For Patients

From the American Society of Anesthesiologists 

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If you’re preparing for surgery, you’ve probably given a lot of thought to the education, training, and experience of the surgeon performing the procedure. But you may not have thought much about the anesthesiologist or the importance of his or her medical expertise in your procedure — before, during, and after — to keep you safe and comfortable.

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Anesthesiologists meet with you and your surgeon before surgery to assess your health and make decisions to ensure your anesthesia care is as safe and effective as possible. They monitor your vital signs during surgery, including how well your heart and lungs are working while you’re unconscious, and they take care of you after surgery to make sure you’re as comfortable as possible while you recover.

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Anesthesiologists also play a key role in taking care of patients who are having minor surgery or who may not require general anesthesia, such as women in labor who need to be awake and alert but require effective pain management. They also help patients who have serious pain from an injury, or chronic or recurring pain such as migraines or ongoing back problems.

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What is an Anesthesiologist?

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Anesthesiologists are medical doctors just like your primary care physician and surgeon. They specialize in anesthesia care, pain management, and critical care medicine, and have the necessary knowledge to understand and treat the entire human body. Anesthesiologists have 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training.

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Anesthesiologists evaluate, monitor, and supervise patient care before, during, and after surgery, delivering anesthesia, leading the Anesthesia Care Team, and ensuring optimal patient safety.

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What types of anesthesia do anesthesiologists provide?

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Anesthesiologists are usually in charge of providing the following types of anesthesia care:

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• General anesthesia. This type of anesthesia is provided through an anesthesia mask or IV and makes you lose consciousness. It is used for major operations, such as a knee replacement or open-heart surgery.

• Monitored anesthesia or IV sedation. IV sedation causes you to feel relaxed and can result in various levels of consciousness. Depending on the procedure, the level of sedation may range from minimal (making you drowsy but able to talk) to deep (meaning you won’t remember the procedure). This type of anesthesia is often used for minimally invasive procedures such as colonoscopies. IV sedation is sometimes combined with local or regional anesthesia.

• Regional anesthesia. Pain medication to numb a large part of the body, such as from the waist down, is given through an injection or through a small tube called a catheter. You will be awake but unable to feel the area that is numbed. This type of anesthesia, including spinal blocks and epidurals, often is used during childbirth and for surgeries of the arm, leg, or abdomen.

• Local anesthetic. This is an injection that numbs a small area of the body where the procedure is being performed. You will be awake and alert but feel no pain. This is often used for procedures such as removing a mole, stitching a deep cut, or setting a broken bone.

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Types of Anesthesia Providers

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Several professionals may be involved in providing anesthesia care:

• Anesthesiologists (MD or DO): Physicians who lead and oversee anesthesia care, make complex medical decisions, and ensure patient safety before, during, and after procedures.
   

• Certified Registered Nurse Anesthetists (CRNAs): Advanced practice nurses with specialized training in anesthesia who administer anesthesia and monitor patients.
   

• Anesthesiologist Assistants (AAs): Highly trained allied health professionals who work under the supervision of an anesthesiologist to deliver anesthesia care.

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Anesthesia Care Team

 

If you’re planning to have surgery, you probably know that your surgeon is not the only person who will be taking care of you. An entire team of physicians, nurses, and other medical professionals will be working together to make sure your surgery and recovery are safe and successful.

 

The Anesthesia Care Team model is a collaborative approach designed to provide safe, high-quality care. One of the key members of that medical team is the anesthesiologist, a medical doctor who specializes in anesthesia. This physician often leads the Anesthesia Care Team, which might include nurse anesthetists, anesthesiologist assistants, and anesthesiology resident physicians who will guide you throughout your entire surgical experience — before, during, and after the procedure. Each team member plays a role in delivering anesthesia, monitoring patients, and supporting recovery, but the anesthesiologist retains ultimate responsibility for the patient’s safety and outcomes.

 

Types of Anesthesia

Adapted from the ASA’s Made for this Moment

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• While there are many types and levels of anesthesia—treatment with medication to keep you from feeling pain during surgery—general anesthesia is most commonly associated with major operations. Many of these procedures are lifesaving or life-changing and would not be possible without general anesthesia.

• With general anesthesia, you will be unconscious and unaware of anything that happens during your procedure.

• General anesthesia is administered by or under the direction of an anesthesiologist by means of a mask placed over the nose and mouth or an IV placed in a vein, usually in an arm. 

• While the anesthesia is working and you are unconscious, many of your body’s functions will slow down or need help to work effectively. A tube may be placed in your throat to help you breathe. During the surgery, the anesthesiologist will monitor your heart rate, blood pressure, breathing, and other vital signs to make sure they are normal and steady while you remain unconscious and free of pain.

• Once your surgery is complete, your anesthesiologist will reverse the medication and stay with you as you return to consciousness, continually monitoring your breathing, circulation, and oxygen levels. 

• Some patients feel fine as they wake up; others experience symptoms such as nausea, vomiting, or chills. Your throat may be sore from the breathing tube. Your anesthesiologist will help you manage these symptoms.

• After you’ve had major surgery, you will probably have pain and discomfort as you recover, which might get worse as the effects of the general anesthesia wear off. Your anesthesiologist will advise you about how to manage your pain during recovery in the hospital and at home.

• If you are able to go home the day of surgery, you will not be able to drive after having general anesthesia—so make sure a family member or friend will be available to take you home. You will not be able to take a taxi or use a ride share service to get home. It may take a day or two for the anesthesia medication to completely leave your system, so you may be sleepy, and your reflexes and judgment may be affected

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Monitored Anesthesia Care (MAC)

• One common type of pain control is called sedation, which relaxes you and sometimes makes you fall asleep. Sedation, when provided by an anesthesiologist or anesthesia care team, is also known as monitored anesthesia care (MAC anesthesia). 

• Monitored anesthesia care (MAC) may be performed in a hospital or in an outpatient setting, such as a same-day surgery center. 

• Conscious sedation is typically used for shorter, less complex procedures, and is ordered by the physician performing the procedure and administered by nursing staff. 

• Sedation and analgesics (medications for pain) are usually provided through an IV placed in a vein. Depending on the procedure, the level of sedation may range from minimal (you’ll feel drowsy but able to talk) to deep (you probably won’t remember the procedure). But even with deep sedation, you won’t be unconscious, as you would be with general anesthesia.

• Most patients wake up quickly once the procedure is over and the medications are stopped. Possible side effects include headache, nausea, and drowsiness, but you will likely experience fewer effects than you would from general anesthesia — and you’ll probably recover faster and go home sooner.

• The level of sedation a patient experiences depends on several factors, including the type of procedure you’re having and how your body responds to anesthesia. Your age, medical condition, and health habits may also affect the type of anesthesia you’ll receive. Regardless of the level of sedation, it’s important that an anesthesiologist be involved in your anesthesia care.

 

Regional Anesthesia

• Regional anesthesia is a type of pain management for surgery that numbs a large part of the body. Regional anesthesia is delivered through an injection or through a small tube called a catheter that is inserted near the part of the body where the surgery will take place.

• Regional Anesthesia for Child Birth

  • Epidural analgesia is often used for childbirth. It allows the laboring patient to be awake and able to push when it’s time to deliver the baby, but it numbs the pain. 

  • Spinal analgesia is stronger and is used during procedures such as cesarean deliveries, also known as C-sections, and knee and hip replacements. Spinal analgesia and epidurals allow the doctor to deliver the baby surgically without causing pain to the birthing parent, and without subjecting the baby to sedating drugs that might be harmful.

• Other types of nerve blocks are used to help control pain after certain orthopedic procedures, such as shoulder, knee, and ankle surgeries.

• Nerve blocks can also be used to help manage chronic pain. Anesthetic medication is injected near a nerve or group of nerves to numb them for hours, and sometimes days, to reduce pain.

• Regional anesthesia is very safe and doesn’t involve the potential complications and side effects that can occur with sedation and general anesthesia. But it does carry some risks, and it’s important that it be provided and monitored by an anesthesiologist.

 

Effects of Anesthesia 

Side effects of general anesthesia can include:

• Nausea and vomiting – This very common side effect can occur within the first few hours or days after surgery and can be triggered by a number of factors, such as the medication, motion, and the type of surgery. If you have had this in the past, let your anesthesiologist know, and he or she can take extra precautions to try to prevent this. 

• Sore throat – The tube that is placed in your throat to help you breathe while you’re unconscious can leave you with a sore throat after it’s removed.

• Postoperative delirium – Confusion when regaining consciousness after surgery is common, but for some people — particularly older patients — the confusion can come and go for about a week. You may feel disoriented and have problems remembering or focusing. This can worsen if you are staying in the hospital for a few days after the procedure, especially in intensive care, because you are in an unfamiliar place. Having a loved one with you helps, along with doing some other simple things: wearing your glasses or hearing aids as soon as you can after the procedure and making sure you have family photos, familiar objects, and a clock and calendar in your room.

• Muscle aches – The medications used to relax your muscles so a breathing tube can be inserted can cause soreness.

• Itching – This is a common side effect of narcotics, one type of pain medication sometimes used with general anesthesia.

 

Rarely, general anesthesia can cause more serious complications, including:

• Postoperative delirium or cognitive dysfunction – In some cases, confusion and memory loss can last longer than a few hours or days. A condition called postoperative cognitive dysfunction can result in long-term memory and learning problems in certain patients. It’s more common in older people and those who have conditions such as heart disease (especially congestive heart failure), Parkinson’s disease, or Alzheimer’s disease. People who have had a stroke in the past are also more at risk. It’s important to tell the anesthesiologist if you have any of these conditions. Your anesthesiologist will avoid any medications known to increase this risk. 

• Malignant hyperthermia – Some people inherit this serious, potentially deadly reaction to anesthesia that can occur during surgery, causing a quick fever and muscle contractions. If you or a family member has ever had heat stroke or suffered from malignant hyperthermia during a previous surgery, be sure to tell the anesthesiologist.