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How Does Anesthesia Work?

(Originally posted 14 January 2001 on About Anesthesiology)

One of the most common questions that anesthesiologists are asked is "how does anesthesia work?" Often this question is asked in such a way that makes it clear that anesthesia is perceived as a single entity, one medication or one technique. This is a common misconception among patients.

The question is one that actually requires a relatively long and fairly involved answer. In addition, it is actually an extremely difficult question to answer for many reasons:

1. Anesthesia is not a single entity or a single drug.

2. There are many different techniques that are utilized in anesthesia ranging from local anesthetic injections to regional anesthetics (such as spinal and epidural) to general anesthesia.

3. There are many different medications utilized in anesthesia.

4. There are many different methods to deliver that medication, ranging from intravascular injection to inhalation of medication in gas form.

5. In addition, this question is difficult to answer because in some cases we simply do not know how anesthesia works.

While it might seem impossible to believe that with today's advanced scientific knowledge base and experimental techniques, it is indeed true that the mechanism of many medications used in anesthesia is simply not clear. There are many theories and many people studying the question, but often the good answers simply do not exist yet.

Still, there are some general concepts about what is known that can help with the understanding of how anesthesia works. Let's look at some of the questions that we can address:

What are the types of anesthesia?
There are four broad categories of anesthesia that can be used - local anesthesia, regional anesthesia, sedation and general anesthesia.

What is local anesthesia?
Local anesthesia is the term used when injections of local anesthetic drugs are used to block sensation to a very small and specific area of the body. Again, this if often used in conjunction with sedation for reasons of patient comfort.

What is regional anesthesia?
Regional anesthesia usually refers to the use of local anesthetic drugs to block an area of the body. It does so by blocking a set of nerves that are responsible for the sensation of that area, whether it is the arm, leg, etc. True regional anesthesia does not affect the brain, but it is often used in conjunction with sedation for patient comfort.

What is sedation?
Sedation implies the use of medications to make a patient "drowsy" in an effort to make them more comfortable. It does not result in complete unconsciousness but can result in amnesia (not remembering what happens) and the patient may "fall asleep" for a period of time.

What is general anesthesia?
General anesthesia, in very simplistic terms, implies that medications are used that affect the brain in a way that causes unconsciousness. As a result, the patient becomes unaware of stimulation and pain and does not remember anything (amnesia). Some of the medications used are the same or similar to medications that are used in sedation, but often at a higher dose.

So, how do these types of anesthetic work?
Each type of anesthetic involves different medications and different techniques. Let's look at each one individually and explain some of the basics of each technique...

Next page ---> How Does Each Technique Work? Page 1, 2, 3


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