Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And today, we're talking about anesthesia. For those of you that are not sure what to expect, if you're told that you need to go under anesthesia, well, we've got the answers for you today. Joining me is Kirsten Hollenbeck. She's a certified registered nurse anesthetist at Associated Anesthesiologists, P.C.

Kirsten, thank you so much for joining us today. So first of all, what is anesthesia? Because people don't know what it is that's putting them out. 

Kristen Hollenbeck: Yes, thank you for having me. So, anesthesia is the use of certain drugs to alter the level of consciousness, modify the pain response, and induce muscle relaxation. These drugs primarily work in the brain and spinal cord. Our sedation and pain management plan is specific to each patient based on their unique needs.

Anesthesia also means that we are completely focused on our patient, being their eyes and ears during surgery. We ensure correct positioning to avoid nerve injury. We maintain normal vital signs. And we also make you feel safe and confident going into surgery. 

Melanie Cole, MS: We hear about different kinds, Kirsten. Tell us a little bit about the difference between general anesthesia, a local one that might be used during some sort of procedure, and twilight, the kind that we might get at a colonoscopy or something. Tell us the difference between those. 

Kristen Hollenbeck: You're absolutely right. There are several methods and choices that we can use based on your comfort and safety needs for your procedure. With a local anesthetic, oftentimes you don't even need anesthesia. Usually, the surgeon is just numbing up the area and they can keep you comfortable like that. For twilight, like what you would see with a colonoscopy, typically, we just use IV sedation and monitor your vital signs, make sure that you're breathing effectively, and then you are able to have that medication wear off as you are waking up.

As far as general anesthesia goes, that is when you are needing to be deeply anesthetized for your procedure. So, what that means is we will put you completely asleep with IV medication, and then we'll carefully place a breathing device that allows us to give you anesthesia gas to keep you sleepy during your procedure. We'll monitor your vital signs just as we did before, keeping you comfortable with pain medication, anti-nausea medication, and any other medications needed to support your vital signs. Once the surgeon is all done, we shut off that sleepy gas and take out that airway device, and we watch you wake up in the recovery area.

Melanie Cole, MS: I find anesthesia so interesting that we're able to do these procedures that way. It is just absolutely fascinating to me. Now, what's the first step in the process of someone learning they'll need surgery under anesthesia? And I'd like you to speak about the night before as well, because we hear, "Oh, no food in your stomach, no liquids, four to six hours," whatever it is. And that's usually because of the anesthetic, right?

Kristen Hollenbeck: Absolutely. You will be instructed to see your primary care doctor for surgical clearance. Your primary care doctor has established a relationship with you and knows your medical history well. He or she will do a full assessment to make sure that you are ready to undergo anesthesia. We want to see a thorough note about your health history, your medications, past surgical history, and if you have any personal or family history of anesthesia complications.

It is important to let your primary care doctor know if you've been sick recently. Respiratory symptoms such as a productive cough, wheezing, shortness of breath, along with fever, or any positive results such as an influenza or COVID test should be discussed. It is important that you discuss your lifestyle habits, such as your activity tolerance and any tobacco, alcohol, or substance use.

And yes, the night before, we have specific instructions. Typically, it's safe to just say nothing by mouth after midnight. Some will instruct you that you can have clear liquids up to two hours before, but it's important that you verify that when you get your preoperative phone call.

Melanie Cole, MS: This is great information. Now, complications from anesthesia. You mentioned an anti-nauseant. Some people wake up from anesthesia feeling very ill. Some people have no effects whatsoever. Tell us what you see most often.

Kristen Hollenbeck: Yes, it is important to know that there are always risks with anesthesia, and your anesthesia provider will discuss your personal risk based on your health history and lifestyle. Nausea is a common problem after anesthesia. This is most common in young women, patients who are prone to motion sickness, and patients who are having certain procedures such as a laparoscopic surgery.

We have medications that we give to help prevent nausea and also to relieve nausea. Patients also sometimes report a scratchy throat from the breathing tube and this typically goes away after a day or two. Patients also want to know how long it will take for the anesthesia to wear off. It's normal to feel groggy for the rest of the day, but the vast majority of our drugs are short-acting. So, most patients are opening their eyes and communicating with staff shortly after we get to the recovery room.

Melanie Cole, MS: Speak about safety for us, Kirsten, because I think that's the biggest fear and the most common questions about anesthesia that you probably get and that I've heard over the years. Is it safe? And for some patients, elderly patients or serious comorbid conditions, are there safety issues?

Kristen Hollenbeck: Anesthesia techniques used today are actually very safe. Our technology and monitoring systems give us a lot of really good information. At Bryan, you will cared for by either a nurse anesthetist or a physician anesthesiologist. We are trained to manage your airway, give you the appropriate doses of medication, and respond quickly in the rare event of an emergency. But you are right, we all have our individual risk factors that will be discussed with you during your preoperative interview based on your health history and your comorbidities.

Melanie Cole, MS: So, I'd like you to speak about what the experience is like and the procedure. We mentioned the night before and when somebody goes in and they've met with their primary care and then they've been told their specific instructions for the day of the procedure for which they need anesthesia. So, speak about the experience itself because I liken a colonoscopy, it's like a nap, right? All of a sudden you're asleep. It's so fast. Is normal anesthesia like that as well? 

Kristen Hollenbeck: Yeah, you're right. Oftentimes, patients don't even remember going to sleep because it does happen very quickly. Just to give you an idea of what an anesthetic might look like at Bryan, after thoroughly reviewing your record and interviewing you in the preoperative area, I would choose the appropriate method and medications needed to keep you comfortable and safe during your procedure.

The hardest part for the patient is often the anticipation. If it is appropriate for your specific situation, I could give you medicine for anxiety on the way to the operating room. Once we arrive to the operating room, you will probably notice that it's a big, bright, cold room. We keep the temperature low to help control infection and keep our staff cool.

I will be sure to keep you comfortable and warm with blankets during the procedure though, so don't worry. The operating room team will help you to move over to the operating room table and attach vital signs monitors. I monitor your blood pressure, cardiac rhythm, temperature, respirations, and oxygen level during the case.

Some procedures only require IV sedation and others require you to be deep asleep under general anesthesia with a breathing tube like we talked about earlier. During the procedure, I will likely give you some sort of pain medicine and anti nausea medicine. I'll be monitoring you, your vital signs, the equipment, and responding to any changes as necessary. After the surgeon is done, I will start the wake up process. I will be sure that you are breathing effectively on your own, and I will start to turn off the sedation medicine. We will then go to the recovery room to watch you fully wake up and to continue to monitor you. 

Melanie Cole, MS: Wow, this is such great information you're giving us today, Kirsten. As we wrap up, what's one thing you'd like patients to know about anesthesia? If you could tell them just one thing, what would that be?

Kristen Hollenbeck: So, we want you to have a very positive experience and for you to feel confident in your care plan. If you have any questions or concerns, we want to hear about them so that we can discuss them together as a team. Your comfort and safety are our first priority always. 

Melanie Cole, MS: Thank you so much, Kirsten, for joining us today. And I’d also like to thank our Bryan Foundation partner, Swanson Russell. And to listen to more podcasts from our experts, please visit bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast. I'm Melanie Cole.