From the birth of Anesthesiology to the present day, numerous popular beliefs about this speciality have emerged. Despite the scientific and technological advances that we have today, many of these issues continue to cause concern among people who undergo an anaesthetic technique.
In this article, we have compiled the ten concerns about anaesthesia that our patients frequently express to us to resolve doubts and debunk myths.
1. Is it true that, in general anaesthesia, we fall asleep breathing from a mask?
This may be true on some occasions, but in most cases, general anaesthesia is induced by administering medication intravenously. Indeed, the patient is always asked to breathe through a mask, but what is lived is oxygen. We do this to increase the available oxygen reserves from when the patient stops breathing when they fall asleep until they are intubated and placed on a ventilator.
On other occasions, we perform an inhalation induction of general anaesthesia when they fall asleep breathing from the mask. A flow of air mixed with volatile anaesthetic agents is circulated through this mask, which exerts the same hypnotic effect as intravenous drugs but enters the body through the lungs.
2. I have a hard time giving the anaesthetic” or “Last time I vomited the anaesthetic.”
To clarify this myth, we must talk about the metabolism of drugs: they are the degradation processes that medicines undergo in the body after being administered, mainly in the liver. Here a series of chemical reactions transform the drugs into inactive compounds. They return to the bloodstream and are eliminated through the kidney, that is, through the urine. In short, anaesthetic drugs are inactivated in the body and are expelled when they have lost their effect, meaning that you do not need to urinate to get rid of the anaesthetic.
Nor are the drugs eliminated through the digestive tract. The problem is that some have nausea and vomiting as a side effect. However, we have medications to prevent or relieve these symptoms effectively.
3. Can I wake up during anaesthesia?
When there were not so many means available to monitor the vital functions of patients, it was common to use low doses of anaesthesia in very complex operations or very critical patients to avoid lowering blood pressure too much during the procedure, which resulted in intraoperative awakenings. Today we have many monitors that allow us to control the main vital functions of patients and also the depth of sleep, so these awakenings are highly unusual.
4. Are there people resistant to anaesthesia?
No one is resistant to anaesthesia. The drugs are dosed according to the patient’s weight, age and physical condition, so some people need fewer doses, and others need more, but everyone can be anaesthetised.
5. I’m afraid of staying on the operating table because they “go overboard” with the anaesthesia.
It is doubtful to die from an anaesthetic technique. Anesthesiologists are well aware of how the drugs we use work and the repercussions they can have on patients, so undergoing an anaesthetic technique is a safe and controlled procedure at all times.
6. Why do I have to undergo surgery on an empty stomach?
The main reason is to reduce the risk of bronchial aspiration, that is, the passage of gastric content into the lungs, which can cause pneumonia. This can happen because the anaesthetised patient cannot protect his airway by himself, through reflexes such as coughing, for example. With the drugs we use to put patients to sleep, the lower part of the oesophagus relaxes, and if there is food in the stomach, it can travel up to the mouth and into the trachea and lungs. In contrast, on an empty stomach, the stomach is practically empty, and this is much less likely to happen.
7. General anaesthesia is the most dangerous of all.
General anaesthesia may seem, a priori, the most dangerous because we are asleep and paralysed. In any case, the anesthesiologist is always present and is responsible for monitoring and controlling the situation so that it is just as safe as any other anaesthetic technique. The most important thing to remember is that any method has its advantages and disadvantages, and each has its indication for different procedures. Anesthesiologists are specialised doctors who administer the most appropriate type of anaesthesia to each patient.
8. How does the anesthesiologist know when I will wake up?
During general anaesthesia or sedation, we administer drugs in a continuous and controlled manner so that the patient remains asleep and, when we stop doing so, they are progressively eliminated from the body until the patient wakes up. This elimination is carried out in a predictable time that we know. In addition, we have monitors that monitor the depth of sleep that helps us see how the patient is progressively waking up.
9. Is it reasonable to stop smoking before an intervention?
Yes, because it has been shown that quitting smoking at least four weeks before surgery reduces respiratory, cardiovascular and infectious complications. If the abandonment or the reduction in the number of cigarettes occurs only a few days or a few weeks before, it is not clear that the complications decrease. Still, it does improve the oxygenation of the tissues. Although it is true that quitting smoking a few days earlier increases anxiety, mucus production and airway reactivity, it is not associated with significant adverse effects. In the case of heavy smokers, psychological and pharmacological help (bupropion and nicotine patches) is recommended to control the symptoms related to anxiety.
10. Is it true that I can become paraplegic after epidural anaesthesia?
Epidural anaesthesia is not a harmless procedure. The most severe complications, such as paraplegia, are fortunately infrequent (1 in 200,000 epidurals). Paraplegia occurs due to compression of the spinal cord or nerves exiting from it by a mass, usually an epidural hematoma or abscess. The epidural abscess is produced by the colonisation of a germ of the skin of the puncture area or by dissemination through the blood of another infectious source (urinary). Epidural hematoma is related to severe blood coagulation disorders or the administration of anticoagulant medication. To avoid these complications, all patients undergo disinfection of the puncture area, analytical control to ensure that there is no infection in the blood or coagulation disorders, and the doses and administration times of the anticoagulant medication are also controlled. In this way, we make sure that we can perform this anaesthetic technique safely.
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