Almost every back surgery procedure will involve the use of some kind of anaesthetic, whether local or general. Patients with a previous history of problems with anaesthesia should discuss their options with their surgeon as alternative arrangements may be possible allowing surgery to go ahead under different conditions. Anaesthesia allows a patient to undergo surgery without experiencing the sensation of the trauma involved or, in the case of general anaesthesia, in a state of unconsciousness where they remain unaware of the procedure.
Local anaesthetic presents the simplest form used during back surgery and may be indicated in cases where the spine surgery is minimally invasive, or where general anaesthetic would present problems for a patient (due to allergy, obesity, cardiovascular or respiratory issues, and age). An injection of a drug such as Novocaine is administered to the surgical area in order to numb the region and prevent nerve signalling as the surgeon operates. A sedative is often administered in addition to local anaesthetic to help the patient relax during the operation. As the patient remains awake during the operation there is a much shorter period between the end of the procedure and the patient becoming ambulatory (in most cases). This can help to reduce the risks of thrombophlebitis (blood clots), stroke, muscle stiffness, and other concerns with general anaesthetic such as respiratory problems. Another advantage is that the surgeon is able to communicate with the patient during the operation and ensure that no problems arise (patients may be asked to move their fingers or wiggle their toes, for example). Surgeons may be able to operate closer to the spinal cord when using local anaesthesia as the real-time patient experience can alert the surgeon to any potential problems.
General anaesthetic is given either as a gas or intravenously; shorter operations often utilize the former option. Patients under general anaesthetic will be monitored during their procedure and recovery, with heart-rate, breathing, and other vital signs observed. Machines will help to control breathing and administer further anaesthetic gas if necessary. Patients remain asleep throughout their surgery and for a brief period afterwards which means that the pain and other sensations accordant with invasive spinal surgery are not experienced. In rare cases a patient may go into anaphylactic shock when a general anaesthetic is used. If this has occurred previously then patients will undergo further surgery using sedatives and local anaesthetic where appropriate. In severe cases that can not be controlled a patient may have acute respiratory problems, due to this allergic reaction or other issue, and die. Death from the use of general anaesthetic occurs in about 1 in 250,000 people, making it an extremely rare occurrence, but a consideration nonetheless.
Lung problems can also occur after the operation itself, when general anaesthetic has been used. Infections of the pulmonary system, including pneumonia, may develop which will usually be treated with antibiotics. General anaesthetic also increases the length of time that a patient is immobile, which has ramifications for the risk of blood clots to develop (thrombophlebitis) as circulation is reduced in the legs. These blood clots may travel to the heart, lungs, or brain and cause problems such as heart attack (myocardial infarction), pulmonary embolism, or stroke. Blood thinning medication may be given to patients deemed high risk for blood clots. However, patients should be aware that any medications they take that have an anticoagulant effect (including aspirin, fish oil, and other conventional and alternative remedies) can increase the risk of problem bleeding during surgery and their surgeon should be made aware of their use prior to surgery.
Patients with hypertension (high blood pressure) will likely need an altered dosage of their medication when scheduled for surgery as the anaesthetic and stress of the surgical procedure itself can cause an elevation in blood pressure. In some recent cases, acupuncture, and hypnosis, have been used, seemingly effectively to keep patients free of pain during some surgical procedures. Unfortunately, it appears that sedatives were also used in these operations making it very difficult to verify the usefulness of such techniques.
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