Dr. Nicholas Marsh, MD

Despite improvements in anesthesia, surgical techniques, and preventative medicines, post-operative nausea and vomiting may still sometimes occur, particularly following general anesthesia. Several things may contribute to this including surgical procedure and site, use of narcotic pain medicines, use of preventative nausea medicine, and the sensitivities of each patient. Younger, non-smoking females are most likely to develop this problem, especially if they have a history of motion sickness. While unpleasant, these symptoms will typically only last a short while.

That's a good question. In general, it is considered reasonable that anyone receiving anesthesia of any kind, even sedation, should wait at least 24 hours before getting behind the wheel of a car. The anesthesia medicines used for general anesthesia especially, can have a prolonged residual effect that may impact your reflexes enough to impair your ability to drive safely. Vapor (gas) type medicine, for example, will largely dissipate shortly after initially being turned off. This why you awaken quickly after surgery. But not all of the medicine leaves your system immediately. Some of this gas medicine will "redistribute" to tissues like fat or bone, from where they will continue to slowly leak until all of it has gone from your system. Because those tissues get a lower blood flow, this residual gas medicine may take a long time to leave, days in some cases. So, even though you feel awake, there may continue to be some residual impairment of your reflexes. Other factors may also impact on your ability to drive safely. Pain medicine after a surgery may impact your response times. Discomfort from the surgery itself may also impede your ability to respond quickly. Everyone's sensitivity to these factors is different.
Bottom line: listen to the recommendations of your surgeon, anesthesiologist and nurses regarding when you can safely return to driving.

Anesthesia involves the use of a variety of medicines with a variety of goals. Before going to sleep, calming medicines are often given to reduce situational anxiety. Going to sleep usually involves a “hypnotic,” or sleep-inducing medicine. Remaining asleep frequently involves a vaporous medicine. Before awakening, medicines for pain relief and nausea control are often provided. Awakening from anesthesia typically involves withdrawing the vapor medicine with a gradual emergence as you breath out the medicine. While in most people, the awakening phase is gradual and relaxed, in some a more vibrant or exaggerated awakening can occur. When emotions are exaggerated like this it is called “disinhibition” and can result in unpredictable elevated effect (happy drunk) or other escalated emotions like sadness or dysphoria. These emotional events almost always result from some level of confusion caused by awakening, so called emergence delirium. Once you have regained your bearings, prolonged emotionality is rare. What causes these emotional responses is not completely clear, but they are most often associated with the vaporous anesthesia medicines. Since the effects of anesthesia medicines are very short-lived once discontinued, any persistent emotional effects are usually the result of something else such as pain medicine.

Anxiety, whether short-lived situational anxiety or life-long generalized anxiety, is something commonly encountered by anesthesiologists. Anxiety calming medicines (anxiolytics) are commonly used to help patients manage with the stress of surgery. If you suffer from anxiety, it is helpful to let your anesthesia provider know so that they can anticipate your needs and help.
Sometimes the medicine you take regularly for treating anxiety may increase the dose requirements in the OR. It is not uncommon that people with severe anxiety may need more anesthesia than others during surgery. It is a combination of normally heightened awareness coupled with chronic anxiolytics that usually results in these observed greater requirements.

Anesthesia providers are highly trained and skilled providers who will be present and attentive to you the entire time you are asleep. The basic elements of safe anesthesia care start with A B C. Airway, breathing and circulation. Your provider will be paying close attention continuously to these. Anesthesia care frequently suppresses breathing drive, amongst other things. It is an anticipated event in many cases and it is one that every anesthesia provider is skilled at managing. Sometimes simple positioning maneuvers or placement of an artificial airway is what is needed. Sometimes more help by using a mask with positive pressure or a breathing tube may be indicated. Whatever measures are needed, the anesthesia provide will deliver. That’s their job.

Whether or not you are asleep for oral surgery depends on several factors. The surgeon, in conjunction with the anesthesiologist, will determine whether sedation or general anesthesia is indicated. Factors that influence this decision include patient factors (age, medical condition, preference, etc.), the extent and type of surgery and the availability of trained personnel and equipment to provide the anesthesia. Sometimes oral surgeons and dentists will administer their own sedation, including nitrous oxide. But that kind of sedation is usually aimed at provided a calm experience rather than an “asleep” experience. If you are planning to have oral surgery, be sure to ask your surgeon about sedation and anesthesia options.

Spinal anesthesia is only rarely used for surgery on hemorrhoids. With new medicines and techniques, a brief general anesthesia is generally an excellent choice for a pleasant experience and prompt recovery with quick discharge.

The actual technique used will vary depending on the preference of the pulmonologist and anesthesiologist, and the illness of the patient. But, for a lot of patients, general anesthesia can be used safely and comfortably.

Definitely. Most ankle surgery is performed under general anesthesia. Post-op pain management for this kind of surgery may also include a nerve block performed by the anesthesiologist. Newer drugs and techniques can result in prolonged pain relief with these blocks.

Colonoscopies are usually performed under either conscious sedation (given by the endoscopist) or intravenous general anesthesia given by an anesthesia provider. The medicines for this kind of general anesthesia often produce a profound sleep but rapid emergence and recovery with few side effects.

Most radiation therapy does not require anesthesia unless there is surgery involved. Some radiation therapy involved surgery to place radioactive materials in the body as therapy.

Kidney stone removal almost always involves general anesthesia. The ureters are the little tubes that connect the kidneys to the bladder. The urologist must pass an instrument up the ureter to extract the stones and these tubes are extremely sensitive. Without anesthesia this surgery is not possible. Rarely, regional anesthesia, like spinal anesthesia, may be used.