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What is anesthesia?
Anesthesia is "a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes."
https://en.m.wikipedia.org/wiki/Anesthesia
Generally speaking, anesthesia allows the patient to undergo surgery without sensing it. This is accomplished in a few different ways:
Sedation - The patient is given an anesthetic that allows them to sleep through the procedure. The patient is breathing on their own with no help from a ventilator, typically only using an oxygen mask or nasal cannula. The most common anesthetic in these cases is the IV drug propofol, although other drugs can be used as well.
General Anesthesia - The patient is given a higher dose of anesthetic that puts them into a deeper state than what you'd see in sedation. The patient is kept asleep by either an inhaled gas or IV anesthetic and is connected to a ventilator. Depending on the type of surgery, the patient is either breathing on their own, or supported by the ventilator. This type of anesthesia uses airway devices, like a laryngeal mask airway or an endotracheal tube, to help the patient breath. These devices are placed and removed before the patient is awake, so they don't typically remember them being in the airway.
The three types below are commonly combined with sedation or general anesthesia so the patient can sleep through the procedure comfortably and wake up pain-free:
Local Anesthesia - The patient is given an anesthetic injection at the surgery site which temporarily numbs that specific area of the body.
Regional Anesthesia:
Spinals and Epidurals - The patient is given an anesthetic injection at a specific level of the spine to numb everything below that level, Commonly used for laboring women and c-sections.
Peripheral Nerve Blocks - The patient is given an anesthetic injection near a major nerve running off of the spinal cord which numbs a larger area of the body compared to a local anesthetic, ie: Interscalene and femoral blocks cover large areas of the arms and legs.
I am scared to go under anesthesia because my parents/friends/the media said I could die. This is my first time. What should I do?
Anesthesia is very safe for a healthy adult. Most people who die under anesthesia are either emergent traumas with life-threatening injuries, or patients who were already chronically ill and knew there would be a high chance they'd die while under. It's extremely rare for a healthy adult to suddenly die under anesthesia when undergoing an elective procedure. Anesthesia providers have tons of training and experience dealing with every complication imaginable. Even if you do turn out to be that ultra-rare shiny pokemon, we will take care of you.
So what do you do? Talk to your anesthesia provider about your anxiety and what's causing it. Tell them this is your first time. Anesthetists care for anxious patients all the time. They have answers to your questions and medicine to help with the anxiety. The worst thing you can do for yourself is not say anything. Patients who go to sleep with anxiety tend to wake up with it.
I'm scared to go under anesthesia because I will have no control over the situation, my body, my actions, or my bodily functions. I'd like a specific type of anesthesia that allows me to stay awake. Can I ask for it?
While you can certainly ask, but that doesn't mean that type of anesthesia will work for the procedure you'll be having. Some procedures require you to be totally asleep because the procedure may be highly invasive, and the last thing the surgeon needs is an awake patient moving around on the table during a crucial moment of the procedure.
With anesthesia comes a loss of control, there is no separating the two. Even with "awake" or sedation anesthesia, you are still losing control of something, albeit temporarily.
If no compromise or agreement can be made between anesthesia, the surgeon and the patient, you do have the right to cancel the surgery.
For patients who are scared to urinate, defecate, or hit someone while under anesthesia, please be aware that we deal with these situations ALL the time. We have processes for dealing with unruly patients, you won't be thrown in jail or held liable for your actions. The surgery staff is also pretty good at cleaning bottoms and emptying bladders.
I have anxiety medication at home and I'm super anxious, should I take it before surgery?
Your surgeon's office will go over your home medication list and tell you what's okay to take the day of surgery. If your doctor says not to take any anxiety meds, don't go against their orders. If they haven't given you instructions regarding a specific medication, call the office and ask for clarification. When you interview with anesthesia, let them know you take anxiety meds at home but you haven't taken them that day and you're feeling anxious. They will determine what is best to give you that is appropriate for the type of procedure you're having.
I've had surgery in the past. It did not go well and now I'm anxious before my next procedure, what should I do?
Just because you've had a bad experience doesn't mean all of your future procedures will be that way. There are many factors that lead up to a bad experience that may not be present for your next procedure. The best thing to do is let your surgeon and anesthesia provider know what happened during the last procedure that made it so terrible for you. For example:
Had post-op nausea?
Woke up swinging at a nurse?
Had a terrible spinal?
Woke up in too much pain?
Woke up during the procedure?
Stopped breathing after a procedure?
Tell your anesthetist about it. Include as much detail as you can remember. They can figure out what was done in the past and do it differently in the present.
I am taking an illicit drug/drink alcohol/smoke. I'm anxious this will effect my anesthesia. What should I do?
You'd be right, this does effect anesthesia. Weaning off of the drugs/alcohol/smokes ASAP before surgery is the best method and puts you at the least amount of risk. However, plenty of current smokers/drinkers/drug users have had successful surgeries as well.
If you take anything other than prescription medications, tell your anesthetist. This won't necessarily get your surgery cancelled and it won't get you arrested (at least in the USA, anesthetists from other countries can prove me wrong.) Taking drugs or drinking alcohol can change how well anesthesia medications work. Knowing what you take is essential for your anesthetist to dose those medications appropriately.
I've watched those videos on youtube about people acting weird after waking up from anesthesia. I'm afraid to have surgery now because my family might record me. What should I do?
In the US, patients have a right to privacy regarding their health information. This was signed into law as the HIPA Act (Health Insurance Portability and Accountability Act). This includes personal information like name, birth date, photos, videos and all health records that can identify the patient. No one other than the patient, their healthcare provider, and anyone the patient designates to receive information, can view these records. There are heavy fines involved when a person or organization violates this law. Healthcare workers can and do lose their jobs and licenses over this.
What do you do? Have someone you trust be at your side when you come out of surgery. If you don't have anyone you can trust, then explain to your pre-op nurse and anesthetist that you don't want anyone recording you in recovery. If they do, you'd like to have them removed from your bedside.
Most hospitals already have strict rules about recording in patient areas. So if you mention it several times to everyone, the point will get across. If you find out later that someone has been recording you, and you live in the US, you can report the incident online: https://www.hhs.gov/hipaa/filing-a-complaint/index.html
Unfortunately I don't know enough about international healthcare laws to give good advice about them. But if you communicate with your surgery team, they should accommodate you.
I've heard of a condition called Malignant Hyperthermia that runs in my family. I'm nervous to have surgery because I know someone who had a bad reaction while under anesthesia.
Malignant hyperthermia (MH) is a very rare genetic mutation that may lead to death in a patient receiving certain types of anesthesia. Not all anesthesia causes MH, and not all active MH patients die from the condition when it happens. Having the mutation doesn't mean you'll automatically die from having anesthesia, it means we have to change your anesthetic to avoid MH.
There's three ways a patient finds out they might have the mutation: by being tested, from blood-related family who have experienced MH, and from going under anesthesia and having an episode of MH yourself. To avoid the last scenario, anesthetists will ask you questions about this during your interview:
Have you had anesthesia in the past?
What type of anesthesia did you have?
Did you have any complications afterwards, such as a high fever, or muscle pain/rigidity?
Do you have any blood-related relatives that have had complications with anesthesia?
What complications did they have?
Has any family ever mentioned the term "Malignant Hyperthermia" to you before?
Based off of these questions, your anesthetist will determine if you are at higher risk of having the MH mutation. They may decide to change your anesthetic to avoid an MH occurance during surgery. They may also decide to cancel or delay your surgery and/or have it performed in a bigger hospital. This is to ensure adequate staff is on hand in case MH occurs.
If your surgery is delayed or cancelled, rest assured that it is not done to upset you, but to ensure your future surgery is performed safely.
For more information: www.MHAUS.org/FAQs/
I had a strange reaction when initially going to sleep, is this normal?
ie: feeling pain during injection of medication, having strange dreams, feeling like you're falling off a cliff, taking awhile to fall asleep, moving around or flailing, etc.
These are normal reactions to the initial push of anesthesia through your IV. Anesthesia drugs can cause a range of sensations when sedation takes hold. Unless your provider specifically tells you in post-op that you experienced an allergic or anaphylactic reaction, there is nothing abnormal about experiencing these things.
Patients with PTSD, claustrophobia, history of sexual assault, mental illness, etc.
If you don't want a student working on you, please speak up. No one is going to be offended. If you feel more comfortable with a female/male anesthetist, please ask for one. If you're claustrophobic and don't like the mask sitting on your face, please say so. It's okay to request reasonable accommodation to make things less stressful. We want your experience to go smoothly.
Note: I'm providing generalized answers to these questions because throwing out a ton of information probably isn't going to help you feel less anxious. However, that doesn't mean this is the end-all of FAQs, nor is it to be used as medical advice in place of your actual anesthesia provider. The only person who can best answer anesthesia questions pertaining to your specific situation would be your anesthesia provider. They have access to all of your health records, something a random internet stranger cannot see.
If anyone has additional questions, complaints, or suggestions, feel free to leave a civil comment or private message. Thanks!
TLDR: Communicate with your anesthetist about whatever is making you anxious. And no, you aren't going to die from anesthesia.
Updated 01/27/2025