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December 18, 2020/Living Healthy/Primary Care

How Safe Is Anesthesia? 5 Common Concerns

An anesthesiologist weighs in on why you shouldn't be afraid

patient undergoing anesthesia

For some people, anesthesia is one of the scariest parts of surgery. Do you wonder about the risks, too?


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Anesthesiologist Christopher Troianos, MD, offers some insights to help separate fact from fiction. He highlights five key points about anesthesia that are sometimes misunderstood or have changed in recent years.

1. Anesthesia doesn’t always mean you go to sleep

There are four different types of anesthesia, and you’re only completely unconscious with one of them.

  • General anesthesia is what many people think of when they think of anesthesia and sleepingduring surgery. It is typically used for surgeries in areas such as the abdomen, chest or brain. Doctors also may recommend general anesthesia if they expect a long or complex surgery.
  • Intravenous (IV) monitored sedation is also known as “conscious sedation,” “twilight sedation” or “monitored anesthesia care” (MAC). Doctors use a combination of IV sedation along with local or regional anesthesia to make you more relaxed and comfortable, but not totally asleep. It’s mainly used for shorter, less complex surgeries like colonoscopies, biopsies, eye and foot procedures. After your procedure, you may not remember what happened but that’s not true in every case. Patients receiving a smaller dosage may also still be able to talk with medical staff during their procedure.
  • Local anesthesia involves numbing a specific part of the body to prevent pain during surgery or other procedures. It’s often used for dental work — the dentist numbs only the part of your mouth where you need a filling or extraction.
  • Regional anesthesia blocks pain in a larger part of the body, such as an arm or leg, or below the waist. The most common example is an epidural, which blocks pain around the uterus during childbirth.

2. Anesthesia is very safe

This is true nowadays, but wasn’t always the case, Dr. Troianos says.

“In the 1960s and 1970s, it wasn’t uncommon to have a death related to anesthesia in every one in 10,000 or 20,000 patients,” he says. “Now it’s more like one in every 200,000 patients — it’s very rare.”

He emphasizes that anesthesia is safer today because of advances in both technology and medication.

  • Anesthesiologists use a pulse oximeter to ensure that you get enough oxygen during surgery. It helps make sure the breathing tube used for general anesthesia goes into the trachea (windpipe) and not the esophagus — something that was more difficult to determine in the past.
  • Another thing anesthesiologists watch for is malignant hyperthermia. This is a rare reaction that some people have to anesthetic drugs that causes a high fever and can result in complications and even death. Anesthesiologists are now better able to treat this thanks to enhanced awareness, avoiding triggering anesthetics, and better medication to treat, Dr. Troianos says.
  • With advances in electronic medical records today, providers now have more complete information easily accessible to improve patient care.
  • Monitoring has become less invasive and clinical decision support systems are more common, ensuring patients better care than ever.

3. Side effects are relatively minor

It’s common to experience the following when you wake up from anesthesia:

  • Nausea.
  • A sore throat because of the breathing tube (for general anesthesia).
  • Minor soreness at the injection site (for local or regional anesthesia).
  • Mild pain or discomfort at your incision or site of surgery.


Although most anesthesia wears off fairly quickly, you may still feel groggy or have impaired judgment after surgery.

“We usually tell people not to make any major life decisions or drive a car or operate machinery for the first 24 hours after surgery,” Dr. Troianos says. “A few patients, particularly elderly patients having longer surgeries, may exhibit memory problems, difficulty multitasking, or learning new things. This is temporary for most patients but for others these symptoms may persist for a few months after surgery.”

He says it’s unclear whether this condition is due to their exposure to general anesthesia or the stress of surgery. But it’s for this reason that a regional or local type of anesthetic is prescribed for elderly patients by their physician anesthesiologist.

4. There’s very little risk of paralysis from epidurals

In the past, people who had an epidural or spinal block had a risk of paralysis because of the anesthetic, Dr. Troianos says.

“The anesthetic was in glass bottles, and the staff cleaned those glass bottles in an alcohol-based solution,” he says. “Alcohol can cause nerve damage. So if the alcohol leaked into the bottle, that could cause paralysis.”

Since bottles are no longer sterilized this way, that risk is gone.

5. You don’t need to be afraid of waking up during surgery

“Some people worry about being awake but paralyzed during general anesthesia,” Dr. Troianos says.

You may have seen movies that have used this as a plot point but it’s exceedingly rare, he says. And anesthesiologists use many strategies to prevent it.

“Typically, the patient’s blood pressure and heart rate would go up before they would regain awareness. So we monitor those vital signs to guide the amount of anesthetic that we use,” explains Dr. Troianos.

If someone is extremely sick or was in a serious accident, vital signs are less reliable. And those who abuse drugs and alcohol are sometimes less affected by anesthesia than others due to tolerance.

In those higher-risk cases however, anesthesiologists carefully monitor brain waves to help make sure the patient stays asleep. This allows doctors to adjust the anesthesia to maintain unconsciousness until the procedure is over, Dr. Troianos says.

“You don’t need to fear any medical procedure because you fear anesthesia,” Dr. Troianos emphasizes. “Talking with your doctor ahead of time will identify any risks and will guide the best type of anesthesia for you. No matter what procedure you need there will be an entire team of knowledgeable anesthesia medical professionals around you whose sole job is to take good care of you during your surgery.”


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