(This is a continuation of the article I posted last night!)
What kind of anesthesia should I get?
The type of anesthesia you will receive depends on a number of different factors. One of these factors is definitely your preference and choice… however, the options may be limited by the requirements of the surgery, your medical condition, etc.
What kinds of anesthesia are there?
There are four types of anesthesia commonly employed – general, regional, monitored anesthesia care (MAC) and local. In very broad terms:
General Anesthesia affects your entire body and may be given intravenously or as an inhaled gas. These medications cause you to lose consciousness. As a result of these medications, you might stop breathing on your own and therefore you might have breaths given to you through a mask or a small tube gently inserted into your lungs through your mouth.
Regional Anesthesia only affects a section of your body, blocking sensation and making it numb. You may remain awake or be sedated. Spinal and epidural anesthesia fall in this category.
Monitored Anesthesia Care (MAC) involves medications given to make you drowsy and to relieve pain. This type of anesthesia may be given to supplement local anesthesia (see below) or to make the injection of local anesthesia more tolerable.
Local Anesthesia affects only the location of surgery. It is usually injected, but can sometimes be given as a ointment, cream or spray. You may remain awake or be sedated for this as well. This type of anesthesia is usually used for small, less extensive procedures.
Now that you have a better understanding of how anesthesia works, you’ll probably want to consider using music during your surgery to lessen the amount of anesthesia you’ll need. Although modern anesthesia is a wonderful thing, you’ll still want to take as little as you can for the safest procedure possible. Here’s the link: Healing Music for Surgery Don’t wait! Prepare for the safest surgery possible.
General anesthesia is much more profitable than either type of nerve block (local or regional) because there is much more consumption involved, therefore more business transactions. No science there. It is also a sexual fetish, as I found out the hard way from watching medical programming on public TV while in junior high. No science there, either. This is why most patients are seldom offered either type of nerve block. Women are often not offered nerve blocks, a sin I call anesthetic misogyny; peoples of color are virtually never offered nerve blocks, a sin I call anesthetic racism; poor whites are virtually never offered nerve blocks, a sin I call anesthetic classism; and tropical peasants are never offered nerve blocks, unless financial constraints force the issue. I call this sin anesthetic colonialism. Poor and working class people of all races want nerve blocks; they don’t want to be in a coma. I know this because I ASKED them. Low education is a known risk factor for frank postoperative cognitive dysfunction, an inconvenient truth that is slowly being forced out into the open. Another type of regional nerve block is the brachial block, which can be used for the hand, arm, or shoulder. Even when a nerve block by itself is not possible, it can always be used supplementally as an anesthetic-sparing technique. The music for the nerve block patient should be the same tempo as that for the anesthetized patient to keep the heart rate and BP from becoming elevated, but can have polyphony and/or lyrics. It should be more through-composed, particularly if it’s a long surgery, to fend off patient boredom, while that of the anesthetized patient should have more form and repetition. The nerve block patient should also have some sort of private listening system, because what the patient wants/needs is seldom what the surgeon wants. Your headphones can keep the patient from being subjected to unintentional polytonality from the patient’s music being in a different key than the surgeon’s music.
One other thing: except for very short, simple procedures like tonsillectomies (which I oppose unless badly swollen tonsils are jeopardizing the airway), all anesthetized patients are intubated. The tube can either be in the center, towards the left, or towards the right, depending on whether there are any tender spots in the throat to be avoided. Either way, it is held in place with long strips of paper tape across the mouth and wrapped around the cheeks. Occasionally, intubation is accomplished through a nostril instead. Most of the time, the anesthetized patient is ventilated, because strong muscle relaxants are used to paralyze all skeletal muscle, including the diaphragm and the breathing accessory muscles. I staunchly oppose the use of paralytics, and this is also a significant issue in the movement against capital punishment. There is a lot of latitude possible in the rate and depth of the breaths given by the ventilator, and this should be discussed and a consensus reached beforehand. We only consciously control our breathing when speaking, eating and drinking, singing, and exerting ourselves. The rest of the time, the subconscious mind governs our breathing, and it is very appropriate to ask it whether it wants to breathe faster or more slowly. When not paralyzed by muscle relaxants, anesthetized patients can respond to simple verbal commands and queries.