At some point in our lives, most of us will receive anesthesia for a surgical procedure or a diagnostic test. As common as “going under” is, it’s not a particularly well-understood experience. Anxiety related to anesthesia is common among patients, as are misconceptions about the risks.

“Anesthesia today is safer than it’s ever been, and there are many different types of anesthesia we can use that can be tailored to the patient and the type of procedure you’re having,” says Dr. Linda Mason, president of the American Society of Anesthesiologists and a professor of anesthesiology and pediatrics at Loma Linda University. Whichever anesthetic agents a provider chooses, “our main goal is to keep you safe and pain-free,” she says.

Here’s an overview of the four main types of anesthesia: what they do, when they’re used, and what you should ask before you get them. 

General anesthesia

It’s the most common type, and it’s probably what comes to mind when you picture surgery. General anesthesia lulls you into an unconscious state in which you can’t feel pain or move on the operating table, while other methods sedate you to varying degrees. Because it can suppress breathing and lead to complications that are life-threatening, general anesthesia is the riskiest method. Yet while this form of anesthesia demands caution and can pose risks, it’s not the gamble it’s sometimes made out to be, and serious complications very rarely occur in healthy people. Deaths attributable to general anesthesia are very rare, occurring in only 1 of every 100,000 or 200,000 operations; likewise, people very rarely wake up during a procedure once they’ve been anesthetized. To be safe, though, providers strive to use the least anesthesia necessary to keep you comfortable. 

General anesthesia involves drugs administered intravenously through a needle in your arm or via inhaled drugs given through a mask. It’s the go-to form of anesthesia for most major operations, such as back, heart, stomach and brain surgery — basically any operation that covers a large swath of the body, takes a long time to perform and/or requires a person to be totally immobilized. After you drift off to sleep, you might be given other agents in addition, like muscle relaxants and narcotics, to make sure you’re totally relaxed and pain-free. When you wake up, you won’t remember the operation. Common side effects include drowsiness, nausea and chills. Your throat might also be sore from the breathing tube used during the procedure.

IV/monitored sedation

Intravenous (IV) sedation is for shorter, less complex surgeries like eye or foot procedures, colonoscopies, endoscopies and biopsies. It’s known by a number of different names, such as conscious sedation, twilight sedation and monitored anesthesia care. This type of anesthesia “entails injection of a pain-killing drug into a specific body part, followed by IV drugs to keep you sedated,” says Kathryn Jansky, a certified registered nurse anesthetist and president-elect of the American Association of Nurse Anesthetists. IV/monitored sedation is safer than general anesthesia, and depending on how deeply you’re sedated, you may or may not have amnesia about the procedure. With minimal sedation, you will be able to communicate with the surgical team during the operation. 

Nurse anesthetists, by the way, are often the providers who actually deliver anesthesia and monitor you during surgery, working under the supervision of any physician. However, CRNAs can practice on their own in many states, and may be the sole anesthesia providers in rural areas. 

Regional anesthesia

This form of anesthesia blocks sensation in areas of the body, and can entail a nerve block (injection of an anesthetic near nerves to numb a specific body part) or spinal or epidural administration. When you get a spinal, the anesthetic is injected directly into the cerebrospinal fluid in your spinal cord using a very small needle. With an epidural, the anesthetic is administered through a catheter inserted into the epidural space, which lies between the spine and its outer membrane. (The advantage of the catheter is that it can be used to give more medication during the surgery.) Either way, you don’t feel anything in the body part being operated on. 

Nerve blocks can be used for dental work, upper or lower extremity surgery, pain relief after total knee replacement, abdominal surgery or retinal surgery. Epidurals are often given during childbirth, numbing your lower body for labor, while a spinal may be used if a Caesarean section is required to deliver a baby. Spinals are faster-acting, but epidurals last longer. As to whether you want to be conscious for a procedure where you receive a regional anesthetic, that’s often up to you. Headaches are a common side effect of regional anesthesia.

Local anesthesia

This is what you receive at an urgent care center before getting stitches for a deep gash, or at a plastic surgeon’s office before having laser surgery. It numbs a small area so you don’t feel pain but leaves you fully conscious. It can be delivered via needle or applied to the skin.

Questions to ask your anesthesia team

It’s always good to prepare for your meeting with the anesthesia team by having a list of questions you’d like to ask. Make sure you include:

• Do I need to have general anesthesia for this procedure?
• Do I have risk factors that make anesthesia risky for me?
• How can I lower my risk of having an anesthesia-related complication?
• How will I feel when I wake up?
• What kinds of drugs will I be prescribed to relieve pain after my procedure?

How to have anesthesia safely

“It’s important that we have all relevant information about you when we’re planning what medications to use,” says Mason. “Don’t leave anything out.” That means you need to: 

• Tell your anesthesiology team about all medications you’re taking and all medical problems and drug allergies you have. Also clue them in on whether you’ve ever had a reaction to anesthesia before.

• Don’t eat or drink before surgery for which you’re scheduled to have general, IV/monitored sedation or regional anesthesia. The general rule is don’t have any solid food for eight hours prior to having anesthesia, or clear liquids like water or coffee for two hours beforehand. Food can regurgitate into your lungs after anesthesia, making it difficult for oxygen to reach the lungs. “That’s called pulmonary aspiration, and it is a very serious problem,” Mason says.

• Stop using medications and supplements prior to surgery as directed by your surgical team. I was told to stop taking omega-3 fish oil supplements a couple of days prior to foot surgery because they thin the blood and could lead to excessive bleeding.

• Stop smoking at least 24 hours prior to surgery, even if you’re not trying to quit for good. Smoking can lead to breathing problems and increases the risk of complications from anesthesia both during and after surgery.
• Arrange for someone to pick you up and take you home. You won’t be allowed to drive if you’ve had anything more than local anesthesia, since you’ll be drowsy and your reflexes will be dulled, or if you’re using opioids for pain.

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