A surprising number of people are afraid of anesthesia. The idea of “going under” or being “put to sleep” can stir some anxiety in most of us. However, is this fear completely irrational? Or is there really something to worry about?
Two common fears that patients cite about anesthesia are: 1) not waking up or 2) not being put “fully to sleep” and being awake but paralyzed during their procedure.
First and foremost, both cases are extremely, extremely rare. In fact, the likelihood of someone dying under anesthesia is less than 1 in 100,000. This is the same as 0.0001% of a chance. To put this into perspective, you’re twice as likely to be out for a walk and hit and killed by a car (creepy, we know). Similarly, in the US, you’re almost twice as likely to die in a Tornado.
These statistics aren’t meant to be fear mongering. They’re meant to underscore just how rare serious complications from general anesthesia are. In this post we’ll share facts surrounding anesthesia to hopefully remove some of the “unknown”. We will also provide medical information about different types of anesthesia, and lowering your (already low) risk of complication during surgery.
First, Let’s Debunk the Fear of Anesthesia
As we illustrated above, the likelihood of serious complication and death from anesthesia is very, very, VERY low. An unexplained death from general anesthesia is extremely rare. In the cases where a patient does die during surgery, it’s almost always from confounding medical factors (several things at play that created a “perfect storm”).
As for the circumstance of “being awake” during surgery, this is also extremely rare. In most of these cases, the patient feels as though they have a vague recollection of surgery (called “intraoperative awareness”). Usually, these cases are a result of patients not receiving enough anesthesia due to an underlying medical condition or emergency (e.g. an emergency, trauma surgery where there may not be enough time to properly administer anesthesia).
Not All Anesthesia is Created Equal: 3 Different Types of Anesthesia
You’ve probably heard of different types of anesthesia, but may wonder “what’s the actual difference?”. Basically, there are 3 different types of anesthesia: local, regional and general. General is the anesthesia type we think of most during a surgery where the patient is completely asleep. Local and regional are the two that are often confused with one another.
Here are the different types of anesthesia:
- Local—Numbs only the area treated. Local anesthetic is the “mildest” form of anesthesia used to just numb the area. Think: numbing cream or an injection. This type of anesthetic would not be used for a major surgery, but may be used to numb the area while a spinal block is administered. With this type of anesthesia, you are fully awake and conscious.
- Regional—Blocks the nerves in a specific area (region) to block any pain. This method does not affect the brain or breathing. With this method you are conscious but are usually given sedatives to fall asleep. This type of anesthesia is like the “middle-ground” between local and general, and can be used for some more serious surgery types like hip or knee replacement surgery.
- General—Medication is given and you are completely unconscious. This type of anesthesia is given for longer, more serious surgeries. This is the “catch-all” anesthesia type often referred to as “going under”. With this type, a breathing tube is administered to assist with breathing.
Anesthesia + Risk
Like anything medical-related, things like your history, general health, and other lifestyle factors (like alcohol consumption) can make you more (or less) at risk during surgery. Here are some known risk factors for patients undergoing anesthesia:
- A history of seizures
- Alcoholism or drug use/abuse
- Previous poor reactions to anesthesia
- Smoking cigarettes
- Abnormal blood pressure
- Being on medications that increase bleeding (e.g. Aspirin)
- Allergies (specifically those to certain medications)
- Diabetes
- Overweight/ obesity
If you have any of these have added risk factors your care team will work with you. In some cases, this may mean opting for regional anesthetic instead of general. If there is a longer lead-time before an elective surgery (like joint replacement, back surgery, ACL surgery etc.), engaging in a PreHab program before surgery will reduce your surgery-day risk when it comes to anesthesia and beyond. Read on as we share how exactly you can lower your surgery risk.
What is PreHab before surgery? PreHab is everything that you actively do before surgery to prepare yourself. PreHab includes exercise, creating mental preparedness, improving nutrition, getting your recovery environmental ready, and so forth. Each surgery comes with unique activities, lessons, and tips to get a patient the most prepared for their surgery as possible. PreHab aims to reduce surgery day risk, lower complication rates, and set a patient up for a faster, safer recovery.
How to Lower Your Surgery Day Risk
Once again, we should remind you that anesthesia is incredibly low risk. To further put your risk-level into perspective, you have an equal chance of dying due to lightning.
Despite most elective surgeries and anesthesia being low risk, you should always work towards being the most prepared as possible on surgery day. For orthopedic surgery, this means engaging in a PreHab program that will get you physically, mentally, and environmentally ready for surgery and at-home recovery.
Do Your PreHab!
Whether or not your physician sets you up with a PreHab program, doing PreHab in the weeks leading up to surgery is the best thing you can do to lower your surgery day risk. A PreHab program should be customized to the surgery you are undergoing, as well as your individual case.
For example, do you smoke? Are you overweight? Are you physically strong enough to support yourself as you recover at home? A daily PreHab program should work to lower any risk factors you have by helping you take a smoking “time-out”, encouraging you to lose extra weight, and targeting key muscle groups and movements needed for a safe and speedy recovery.
A good PreHab program before surgery should:
- Strengthen your body so that it can support recovery
- Improve your nutrition with a focus on foods and vitamins that boost healing
- Cuts down pre-surgery jitters, stress and anxiety
- Helps get your home ready for recovery
- Help you manage preoperative and postoperative pain