1. What are the risks of anesthesia?
  2. Should I take my usual medicines?
  3. Could herbal medicines and other dietary supplements affect my anesthesia if I need surgery?
  4. What makes office-based anesthesia different?
  5. How is the epidural block performed for labor and delivery?
  6. Is there anything the anesthesiologist can do to prevent urinary retention?
  7. Are anesthetic risks increased with long surgeries?
  8. Are spinal anesthetics safe?

Q. What are the risks of anesthesia?

A. All operations and all anesthesia have some risks, and they are dependent upon many factors including the type of surgery and the medical condition of the patient. Fortunately, adverse events are very rare. Your anesthesiologist takes precautions to prevent an accident from occurring just as you do when driving a car or crossing the street.

The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your anesthesia.

Q. Should I take my usual medicines?

A. Some medications should be taken and others should not. It is important to discuss this with your anesthesiologists. Do not interrupt medications unless your anesthesiologist or surgeon recommends it.

Q. Could herbal medicines and other dietary supplements affect my anesthesia if I need surgery?

A. Anesthesiologists are conducting research to determine exactly how certain herbs and dietary supplements interact with certain anesthetics. They are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists anticipating a possible reaction is better than reacting to an unexpected condition. So it is very important to tell your doctor about everything you take before surgery.

Q. What makes office-based anesthesia different?

A. There is one fundamental and very important difference between office-based anesthesia and receiving anesthesia in a hospital or ambulatory surgical center. The strict, well-defined standards and regulations that keep surgery and anesthesia very safe in hospitals and ambulatory surgical centers do not uniformly apply to physicians offices in the United States.

Q. How is the epidural block performed for labor and delivery?

A. An epidural block is given in the lower back. You will either be sitting up or lying on your side. The block is administered below the level of the spinal cord. The anesthesiologist will use a local anesthesia to numb an area of your lower back. A special needle is placed in the epidural space just outside the spinal sac.

Q. Is there anything the anesthesiologist can do to prevent urinary retention?

I am 75 year-old man. I have had surgeries for replaced knees, bladder tumors, and others, all with GA. After all the work is done and I am back home or in the hospital room I can never pee.

A catheter has to be put in always. A lot of hospital and Dr. office people have told me that the anesthesia has affected my bladder muscle and it won’t squeeze the pee out.

After 4-5 days when the catheter is taken out, I can pee again, but even then it takes a few days to get back to normal.

Is there anything the anesthesiologist can do so my bladder will not be so affected?

It is not a blockage like an enlarged prostate or anything (my urologist has confirmed that) but just the inability of the bladder to empty itself.

A. Thanks for your interesting question. Studies have shown that anesthesia is only one of several factors that can cause your problem, which is known as “urinary retention”. But there is a perhaps understandable tendency among some doctors to blame anesthesia for anything that goes wrong after surgery! As anesthesiologists, we are accustomed to this phenomenon and usually are able to make light of it with our surgical colleagues.

Spinal or epidural anesthesia is a well known cause of urinary retention – in these cases, the retention usually lasts only a few hours and can be remedied by emptying the bladder with a catheter during that short period of time while the anesthetic wears off. However, specific anesthetic agents used in premedication and in general anesthesia seem to have little to do with urinary retention. Similarly, analgesic (pain) medications probably have little effect.

Surgery of the pelvis or urinary tract can cause urinary retention through inhibition of bladder reflexes caused by surgical manipulation. Another factor that can prevent the bladder from emptying normally is excess fluid administration resulting in bladder distension. Pain and anxiety can also contribute to the problem. The effects of non-anesthetic medications can play a part – the medications that do this, such as anticholinergic medications, have effects on parts of the autonomic nervous system which control bladder emptying. Inability to stand or sit after surgery has been found to be a common cause of retention. In older men, enlargement of the prostate gland frequently leads to urinary retention.

Unfortunately, patients who have had urinary retention, like yourself, are at particularly high risk of having this happen again. Individuals with this problem often have an abnormal voiding history before the surgery, which may indicate the presence of an “occult” (silent) neuropathic (nerve) or obstructive bladder disorder. The fact that you have previously had surgery on your bladder makes me suspect that this is case – however this is only speculation, and you should discuss this in detail with your urologist. Your urologist may be able to do special tests to determine whether there is a subtle bladder problem which is your predisposing factor for postoperative urinary retention.

Regrettably therefore, there is probably not much your anesthesiologist can do to prevent this from happening again. However, you should definitely discuss this problem with both your surgeon and your anesthesiologist before any subsequent surgery to try and address correctable factors, such as those I’ve mentioned, before, during and after the surgery.

Q. Are anesthetic risks increased with long surgeries?

I will be having breast surgery and reconstruction soon. My HMO has plastic surgeons who can do a bilateral mastectomy with a Deep Interior Epigastric Perforator (DIEP) flap reconstruction in 12-18 hours. An outside physician can do the same surgery in 6-8 hours. Can you tell me what greater risks would be involved in being under anesthesia for 12-18 hours versus 6-8 hours? I am 52 years old. Thank you.

A. Thanks for your question. If you are a healthy individual without other medical problems, your risk of an anesthesia complication from a mastectomy and reconstructive surgery is rather low. I cannot comment on the risk of the surgical procedure itself, which is probably the most important issue in your case. I would advise you first of all to get some clarification from your surgeons as to why there is such a big time difference between the two procedures you describe. It is possible that the shorter procedure (6-8 hrs) is actually a different operation in some way. For that kind of information you should speak directly with your surgeons. The best person with whom to discuss the risks of anesthesia is an anesthesiologist who has had the opportunity to review your medical records, take a full medical history and examine you, and who is aware of the nature and extent of the planned operation.

Having said all that, I am not aware of any evidence that the duration of general anesthesia by itself increases the risks of anesthesia complications. Studies of anesthesia-related risk have shown correlation with other factors, like:

  1. Your general medical condition especially problems like diabetes, heart or lung disease, malnutrition or obesity,
  2. Your functional status, that is your ability to tolerate at least moderate levels of physical activity.

Obviously, anesthetic outcomes are also related to the skill and experience of the anesthesiologist or anesthesiology team that is taking care of you. The anesthetic needs to be tailored to your medical condition, to the surgery itself, and wherever possible, to your individual preferences. As with other medical outcomes, having your surgery in a center that performs larger numbers of the procedure is more likely to result in a good outcome than having it in a hospital does only a small number each year.

Q. Are spinal anesthetics safe?

I need a total hip replacement and the surgeon I’ve seen says he uses spinals for surgery. I’ve heard bad things about this and wonder how safe that kind of anesthesia is.

A. Thanks for your question. You can rest assured that spinal anesthesia is a safe choice for hip surgery. Many patients when offered this type of anesthesia are concerned about serious side effects, such as paralysis, and also about troubling but less dangerous side effects, such as headache. There seems to be a common, although false, perception that these complications occur often. In fact, spinal anesthesia has a long track record of safety, with a rate of serious complications (low!) about equal to the rate of major problems with general anesthesia (also low!). Studies that have looked at the overall outcome of spinal and general anesthesia for hip surgery have not found a completely convincing advantage of one over the other, and therefore both types of anesthesia are commonly used. In our hospital, at least half of the hip replacement surgery is done with spinal anesthesia. Among the reasons it is favored, include: (1) more rapid recovery of mental function, (2) the lack of need for insertion of breathing tubes, (3) the lower incidence of nausea or vomiting, and (4) the prolongation of anesthesia after completion of surgery, which means a longer pain free period. Paralysis after spinal anesthesia is very rare. The number of patients who develop a headache is also quite low – in expert hands and using appropriately sized (small) needles, fewer than 1% or so of patients should have a headache. Although a “spinal headache” is troublesome, it is not life-threatening. Not all patients are candidates for spinal anesthesia. We do not offer this technique to patients who are at risk for internal bleeding problems or to patients with infection in the area where the needle is inserted. In our hospital, we try to offer a realistic explanation of the different anesthetic techniques, their risks and benefits. Assuming there is not an absolutely compelling reason to choose a particular technique, we usually allow the patient to make a choice. It is best for you to have this discussion with your anesthesiologist, the physician who will be responsible for this aspect of your care.

This information is from the American Society of Anesthesiologists