For many patients, anesthesia is one of the least understood parts of a surgical or procedural experience.
People generally understand why they are having surgery. They know what their surgeon is going to repair, remove, replace or examine. But when it comes to anesthesia, there is often much more uncertainty.
Over the years as a certified registered nurse anesthetist, I have heard many of the same questions from patients just before a procedure. Will I wake up during surgery? Will I remember anything? Will I be sick afterward? How long will it take me to wake up? Is anesthesia safe for someone with my medical history?
Those are all reasonable questions.
As a CRNA and president of the American Association of Nurse Anesthesiology, one thing I want every patient to know is that you should feel comfortable asking those questions. Good anesthesia care begins with communication and trust. An understanding of what to expect can make the entire experience feel a little less intimidating.
In recognition of World Anesthesia Day, here are five things I wish every patient understood about anesthesia.
1. Anesthesia care starts long before entering the operating room.
One of the misconceptions about anesthesia is that it begins when someone places a mask over your face or gives medication through an IV.
In reality, some of the most important work happens before that.
Your anesthesia professional will review your medical history, medications, allergies, previous surgeries and underlying health conditions before your procedure. We want to know about heart or lung disease, diabetes, sleep apnea, previous problems with anesthesia, and many other things that may influence your care.
We also need patients to tell us things they may not immediately think are important, including supplements, alcohol use, medications taken for weight loss, recreational substances, or whether a close family member has ever experienced an unusual reaction to anesthesia.
There is no advantage to holding information back because you think it might be embarrassing or irrelevant. The more accurate the information we have, the better we can tailor your anesthesia plan to you.
I have had many conversations with patients who start by saying, “I’m probably overthinking this, but …” My response is almost always some version of: If you are thinking about it, ask me.
That conversation is part of your care.
2. Anesthesia is not one-size-fits-all.
People sometimes think of anesthesia as simply being “put to sleep,” but there are many different approaches.
Depending on the procedure and the patient, anesthesia may involve general anesthesia, sedation, local anesthesia, regional anesthesia, spinal or epidural anesthesia, or some combination of these techniques.
Two people having the exact same surgery may appropriately receive different anesthesia plans because their medical histories, medications, anatomy, preferences or risk factors are different.
That is one of the things I have always found fascinating about anesthesia. There is science, pharmacology, physiology, and technology involved, but there is also judgment. We are constantly taking what we know about the procedure and combining it with what we know about the individual patient in front of us.
The best anesthesia plan is not simply the one commonly used for a particular operation. It is the one that makes the most sense for that patient having that operation on that day.
3. One of patients’ biggest fears is also one of the rarest events.
One of the questions I hear most often is, “What if I wake up during surgery?”
The fear is understandable. Movies and television have probably contributed to it over the years, and the idea of being aware during surgery is understandably frightening.
Fortunately, unintended awareness during general anesthesia is extraordinarily uncommon. Throughout a procedure, anesthesia professionals continuously monitor the patient and adjust medications based on the patient’s condition, the surgical stimulation, and many other clinical factors.
We are not simply giving medication at the beginning of a case and waiting until the end. Anesthesia is dynamic. Your blood pressure, heart rate, oxygenation, ventilation, temperature, fluid status and many other variables are being monitored throughout your procedure.
If awareness is something you are particularly worried about, tell your anesthesia professional. Sometimes just understanding what will happen and having the opportunity to discuss your concern can remove a tremendous amount of anxiety before surgery.
4. Recovery is part of the anesthesia plan from the beginning.
Another misconception is that the anesthesia professional’s job ends when the surgery ends.
Recovery is actually something we are thinking about throughout the entire procedure.
As surgery nears completion, we begin adjusting medications so that the patient can emerge from anesthesia safely and appropriately. The goal is not simply to “wake someone up.” We are thinking about breathing, pain control, nausea, blood pressure, temperature and how that patient is going to transition into the next phase of care.
Once you arrive in the recovery area, nurses continue monitoring you while the effects of anesthesia wear off and help manage issues such as pain, nausea, shivering or dizziness.
Before leaving the facility, ask what you should expect when you get home. Know what symptoms are normal, what medications you should take, what activities you should avoid, and when you should call your healthcare team.
Anesthesia recovery does not necessarily end when you leave the recovery room.
5. An informed patient is a better partner in their own care.
The final thing I wish every patient knew is probably the simplest:
Ask questions.
Ask what type of anesthesia you are receiving. Ask why that approach is being recommended. Ask what you should expect when you wake up. Ask about pain control. Ask about nausea. Ask about medications you should or should not take before your procedure.
The internet has made enormous amounts of healthcare information available to all of us, but more information does not always mean better information. Your anesthesia professional can help you understand how anesthesia applies specifically to your medical history and your procedure.
Patients should never feel as though they are bothering us by asking questions.
In my experience, some of the best conversations I have had with patients happen in those few minutes before a procedure, when someone asks the question they have clearly been thinking about all morning. Often, the answer is straightforward, but simply having the conversation allows them to take a little less anxiety with them into the operating room.
That matters.
Anesthesia should not be mysterious
Most of us will need anesthesia at some point in our lives, whether for surgery, a diagnostic procedure, childbirth or another form of medical care.
CRNAs provide anesthesia in hospitals, ASCs, labor and delivery units, physician offices and communities across the country, including many rural and underserved areas where access to anesthesia services can be limited.
Regardless of where your care takes place, you deserve to understand your anesthesia plan, to have your questions answered, and to feel heard throughout the process.
That is something CRNAs take seriously every day.
So, if you remember only one thing this World Anesthesia Day, remember this: Anesthesia should not simply be something that happens to you. You should feel comfortable being an active participant in your care.
Ask questions. Share your concerns. Tell us what you are worried about.
We are there to take care of you, and that conversation is where good anesthesia care often begins.
For additional patient-friendly information about anesthesia and how to prepare for your procedure, visit the American Association of Nurse Anesthesia website.
Tracy Paul Young, MS, MBA, CRNA, is a healthcare executive and certified registered nurse anesthetist who leads large‑scale anesthesia operations as COO of Essential Anesthesia Services. He currently serves as president of the American Association of Nurse Anesthesiology.
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