Novemver 1, 2022
Tarek Elhor
Founder of Brussels Surgical · Anesthesiologist and Aesthetic Physician
Many people fear anesthesia simply because they do not fully understand what it is. Anesthesia may be local, numbing sensation in a specific area, or general, inducing a complete state of unconsciousness. But how does it work? Why does it cause such apprehension? What are the different types of anesthesia? Today, our medical director and anesthesiologist shares insights into his daily practice and explains what anesthesia truly is.
I have always wondered why so many people are afraid of anesthesia. I am not referring to the mild nervousness one might feel before speaking in public or being stopped by the police. I mean the genuine fear of anesthesia, so intense that it can paralyze individuals and prevent them from undergoing necessary treatment.
Typically, before surgery, in addition to questions about the procedure and its outcome, patients often share their deepest concerns. I frequently hear these statements:
And sometimes, when patients struggle to express their fear directly, it surfaces through more technical or seemingly unrelated questions:
And yet, during my training at ULB to become a certified anesthesiologist, no one ever addressed the origins of this fear of anesthesia and anesthesiologists. My mentors taught me how to carry out this exceptional profession, how to prepare for an operation, manage preoperative instructions, monitor the patient’s vital and non-vital functions, choose the right technique, adapt to the procedure, select appropriate drugs, and manage postoperative pain... But nothing about how to help patients overcome their fear.
I must admit something. Even though anesthesia is no longer a mystery to me, it remains an impressive process. For most people, however, it is a surreal, almost mythical experience that carries them into the arms of Morpheus. Today, after many years of practice, I want to prepare my patients as best I can. Since misunderstanding is one of the main causes of fear, I will explain in more detail what anesthesia actually is. This will help you overcome your anxiety and enter the operating room with peace of mind.
When searching the term “anesthesia” on Google, you’ll find this definition from Wikipedia:
“Anesthesia is the loss of sensation (particularly pain). It enables a medical procedure that would otherwise be too painful. Anesthesia may target a limb, a region, or the entire body (general anesthesia). Regional anesthesia is also used in cases of chronic pain. The word ‘anesthesia’ comes from the Greek αἴσθησις, meaning the faculty of sensory perception, combined with the negative prefix alpha (α) and the euphonic nu (ν).”
According to Wikipedia, then, if “esthesia” is the ability to perceive through the senses, “anesthesia” would be the complete absence of sensation or perception. I must admit, defined this way, anesthesia can indeed sound frightening. If someone offered me anesthesia under those terms, I would decline. I imagine myself stripped of all five senses: blind, deaf, unable to smell, and paralyzed. I wouldn’t be able to feel or move anything. That’s hardly reassuring.
Fortunately, this definition no longer reflects the reality of modern anesthesia. In fact, the word’s etymology is no longer aligned with current medical practice. Here is how I define anesthesia to my patients:
Anesthesia is a medical act performed by an anesthesiologist. It enables a diagnostic or surgical procedure to be carried out under optimal conditions of comfort and maximum safety for the patient, while preserving vital functions. Once the procedure is complete, the patient regains full autonomy.
There are several types of anesthesia. The goal is not always to put the patient to sleep. That is the role of general anesthesia. Pain relief in a specific area is also possible, in which case we speak of local or regional anesthesia.
General anesthesia is a state induced by the combined action of various medications on the nervous and muscular systems. It results in varying degrees of hypnosis (sleep), amnesia (lack of memory), nociception (lack of response to pain stimuli), and muscle relaxation.
Local or regional anesthesia involves the use of a single type of medication that blocks the transmission of pain. It acts solely on pain management. The difference between local and regional anesthesia lies in the area affected.
With local anesthesia, the procedure targets a small, well-defined area. All physicians, surgeons or general practitioners, are authorized to perform local anesthesia. However, certain techniques are reserved for anesthesiologists because they require more monitoring and target more complex nerve blocks.
This is the case with regional anesthesia. The goal is to desensitize a group of nerves connected to a part of the body (leg, hand, etc.). Epidural anesthesia, widely known, is one such example.
Whether general or local, the anesthesia process follows a similar sequence. It always begins with a preoperative consultation with your anesthesiologist. During this appointment, they review your medical history, allergies, current medications, and more. Based on this, they determine the most appropriate type of anesthesia for your procedure and your personal profile. The anesthesiologist will explain how the anesthesia will be administered, potential side effects, and associated risks.
Anesthesia must always be performed on an empty stomach. You must stop consuming solid food 6 hours before the procedure and clear liquids 2 hours before. You will receive a list of recommended foods during the preoperative consultation.
In some cases, certain medications must be discontinued. The anesthesiologist will advise you of this during your initial visit.
Everything begins with the setup for the anesthesia, which takes about 15 minutes.
For general anesthesia, when the patient enters the operating room, the medical team places an intravenous line and installs monitoring equipment. Safety checks are performed before anesthesia is induced. Sometimes, the anesthesiologist will ask you to inhale an anesthetic gas through a mask before administering the medication intravenously. Once you are asleep, the procedure takes place as planned, and the anesthesiologist continuously administers medication to manage your sleep and pain levels.
Local anesthesia may be administered in the operating room or in a consultation room. The anesthesiologist injects or applies a numbing agent to the skin in the area to be treated. The physician ensures that the area is desensitized and that you feel no pain before beginning the procedure.
A specific question?
