A Quick Look At General Anesthesia
/What Patients Need To Know About General Anesthesia
If you or a loved one are scheduled to undergo general anesthesia, you might have some questions and maybe even some concerns. As anesthesiologists, we know that being anxious about an upcoming surgery is common and very understandable. So we’re taking this opportunity to briefly explore what exactly it means to undergo general anesthesia in Ontario and how you can be best prepared for this experience.
Please note that the following is for informational purposes only and is not medical advice. We encourage you to speak with your doctor if you have any specific questions about your anesthetics.
General Anesthesia: A Very Safe Procedure
“General anesthesia is a very common and extremely safe procedure that thousands of Ontario residents successfully undergo each year," says Dr. Rohit Kumar, an anesthesiologist with Trillium Health Partners and the Chair of Ontario's Anesthesiologists. "This is because anesthesiologists are highly trained physicians and we are dedicated to providing our patients with the highest quality care possible."
One of the most common concerns from patients about to undergo general anesthesia is that they’ll wake up during their procedure or that they won’t wake up at all. We can reassure you that both of these scenarios are extremely rare.
Becoming aware during your surgery is known as unintended intraoperative awareness. This risk of awareness is highest in cases where people are very sick and unstable, where it may be unsafe to give higher amounts of anesthetics. The risk of awareness for routine surgery is very unlikely.
Death due to anesthesia is exceptionally rare. If you are a healthy patient, the risk of dying from general anesthesia is between one in 200,000 and one in 400,000. Your drive to the hospital is likely riskier!
Before your procedure, you will have a personalized anesthesia plan created for you by your anesthesiologist. If you are having a high risk surgery, or have multiple medical issues, a more detailed health history will be conducted, which may include a consultation with your anesthesiologist. All of the the information collected will be taken into account for your anesthesia plan. But even patients with more complicated health situations rarely face risks from the general anesthesia itself.
The main reason why general anesthesia is such a safe procedure is because anesthesiologists are highly trained and are able to provide you with a medical experience that is as safe and comfortable as possible.
In Ontario, all general anesthesia is administered by an anesthesiologist or a family practice anesthetist. All anesthesiologists are doctors who have completed four years of medical school before undergoing additional training in the field of anesthesiology.
This period, known as residency, is an additional five years of training after medical school. Some anesthesiologists choose to further subspecialize in a particular area of anesthesia and undertake what is known as a fellowship. This can take an additional one to three years for a combined six to eight years of further training after medical school! The number of years of education it takes to become an anesthesiologist is similar to what it takes to become a surgeon or other medical specialty.
Family practice anesthetists are physicians who do two years of family practice training after medical school and then undergo one extra year of training to learn the anesthesia skills needed for common and routine cases and to manage emergency situations in more rural and remote areas of Ontario. Family practice anesthetists are most commonly found in rural hospitals and play a critical role in allowing more patients to receive the care they need closer to home.
You can learn more about Ontario anesthesiologists here.
What Exactly Does Undergoing General Anesthesia Mean?
General anesthesia can be thought of as a state of controlled unconsciousness. Through the careful administration of medications by your anesthesiologist, you will be kept deeply asleep and won’t be awake or aware during your procedure.
“This is not the same as regular sleep,” explains Dr. Monica Olsen, an anesthesiologist with Trillium Health Partners and the past Chair of Ontario's Anesthesiologists. You’ll have no memory of your procedure. Your body also won’t be able to feel pain while you’re having surgery and you will wake up comfortably.
Your general anesthesia experience may begin in the operating room or a prep room. Either way, you’ll be lying comfortably on a bed in a surgical gown. Most healthy patients will first meet their anesthesiologist immediately before their operation. We recognize that this will likely be a stressful time for you, and we aim to make it as calm and comfortable as possible!
Depending on the facility, your anesthesia care may involve a certified clinical anesthesia assistant (CCAA) who helps the anesthesiologist before, during and immediately after surgery. At all times, the CCAA is directed and supervised by the anesthesiologist, who develops and leads the implementation of the patient’s anesthesia plan. You can learn more about the important role CCAAs play here.
In order to receive general anesthesia, you will need an IV inserted into your hand or arm. The IV will be used to administer medications to get you off to sleep and give you any medications you need during surgery. Though it can be an uncomfortable experience, once the IV is inserted it is far less noticeable.
A wide variety of medications are used during general anesthesia, and which combination of drugs you’ll receive will depend on many factors including your type of procedure, your health history and even your age. While most of these medications will be administered through your IV, you will likely also be given anesthetic gasses through a special breathing tube.
The IV medications can potentially include a variety of painkillers and sedatives, which are needed for the surgery and for pain control upon waking. “Especially in the context of the opioid epidemic, we know that some patients have concerns about being given certain types of medication. However, we want to assure you that when pharmaceutical-grade opioids, sedatives and other medications are administered by anesthesiologists they are incredibly safe,” explains Dr. Olsen.
Usually, one of the first drugs you’ll be given—before you go to sleep—is a sedative administered intravenously. This will help you relax and make you feel sleepy. While your sedative takes effect, special monitors are applied to your body to monitor your heart and breathing. Once all of the monitors are on, you will be given the drugs that will render you unconscious for the duration of your procedure.
“In the past, patients were asked to count backwards as they were going to sleep,” explains Dr. Eric Goldszmidt, an anesthesiologist with Sinai Health System in Toronto. “You still see this done in movies and TV shows but now, most modern practitioners no longer do this as our anesthetics act so quickly, most people would not manage a count of five.”
Before being given any anesthetic medications, you’ll be given oxygen by mask to prepare for the start of general anesthesia. After you are deeply asleep, you’ll be given some form of breathing support. This may include having an endotracheal tube placed in your windpipe or having a laryngeal mask airway placed in your mouth. After the surgery is complete, your breathing support will be removed just as you wake up. Most patients will not remember the placement or removal so you’ll never know it was there, other than possibly having a bit of a sore or scratchy throat afterwards.
The device used to support your breathing is also used to provide you with anesthetic gas that will keep you asleep for the duration of your procedure.
During your procedure, the anesthesiologist will closely monitor your vital signs, including your heart rate, blood pressure and breathing. As the surgery occurs, they will adjust or administer medication as needed. The anesthesiologist will stay with you for the full length of your surgery.
Once your procedure is over, your anesthesiologist will stop administering anesthetic medication, which begins the process of waking you up. But while you went to sleep almost instantly, regaining full consciousness can take several minutes. You will be moved to a recovery area, sometimes known as the post-anesthesia care unit (PACU), where you will continue to be monitored by nursing staff until you are fully awake and aware and ready to be moved to either another hospital unit or sent home. How long this takes can vary, but some patients’ stay in the recovery area can be as short as an hour.
Preparing For General Anesthesia
Your surgeon or anesthesiologist should give you specific instructions on how to prepare for both general anesthesia and your procedure. They will include when you need to stop eating and drinking. “We know fasting can be challenging,” acknowledges Dr. Kumar. “But it is very important that you follow your instructions, including limiting what you eat and drink in the hours before your operation.”
These restrictions are in place for a very good reason: if there’s food or liquid in your stomach after you go to sleep, you may vomit and some may enter your lungs, which can cause serious problems.
Surgeries can be cancelled or postponed if fasting instructions aren’t followed.
If you normally take any type of medication, please speak with your health-care provider about when or if you need to stop taking your prescriptions ahead of your surgery. While many drugs can be taken on surgery day, some need to be skipped ahead of undergoing general anesthesia, including a few kinds that must be stopped days in advance.
Please also inform your medical provider about any vitamins or supplements you use. You will likely need to stop taking these ahead of your procedure.
It’s also important that you let your anesthesiologist know if you use alcohol, cannabis or any recreational drugs. We promise not to judge you! We just need to know this information as it can impact which medications and what dose we give you to keep you asleep and wake you up comfortably.
If you smoke cigarettes, you’re encouraged to smoke as little as possible in the days and weeks leading up to surgery. Doing so will lower your risk of complications and promote faster healing. Learn more about smoking and anesthesia here.
Post-General Anesthesia Care
It’s hard to know how you’ll feel when you wake up from general anesthesia as this experience can vary greatly from person to person. Some people feel incredibly rested, while others feel groggy. Occasionally people feel cold and shiver, and unfortunately, some patients can feel nauseous or even vomit for a short period. Some patients may also experience confusion or disorientation until they are fully awake. If you or your loved one experiences any side effects that you are concerned about, please follow up with your doctor.
If you are being released from the hospital on the same day you undergo general anesthesia, you will need to have someone take you home and stay with you overnight. Due to some residual sedation, you should not drive, operate heavy machinery, or sign legal documents for at least 24 hours following general anesthesia. Please also avoid alcohol, cannabis and other non-prescription drugs during this period.
Depending on the procedure, you may have to manage pain or discomfort related to the surgery. Your anesthesiologist will work with you and your health-care team to make sure you are as comfortable as possible. However, it’s important to have realistic expectations about how your body will feel and what it will be capable of in the days following your surgery. It takes time to heal and recover.
It’s also critical that you take your medication, including any painkillers, as directed. Pain medicine is often prescribed on an “as-needed” basis and if you find yourself with unused pills, please return them to your pharmacy for proper disposal.
As anesthesiologists, we understand that what is a typical workday for us may be one of the most vulnerable days of your life. We strive to make that experience as safe and comfortable as possible.
Bonus Content: Scroll to the 22:40 mark in the video below to hear Ontario anesthesiologist Dr. August Pierik sum up what it’s like to undergo general anesthesia. Her talk was part of Northern MEDTalks 2024, which was presented by Science North and the Science Communication Program at Laurentian University.