¶ Introduction to Patient Guide
You're listening to the Anesthesia Patient Safety Podcast , the official podcast of the Anesthesia Patient Safety Foundation . We're bringing you the very best from the APSF newsletter and website , as well as the latest information in perioperative patient safety . Thanks for joining us .
Hello and welcome back to the Anesthesia Patient Safety Podcast . My name is Allie Bechtel and I'm your host . Thank you for joining us for another show . Last week , we introduced the APSF's Patient Guide to Anesthesia and Surgery .
This guide was developed by the Anesthesia Patient Safety Foundation's Patient Engagement Workgroup to help answer some of the most common questions that patients have before surgery and anesthesia . This is an important resource to help patients become more involved in their health care and learn more about what they can do to mitigate surgical risks and complications .
Today , we are going to be highlighting the excellent information that you can find in this patient guide using the question and answer format . Anesthesia professionals and members of the perioperative team can also use the guide to facilitate conversations with patients . This is a good podcast to share with patients too .
Before we dive further into the episode today , we'd like to recognize Medtronic , a major corporate supporter of APSF . Medtronic has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care . Thank you , medtronic . We wouldn't be able to do all that we do without you .
And now it's time to highlight the patient guide to anesthesia and surgery . To follow along with us , head over to apsforg and click on the patient safety resources heading . The fourth one up from the bottom is the patient guide to anesthesia and surgery . I will include a link in the show notes as well . Let's set the scene .
You are in the preoperative anesthesia clinic and have just completed your history and physical exam . Now it's time to talk about the plan for anesthesia , and the patient has some questions for you before their upcoming surgery with a general anesthetic . For my responses , I will be using the information from the patient guide . Here we go .
¶ Understanding General Anesthesia
What's a general anesthetic ?
General anesthesia is a medically induced state of unconsciousness . It involves potent medications that suppress central nervous system activity and reflexes , leading to a complete loss of awareness and sensation . Your vital signs are closely monitored and we will use an airway device to support your breathing .
What are the medications that you're going to be using ?
General anesthesia typically involves a mix of intravenous and inhaled anesthetics for balanced anesthesia . These drugs will vary based on the surgery and the needs of the patient . These drugs will vary based on the surgery and the needs of the patient . Iv anesthetics are the most common drugs used for moderate to deep sedation and to induce general anesthesia .
Most have rapid onset with effects that wear off quickly . This is ideal for shorter procedures . Propofol is the most widely used general anesthetic because it acts quickly , reduces nausea and is easy to control . It also has less hangover after effects like confusion or fatigue .
Anesthesia-inducing agents , drugs that start anesthesia , like propofol , are usually combined with other IV anxiolytics or analgesics . Inhaled anesthetics are typically inhaled through a mask and delivered directly into the lungs with other gases like oxygen .
Anesthetic gases can irritate the airway so patients may experience a sore throat or dry mouth when waking up from surgery . Inhaled anesthetics give anesthesia providers fast and easy control over depth of anesthesia . This makes them useful for maintaining anesthesia after IV induction .
Inhaled anesthetics are also used frequently in small children or in cases where IV access is difficult . Nitrous oxide is the least potent inhaled anesthetic , which produces anxiolytic effects and mild to moderate pain relief . This makes it useful for sedation , for dental work and before surgery . An example of an inhaled anesthetic is sevoflurane .
What happens if I wake up during the surgery ?
¶ Awareness During Surgery
This is a very common concern . Many patients worry about waking up during surgery . This complication is known as anesthesia awareness or intraoperative awareness . However , with advanced monitoring and modern anesthesia techniques , it is a rare event . Let's go into a little more detail from the patient guide . So what is anesthesia awareness ?
Anesthesia awareness happens when a patient becomes conscious during surgery . This can mean hearing conversations , feeling pressure or pain in very rare cases , or not being able to move . Most of the time , patients only recall brief sensations or sounds . Patients are also more likely to remember anesthesia awareness several days after surgery rather than immediately afterward .
Anesthesia awareness is estimated to happen in only one or two out of 1,000 surgeries where general anesthesia is used . It is more common with certain surgeries like heart surgery or C-sections , where lighter sedation is necessary to minimize complications . The patient's health and other factors also play a role .
Anesthesia awareness occurs when the anesthesia is not strong enough to keep a patient fully unconscious during surgery . This can happen for several reasons , including including 1 . Use of muscle relaxers . Muscle relaxers are often used during surgery to prevent movement and assist with placing a breathing tube .
However , they can sometimes make it harder for anesthesia providers to notice if a patient is conscious . 2 . Type of surgery patient is conscious . Number two type of surgery Certain surgeries , like heart or emergency surgeries , have a higher risk of awareness .
This is because anesthesia providers may need to use lighter anesthesia to maintain stable heart and lung function and reduce the risk of complications . And reduce the risk of complications . Number three patient health . Patients with heart disease , respiratory problems or other medical conditions may not tolerate deep anesthesia well .
Number four other patient factors Patients with chronic pain or a history of substance abuse , especially alcohol or opioids , may be less sensitive to anesthetics . This is also true for patients who have had anesthesia awareness before . And number five technical issues Equipment malfunctions or monitoring problems can result in not enough anesthesia .
Anesthesia providers take several steps to prevent patients from waking up during surgery . A pre-surgery checklist Before surgery , the anesthesia provider reviews the patient's medical history , current medications and any past experiences with anesthesia . This helps them plan the right type and amount of anesthesia .
Advanced monitoring During surgery special monitors track vital signs and brain activity to ensure patients remain unconscious , and customized anesthesia plan . Anesthesia isn't the same for everyone . The anesthesia provider adjusts the dosage and combination of drugs to fit each patient's specific needs . What should you do if you experience anesthesia awareness ?
If you believe you were aware during surgery , it is important to tell your medical team right away . They can help you understand what happened and provide support . The incident can also be noted in your medical records to prevent future recurrence . Anesthesia awareness can be deeply distressing for some patients .
Speaking with a counselor can help manage any fear or anxiety that may arise .
I'm feeling better about not waking up during the surgery , but how long will it take me to wake up after surgery ? What if I have trouble waking up from the anesthesia
¶ Wake-up Time and Recovery
?
The time it takes to wake up from anesthesia can vary depending on a number of factors , including the type of anesthesia used . During deep sedation and general anesthesia , patients are always fully asleep . However , with moderate sedation , patients may remain awake or fall into a lighter sleep .
In general , patients start to wake up from anesthesia within a few minutes after the procedure is completed . Full recovery takes from minutes to hours . While waking up from anesthesia , patients may experience side effects such as nausea , dizziness and confusion . These side effects are usually temporary . They will go away as the effects of anesthesia wear off .
If a patient has trouble waking up from general anesthesia , it could be due to several factors . These include type and dose of anesthesia . Different anesthetic drugs work for varying lengths of time . Higher doses or longer-lasting drugs can cause a delayed wake-up time . Length of surgery being under anesthesia for a longer time can result in a longer recovery period .
Drug metabolism Some people metabolize anesthetic drugs more slowly . This can extend recovery time . Age and overall health . Older adults and those with certain health conditions may take longer to wake up . And complications In rare cases , complications such as low blood pressure or low oxygen levels during surgery can lead to a slower recovery .
Here is a little more information about delayed emergence from anesthesia from the patient guide . It is not uncommon for some patients to experience a delay in waking up from anesthesia . This is called delayed emergence . This typically occurs when it takes longer than 30 to 60 minutes for a patient to regain consciousness , depending on the procedure .
In some instances , medications may be administered to promote wakefulness . These counteract the residual effects of the anesthetics used during surgery . It is important to let medical professionals know if you had a difficult time waking up from anesthesia in the past , your health history and any medications that you are taking .
Certain medical conditions and medications can contribute to delayed emergence . After waking up from anesthesia , patients typically spend some time in the recovery room . Vital signs and overall condition are monitored until patients are ready to go home or move to a hospital room .
Due to lingering side effects , patients who have received moderate or deep sedation or general anesthesia will need someone to drive them home .
What about the side effects of anesthesia ?
¶ Side Effects and Complications
Anesthesia is a critical part of modern medicine , allowing patients to safely undergo major surgeries and procedures . However , like any medical intervention , it can cause side effects or complications . These depend on the type of surgery , the patient's age , health and medical history .
Knowing what to expect can help patients and anesthesia providers prepare and manage these adverse effects . General anesthesia puts patients into a deep sleep so they don't feel pain during surgery . While generally safe , it can lead to temporary side effects or , more rarely , serious complications .
A side effect is a mild , expected or usually temporary result of anesthesia . A complication is more serious , can last longer and may require extra treatment . Common side effects include drowsiness or fatigue , very common after anesthesia , and this can last for several hours . Dry mouth , caused by drugs that reduce saliva production . Sore throat or hoarseness Common .
If a breathing tube is used , the throat may feel scratchy or the voice may sound different . Nausea and vomiting this affects about one in three patients . It usually resolves within a few hours and can be treated with medication . Itching , often caused by opioid medications used during or after surgery .
Shivering or chills a common response as the body rewarms after surgery . Dizziness this may be caused by low blood pressure , especially when standing up . Confusions or memory problems that are temporary . Confusions or memory problems that are temporary . Patients may feel foggy or have trouble remembering .
This usually lasts a few hours to a couple days and it is more common in older adults . Muscle aches this may be caused by muscle relaxants or the way the body was positioned during surgery . Headache due to dehydration , stress or the anesthesia itself . Difficulty urinating this may be temporary and more likely after certain surgeries or when opioids are used .
An emergence delirium Some people , especially children , may wake up confused , upset or acting strangely . This usually resolves quickly with calm support . Common neurocognitive complications these include postoperative delirium , which is a state of confusion , disorientation and agitation that can happen in the first few days after surgery and may last up to a week .
It's common in older adults and those with memory problems . Postoperative cognitive dysfunction this includes problems with memory , focus or clear thinking that can last weeks or months after surgery . It's more common in older adults and after major surgery . Rare complications Respiratory problems , and this includes trouble breathing or lung infections like pneumonia .
Allergic reactions , which can range from a mild rash to a severe , life-threatening reaction called anaphylaxis . Malignant hyperthermia a dangerous reaction to certain anesthesia drugs , causing high fever , muscle stiffness and other serious issues . This needs immediate treatment . Nerve damage can occur if a patient is positioned incorrectly during surgery .
Anesthesia awareness patients may regain some awareness during surgery , often due to insufficient anesthesia and death . This is extremely rare and usually related to pre-existing health conditions or complications during surgery . When to seek medical attention ? Most adverse effects of anesthesia are mild and go away on their own .
However , patients should contact their healthcare provider if they experience severe or ongoing nausea and vomiting , trouble breathing or chest pain , signs of infection such as fever , redness or swelling at the surgical site , severe headache or confusion that doesn't improve , and numbness , weakness or other unusual symptoms that last longer than expected .
So how can you reduce the risk of side effects and complications ? To lower your risk , patients should number one discuss their medical history . Tell your anesthesia professional about any health conditions , allergies or medications you're taking . Number two follow pre-surgery instructions . This may include fasting or adjusting medications before surgery .
Always ask your anesthesia provider before starting or stopping any medications . Number three avoid alcohol , smoking and recreational drugs . These can interfere with anesthesia , slow healing and increase complications . Patients should disclose recent use , even if it's uncomfortable , so their team can adjust your care safely . Number four ask questions .
Understand the type of anesthesia being used and its potential side effects . And number five follow post-operative instructions . Take prescriptions as directed , stay hydrated and resume activity as approved by your healthcare team . Number six report side effects . Contact your anesthesia provider if you experience any unusual or concerning symptoms after surgery .
Treating symptoms early may help prevent more serious complications .
Can I be allergic to anesthesia ?
¶ Allergic Reactions to Anesthesia
When people express concerns about being allergic to anesthesia , they might be referring to different types of reactions . Some of these may be allergies , while others are side effects or non-allergic responses .
First let's talk about allergic reactions , including the following IgE-mediated allergic reactions IgE antibodies are produced by the immune system causing the release of histamine . These are known as classic allergies and generally occur within minutes of being exposed to an allergen . Ige allergies can range from mild symptoms to an acute , severe reaction called anaphylaxis .
Because they can become life-threatening , all allergy symptoms to anesthetic drugs should be taken seriously . Symptoms include hives or flushing , swelling , difficulty breathing , dizziness or fainting due to low blood pressure and rapid heart rate .
Non-ige-mediated allergic reactions Some allergic reactions don't involve IgE antibodies but involve other parts of the immune system , such as T-cells . Non-ige allergies are very rarely life-threatening , can still cause troubling symptoms , including rashes , vomiting , diarrhea or stomach pain , fatigue , fever and joint pain .
The most common anesthesia drug allergies are neuromuscular blocking agents and non-steroidal anti-inflammatory drugs . Other common surgical allergies include latex antibodies and contrast dyes . Another type of reaction is a non-allergic reaction called pseudoallergic reaction .
These reactions look like allergic reactions such as hives , flushing or low blood pressure , but don't involve antibodies or the immune system . They are due to the direct release of histamine or other substances from cells like mast cells . Pseudo-allergies are fairly common and rarely severe .
Side effects include nausea , vomiting , dizziness , sore throat from intubation , muscle aches and shivering are common side effects of anesthesia . These symptoms typically appear after waking up from surgery and , unlike an acute allergic reaction , which usually happens immediately after exposure to a drug .
Other adverse reactions include the following malignant hyperthermia this is a rare but serious reaction to some anesthetic drugs , causing a fast rise in body temperature and severe muscle contractions . This is not an allergic reaction , but a genetic condition that requires quick treatment and local anesthetic .
Systemic toxicity or LAST this is a rare but severe reaction that occurs when local anesthetics are absorbed into the bloodstream in high amounts , causing nervous system and heart problems . Now let's return to allergic reactions . Several factors can increase the risk of an allergic reaction to anesthesia .
These include history of allergies , personal or family history of reactions to anesthesia and certain medical conditions like asthma , eczema or mast cell disorders . Before surgery , it is crucial for patients to share their full medical history with the healthcare team . This includes any known drug allergies or previous reactions to anesthesia .
The doctor may recommend preoperative tests , such as skin tests , to identify allergens in anesthetics . If an allergy is detected , the anesthesia provider can select different drugs and may adjust the anesthesia plan to minimize the risk of a reaction During surgery . The medical team will closely monitor the patient's vital signs for any adverse reactions .
Can I have an allergy to anesthesia after surgery , like hours or days later ?
Although less common , patients may experience an allergic reaction to anesthesia hours or even days after surgery . These delayed allergies , known as non-IgE-mediated allergic reactions , involve other parts of the immune system , such as T-cells rather than IgE antibodies . This causes symptoms to develop more slowly .
Patients may experience symptoms such as skin rashes , fever , joint pain or swelling , which could indicate a delayed allergic reaction . However , these symptoms might also be due to lingering side effects from the anesthesia and surgery or pseudo-allergic reactions to new medications or dietary changes .
Although these non-IgE reactions are typically not severe , they can still cause distress and should be reported to a healthcare provider .
Can I have an allergy to dental anesthetics ?
Like with all anesthetics , allergies from dental anesthetics are rare . With all anesthetics , allergies from dental anesthetics are rare . Dental anesthesia mainly uses local anesthetic drugs . Allergic reactions , when they do occur , are often from components like preservatives in the anesthetic .
Sulfites are often used to preserve epinephrine , a common additive drug used in local anesthetics . Patients may also have expected side effects from the local anesthetic itself . These are usually mild and include pain , redness or swelling . In rare cases , patients may experience local anesthetic systemic toxicity or LAST .
This is a serious complication that can result in dizziness , confusion , loss of consciousness , irregular heartbeat and large changes in blood pressure . Patients should discuss any concerns about possible reactions with their dentist or anesthesia professional . They can take precautions to minimize risks and keep patients comfortable .
¶ Closing and Additional Resources
We are going to wrap up our preoperative visit for today , but there is still so much information in the APSF's Patient Guide to Anesthesia and Surgery that we hope you and your patients will check out . Increasing information and sharing this knowledge is another important way to keep patients safe during anesthesia care .
If you have any questions or comments from today's show , please email us at podcast at apsforg . Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice .
We hope that you will visit apsforg for detailed information and check out the show notes for links to all the topics we discussed today . Submissions are now open for the 2025 APSF Trainee Quality Improvement Patient Safety Recognition Program .
This is open for all US and Canadian anesthesia professionals in training , including physician anesthesiology residents , nurse , anesthesia students and student anesthesiologists assistants . Winners will be notified in August and be sponsored to attend the 2025 Stolting Conference in Chicago , illinois , to share their work and network with attendees .
Submissions will be accepted as a document or audio or video recording . The submission deadline is June 1st 2025 at 1159 pm Eastern Standard Time . I will include the link in the show notes for more information . This is an exciting opportunity that you do not want to miss . An exciting opportunity that you do not want to miss .
Until next time , stay vigilant so that no one shall be harmed by anesthesia care .