General anesthesia is usually obtained by intravenous injection, but can also be achieved through inhalation of anesthetics. General anesthesia leads to a loss of consciousness, total muscular relaxation and a complete loss of sensation
Local & Regional Anesthesia
This type of anesthesia is limited to one portion of the body and is obtained by injection of an anesthetic either about the spine or in the part of the body to be operated upon. In the case of knee surgery, the injection is given at the lower portion (lumbar) of the spine. These injections are termed "spinal" or "epidural" depending on the exact location of the injection relative to the spinal cord and nerves.
Spinal type anesthetics are carried out with the patient initially in a sitting or side-lying position. With this type of anesthesia, the patient can remain awake and can observe the operation on the television screen. He can talk to the surgeon. However, a patient may choose to some relatively light medication to help him or her dose off.
A consultation with the anesthesiologist is obtained in advance. The anesthesiologist will discuss with the patient the anesthetic options and a choice will be made taking into consideration the specific procedure to be carried out, the patientís medical history and the patientís concerns. The actual anesthetic is administered in the operating room.
After the procedure the patient is taken to the recovery room where the patientís condition is monitored prior to his or return to the hospital room or home.
Adequate pain control is essential for a speedy recovery. Great strides have been made in the control of pain:
- Greater awareness on the part of the surgeons with regards to pain management.
- Greater knowledge of specific anesthetics.
- Improvements in surgical techniques such as arthroscopy which avoids major skin incisions.
- Specific treatments for certain pain producing complications such as hematomas.
- Improvement in post operative pain medications.
Certain procedures such as knee replacement surgery may lead to significant blood loss, enough to require a blood transfusion. The patient has a number of options:
-Pre-operative blood donation on the part of the patient. The patient pre-donates 1 - 3 units of blood within the month preceding the procedure. The blood is treated and conserved, and is then given back to the patient during and after the operation.
-"Blood Salvage". Blood which is lost during the operation is recycled into the patient.
-Post operative blood salvage. Bleeding which occurs post operatively via a drain is transfused back into the patient.