I'm afraid of anesthesia

Undoubtedly, most patients aren't afraid of surgery itself. Rather, it's the anesthesia they fear. Will I wake up? I believe this is an atavistic fear, something deep within us. It's a situation we can't control. Medicine and the science of anesthesia have advanced so much, in both medication and technology, that surgery has become a very safe procedure.

What types of anesthesia exist?

There are three basic types of anesthesia: general, regional, and local. Regional and local anesthesia can be combined with sedation.

What is general anesthesia?

General anesthesia is a state of controlled unconsciousnessSo you feel no pain. You are completely unaware of the surgery being performed. To achieve this state of unconsciousness, different medications are used, both intravenously and by inhalation. Propofol is a medication used to induce sleep. Depending on the dose, this sleep can be more or less light (light sedation, deep sedation, or general anesthesia). During general anesthesia, respiratory depression occurs, so the patient's breathing must be maintained with a ventilator. Therefore, intubation (either endotracheal or laryngeal mask) is used to maintain the respiratory cycle. Muscle relaxants are also administered, both to facilitate intubation and during surgery to aid the surgeon's work (for example, when suturing the abdominal muscles in an abdominoplasty). Inhalational anesthetics keep the patient asleep and pain-free and are delivered through the ventilator. Awakening from general anesthesia is practically immediate. In just a few minutes, as soon as the anesthesiologist stops administering the medication, the patient wakes up and is extubated. Of course, there will be some drowsiness for a few hours after the anesthesia wears off. Think of it as a kind of "strong high." It's very important to enter the operating room as relaxed and calm as possible. The brain doesn't really experience the time of anesthesia. If you're under anesthesia and you're nervous or crying, that's how you'll wake up. So, always try to think about something pleasant.

What is regional anesthesia?

En la anestesia regional se utiliza un anestésico para dormir en una zona específica. Para ello se inyecta un anestésico local alrededor de un nervio o nervios principales, de forma que se duerme un área anatómica (un brazo, una pierna, una zona de la cara). Una forma especial es la anestesia raquídea, epidural o intradural. El objetivo en estos casos es bloquear las raíces nerviosas o la médula espinal desde un nivel determinado. Es muy conocida porque es la que se usa en los partos. En la anestesia regional, el paciente está despierto. Aunque no tenga dolor en la zona, es consciente de lo que ocurre en quirófano. Para reducir el estrés y que la intervención no se haga tan pesada, se combina con una sedación. En la sedación se inyecta una medicación que induce un sueño ligero y sobre todo actúa como hipnótico: prácticamente no te acordarás de nada del tiempo transcurrido en el quirófano.

What is local anesthesia?

Local anesthetics are substances that block nerve conduction, causing the area where they are injected to become numb. Local anesthetics are injected into the area where the procedure is being performed. They eliminate pain but not the sensation of heat (which is why you can feel it when we coagulate with the electrocautery device). You will feel that we are working, compressing, stretching… but not pain. The problem with local anesthesia is the risk of toxicity if the dose is excessive. Therefore, it cannot be used for large areas (in this case, regional blocks must be performed to avoid using such a high dose). Toxicity from local anesthetics is very difficult to control since the body itself must metabolize and eliminate the substance. With local anesthesia, the patient is fully awake. This gives a false sense of security (since I'm awake, it's better), but in large areas (for example, liposuction) it can be much riskier than general anesthesia due to the aforementioned toxicity. It can also be combined with sedation, to improve the patient's experience.

Topical anesthesia

The anesthetic is applied as a cream and is absorbed locally. The anesthesia is very superficial, making it useful for procedures like laser treatments. However, if applied to large areas, it can cause toxicity, particularly a condition called methemoglobinemia (red blood cells release less oxygen to the tissues).

Sedation

Sedation involves the use of medication to reduce irritability and stress, creating a sense of disconnection from the environment. It is used in situations that may be painful or particularly unpleasant (such as when injecting local anesthetic into certain areas or performing a colonoscopy). The main problem with sedation is that it can become too deep and lead to respiratory depression. Therefore, it should always be administered with an anesthesiologist present to monitor the dosage and be able to convert to general anesthesia if necessary.