incredibly safe. As anesthesiologists, we have the privilege of working individually with our patients throughout the entire anesthetic experience—even if they aren’t aware of it!

A typical day for me starts with checking my anesthesia machine. This machine is a critical tool, so we make sure it’s in proper working order every day. The day before your surgery, I already will have looked up your medical record and will be thinking about how to ensure that your anesthesia goes as smoothly as possible.

Then I meet with you, and together we cover all “flight safety” checks to ensure the best possible outcome. This is where you and I, working together, create an anesthetic plan. Believe it or not, there are often different ways to keep surgery patients comfortable and unaware while they are undergoing their procedure. Our goal during this meeting is to find the option that is best for you.

Anesthesia doesn’t necessarily require you to be “asleep” for a procedure. Whether you are under general anesthesia, lighter sedation or regional anesthesia (the blocking of sensation to a particular region of the body), your anesthesiologist will be with you during the entire procedure, monitoring your vital signs: blood pressure, heart rate, oxygen levels, respiratory rate, temperature, electrocardiogram and even the amount of carbon dioxide you exhale. Your safety is our top priority before, during and after the procedure.

Why Can’t I Eat or Drink Before a Procedure?

Our concern for your comfort and safety often requires us to ask you to perform some unusual tasks prior to your surgery. Typically, we will ask you not to eat or drink anything for up to 8 hours before your procedure—except for sips of water to take any “approved” medications you may need.

We understand how frustrating this can be, especially when all you want is a drink of water! But this restriction is especially important, and is one of the parameters that have been established to make anesthesia so safe. Keeping your stomach empty greatly reduces your risk of experiencing aspiration, which occurs when the contents of your stomach enter your lungs. If that should happen, it can cause serious, even life-threatening complications. These restrictions on food and drink help to ensure that aspiration, thankfully, is a rare occurrence.

Will I Remember Anything About My Surgery?

Another rare event many patients can be concerned about is awareness under general anesthesia. “I don’t want to know ANYTHING!” is a common—and understandable—request from our patients.

Patients who are given sedation, as opposed to those given general anesthesia, are more likely to have some memory of their procedures. What they often recall is the voices of those in the procedure room. It’s also normal to remember going into the operating room, as well as the recovery room, where our nurses who specialize in recovery from anesthesia keep careful watch over you until you fully awaken.

Awareness under general anesthesia is fairly uncommon, especially in planned procedures. We take very seriously our patients’ wishes to not remember anything during a procedure, and we have an excellent record of meeting those requests.

How Else Do You Keep Me Safe During My Procedure?

If you are preparing to have a surgical procedure at Sentara RMH, you will first undergo preanesthesia surgical screening (PASS). We anesthesiologists work with our PASS nurses to ensure that you are properly prepared for surgery, even before you arrive on the day of your procedure. Our trained nurses will interview you, often by phone, and gather all your pertinent medical information, including any medications you regularly take. Having this information helps us on multiple levels, letting us know if you are at risk for any complications during or after your procedure, and whether you may have a higher risk of experiencing awareness under anesthesia.

The PASS nurses will also give you instructions on which medications to continue taking and which to refrain from using prior to your procedure. After reviewing your chart, we may even ask you to come to our preanesthesia screening clinic before the day of your surgery so we can be best prepared for your arrival. We are committed to doing everything we can to ensure your safety and comfort.

A Developing Field

Anesthesia has come a long way since 1846, when Dr. William T. G. Morton first publicly displayed ether anesthesia at Massachusetts General Hospital in Boston. A painting depicting the event shows an unconscious patient surrounded by men in black suits, intent on the operation, while even more physicians sit watching nearby. Flash forward more than 170 years, and the same operation looks completely different. The goal, however, remains the same—to keep the patient safe, comfortable and unaware during surgery.

The practice of anesthesiology continues to evolve and become safer. Mortality rates from anesthesia, in fact, have dropped tremendously in the past 20 years. Research conducted by the National Institutes of Health suggests that patient mortality may be as low as 1 per 1.1 million of the population. In addition, in 1984 the American Society of Anesthesiologists created the Closed Claims Project, in which a group of anesthesiologists diligently reviewed hundreds of malpractice cases to discover if there were any similarities. The results were peer-reviewed and published in major medical journals. The Closed Claims Project is still ongoing and continues to give us great insight into those areas of anesthesia practice in which increased vigilance is necessary. In fact, the motto of the American Society of Anesthesiology is VIGILANCE.

It is my great privilege to have worked at Sentara RMH for the past nine years, collaborating closely with a great team of my fellow anesthesiologists, surgeons, nurses and operating room technicians to safely and effectively care for those who turn to us for help. Rest assured that each one of us is dedicated to your safety and well-being.

Dr. Andrea Styron joined the Sentara RMH medical staff in 2009.

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