If you are anticipating major surgery and are worried because your doctor is recommending general anesthesia, you’re not alone in feeling anxious—many people do. While this type of anesthesia is considered very safe, people do worry about side effects. Read on for answers to your questions and information to put your mind at ease.

General anesthesia is treatment with medication to make you completely unconscious, so that your body will be still for the operation and so that you will not feel pain. Modern technology and safety standards have made general anesthesia safe for most people. While there are regional forms of surgical pain control, such as nerve blocks, general anesthesia is still the best choice for many major operations.

"At Yale, we have worked to develop rigorous protocols and specialized expertise to ensure that our anesthetics hold to the highest standards, and that you receive the safest and most effective modes of care,” says Stanley Rosenbaum, MD, chief of Perioperative & Adult Anesthesia for Yale Medicine.

Major surgeries, including heart surgery or organ transplants, and long operations such as some back surgeries, call for general anesthesia. In some cases, general anesthesia is also recommended for children who may have traumatic experiences with a particular medical or dental procedure.

Here are some other reasons why your surgeon may want you to have general anesthesia:

• You are having a procedure that needs stronger pain control than regional anesthesia can provide.
• Your surgery may affect your ability to breathe.
• Your procedure could cause significant blood loss.
• Your anesthesia needs to last for a long period of time.
• You would be uncomfortable during surgery if you were awake and aware.

Your anesthesiologist may administer general anesthesia through intravenous therapy (IV). This delivers a continuous supply of medications directly into a vein in your arm and, thus, into your bloodstream.

General anesthesia may also be given in a gaseous form that you inhale via mask. This may cause a buzzing sensation and dizziness as the gas enters your bloodstream through the pulmonary capillaries (tiny blood vessels in the lungs) and acts on centers within the brain to produce a loss of consciousness.  

The anesthetic is usually administered with a rapid-acting IV sedative to start the anesthesia. A combination of IV and gaseous agents are used to maintain the effect throughout surgery. Most patients regain consciousness quickly after surgery.

Since general anesthesia affects your breathing, the anesthesiologist may also give you a muscle relaxant and insert a tube into your windpipe to help you breathe better throughout your surgery. This will also keep your lungs safe.

General anesthesia puts you into a state deeper than sleep. You should feel yourself drift off quickly, within a couple of minutes. It has three stages:

• Going under: You may feel dizzy and start to feel detached. Sounds may seem louder than usual, and you may have a ringing or buzzing in your ears. Your anesthesiologist will provide the IV anesthetic agents quickly and smoothly, helping you avoid any feelings of anxiety.

• Staying under: At this point, you will be completely unconscious and unaware of your surgery and the doctors and activity around you. Your breathing may be assisted (or supported) by a ventilating machine connected to the breathing tube. Depending on your surgery, you may remain at this stage for hours.

• Recovery: You’ll probably feel groggy as you wake up from your surgery. Your anesthesiologist will monitor you for any side effects that may occur as you come out of anesthesia.

Throughout all of these stages, caregivers will monitor your blood pressure, breathing, and cardiac function, and adjust your anesthesia as necessary. You should not experience any pain, and you will have no memory of your procedure.

General anesthesia is considered to be safe, especially if delivered by anesthesiologists who specialize in your particular surgery. But, just as there are side effects and risks with any surgery, there may be side effects with general anesthesia. Most are minor, including nausea and vomiting, a feeling of disorientation, a sore throat (if you’ve had a breathing tube), itching, and chills. These effects should wear off within a few hours.

Serious complications are very rare. They can include dangerously low blood pressure, harm to the vocal cords, or heart attack, among other things.

One of the best predictors of how general anesthesia will affect you is your own general health. If you are in good health, you will probably have few side effects and complications. If you have a chronic disease, such as diabetes, general anesthesia is still very safe, but your risks for side effects or complications may be higher—your anesthesiologist will need to monitor you closely. If you are elderly, your risk for such problems as pneumonia is higher. Older people and children may have some confusion and delirium for as much as a week after surgery, so you will want to have a loved one around, if possible. If you are overweight or obese, you may experience sleep apnea during the recovery period after surgery.

To avoid problems, it’s important to alert your doctor prior to the surgery if you have any of the following conditions:

• You have any chronic disease or medical problem.
• You are (or could be) pregnant.
• You have a history of alcohol or drug abuse (both prescription and nonprescription); this may make a difference in the type of anesthesia given to you.
• You are a smoker—smoking increases both the risks from anesthesia and from surgery, and can cause complications during and after surgery. If you smoke, you should consider quitting before your surgery.
• You have problems with your heart, kidneys, or lungs.

Be sure to tell your anesthesiologist about any allergies, medication sensitivities, or prior problems with anesthesia. You should provide a list of any medications you are taking already, including vitamins and herbals. You may be asked to stop taking any blood-thinning drugs, such as aspirin, ibuprofen, or warfarin.  

Yale Medicine’s Department of Anesthesiology is dedicated to providing the highest quality anesthesia care for both children and adults. Our anesthesiologists have designed protocols that make general anesthesia as safe as possible. They practice in care teams that focus on individualizing anesthesia care for each patient, often drawing upon the expertise of doctors in our specialty anesthesiology programs, covering areas like cardiac surgery, neurosurgery, obstetrics and gynecology, pediatrics, and thoracic surgery. In addition to our anesthesiologists, our team includes certified registered nurse anesthetists (CRNAs), APRNs, PAs, RNs, and technicians.  

Out specialists have an exceptional level of expertise in providing cutting-edge, safe, and short-acting anesthetic medications, as well as the most sophisticated monitoring devices. 

While general anesthesia is safe and still the best choice for certain operations, we also provide many patients with regional anesthesia options that allow them to minimize or avoid narcotic medications during and after their operation. This may allow patients to stay alert and pain-free during surgery, leave the hospital sooner and recover more quickly, and minimize the risk for addiction to painkillers.