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Docs Tag: sleep medicine

Anaesthesia

Anesthesia or anaesthesia is a state of controlled temporary loss of awareness that is induced for medical purposes.

Local anaesthesia numbs a specific part of your body, while general anaesthesia suppresses central nervous system activity resulting in unconsciousness and a lack of sensation. Sometimes general anaesthesia is also referred to as “sleep medicine”. You may have to get this before a surgery or a test that may be painful or require you to sit or lay very still. Anesthesiologists (or “sleep doctors”) are experts in giving this type of medicine and monitoring your body so that you stay safe. They go to school for a very long time (about 12 years) to do this job.

There are two different methods of receiving general anaesthesia. One is through a mask (typically an option for children 9 and under) and the other is through an IV (preferred for most children 10 and up). –

  • The mask is connected to a machine that blows anaesthetic gas onto your face, and the patient’s job is to sit or lay still and to breathe. After a little while of breathing in this gas, you will have that special sleep so you don’t hear, feel, or see anything during your procedure. The time it will take to fall asleep depends on your body, but it does take longer than getting an IV. The anaesthetic gas has a funny smell, kind of like a permanent marker.
  • With an intravenous (IV), the anesthetic medicine goes straight into your bloodstream through a very small flexible tube. Your skin may feel cold as the medicine enters your body, but very soon after (around 5 seconds), you will have that special sleep so you don’t hear, feel, or see anything during your procedure. The anesthetic medicine is given throughout your entire procedure and once it’s over, it’s turned off. *See my post under the “procedures” folder in documents for detailed information about getting an IV.*

Shortly after the anesthetic is done being administered, you’ll wake up. You may feel a bit groggy and confused.

 

Read below to see the answers to some questions I asked an anesthesiologist:

  1. How do you decide between administering anaesthesia via mask vs. IVs for patients?

Most of the time, we always would prefer to use an IV to administer anesthetic. It is safer for patients. When children are younger sometimes they find starting an IV scary or upsetting so we will use a mask to put them to sleep first. As a general rule, we will put most kids to sleep with a mask 10 years and under if they prefer. Kids come in all sizes though. If you are over 100lbs no matter what your age, an IV is a safer way to go to sleep. There are other medical factors that may mean you need an IV anesthetic – medical conditions, airway structure, if you have recently had something to eat… Your anesthesiologist will let you know what is safe for you. Anesthetics are dosed by weight, so the bigger you are the more you need. It takes a lot of anesthetic gas to breath in when you are big. Anesthetic gases are quite stinky and I don’t like masks, so if I was going to sleep I would always choose an IV.

     2. What questions do you most often get from youth prior to a procedure or in the procedure room?
I get all kinds of questions! Sometimes people want to know if it will feel like time passing (it doesn’t), or if they will wake up during the procedure (you won’t), or if they will hear anything (not one of my patients has heard anything yet). Everyone wants to know how fast they will fall asleep (it does depend on the technique but usually its fast – between 20 seconds to 1 minute). Most people tell me waking up from an anesthetic is like when you sleep really heavy and can’t believe its morning already… a lot of people wake up asking when we are going to start!
     3. What questions would you encourage youth to consider asking their anesthetists prior to a procedure?
Really you should ask anything that is worrying or concerning you. Lots of times we can change things to make it easier for you. You can listen to music while you fall asleep, watch an iPad or TV. Depending on where you have your anesthetic, sometimes you can have a parent or support person there. If you are very nervous, you can have something to relax before you go in the operating room. Often times not knowing what is going to happen in the most anxiety provoking, we can walk you step by step and give you a sense of control. Sometimes surgery needs to happen but we are there to make it as stress free as possible.
    4. What can youth expect to see, hear, taste, smell, and feel when being induced/after waking up?
              When you are going to sleep, it really depends on whether you are using a mask or IV as the experience is very different. With an IV you may feel like you need to cough or get an itchy nose, then you will feel very heavy and sometimes a little dizzy. With a mask the thing you will probably notice the most is the smell of the gas. Some people use laughing gas (which makes people laugh) first and then some people feel a bit light-headed. Some people like the feeling of falling asleep with gas, others do not. It does take longer to fall asleep with gas than an IV.
             When waking up, most people are a bit groggy. Many teenagers like to go back to sleep for 15-20 minutes. Some people will notice a funny taste in their mouths or a scratchy throat. Some people get nausea with anesthesia, and others don’t). Some people feel great the day they have their anesthetic but might be tired or lightheaded the next. Anesthetics affect people very differently – its all normal. You should be feeling back to yourself in 24-36hrs though… if something is not right after that its probably not the anesthetic and you should see a doctor. 
     5. Are there any accommodations anesthetists can make for pediatric patients? (i.e. positioning)
Of course! It depends on where you are though, the hospital, and what resources they have access to. If you are at a hospital or with an anesthesiologist that deals with kids a lot they may be more comfortable with some things than others. I work at a children’s hospital and we regularly change the position (sitting up, for example), or let you sit with parents. Sometimes we can put monitors on after you go to sleep. The more you tell us about what you need, the better we can change things to help you cope with the situation. The hospital may have movies to watch while you go to sleep, or maybe they can put specific smells in the mask to try and hide the stinky smell of the gas. We also do things like use freezing cream before starting IVs to help with that process. 
     6. Any general tips or tricks for youth to prepare for anesthesia?
  1. So often people think “nothing to eat or drink after midnight”  is what we want – NOT TRUE! Coming in dehydrated usually makes you have more nausea, makes it harder to start IVs and makes you hungrier as well. Follow the instructions left by your anesthesiologist – which may include a drink of clear fluids.
  2.  Try and discuss the plan for induction of anesthesia beforehand. If you are using a mask, try practice breathing into a mask at home. If you are getting an IV think about how you want to distract yourself while it is happening. Do you need freezing cream before the IV? If there are specific things that really stress you (i.e. too many people, loud sounds, bright lights) us know that and we can try and avoid those stressors as you are going off to sleep.
  3. Probably the biggest thing is that its ok and completely normal to be nervous (everyone is) .. this isn’t something that you do everyday. We know that. I’d be more surprised if you weren’t nervous. Luckily this is something we do every day. We’ve spent a lot of time being an expert in putting people to sleep and waking them up safely – and you need to know that too. It will be ok.

Procedure Videos

Want to learn about what happens under general anesthetic?
Click on the link below to watch!

What happens in a Nerve Conduction Study.  Watch below!

What happens in a Pulmonary Function test!

What happens when you get an IV (cannula)?

Paulina’s Tips for Bloodwork

Starting an IV