Based on the type of surgery you may justify different anesthetic techniques that are also associated with each other. Usually, general anesthesia is used for laparoscopic and robotic surgery; while loco-regional anesthesia is used for endoscopic surgery.
General anesthesia determines the total abolition of the state of consciousness, the absence of pain and complete muscle relaxation, through the administration of intravenous medications. When the patient is asleep we will ensure the patency of the airway and adequate oxygenation through the placement of a tube into the trachea and the help of an automatic respirator.
To perform regional anesthesia (local anesthetics and painkillers) drugs are injected in the sub arachnoid or epidural space, with a intervertebral puncture, in order to relieve pain. When using these techniques of anesthesia the patient remains conscious, but has temporarily lost feeling in part of the body during surgery. There are different types of loco-regional anesthesia:
§ Spinal anesthesia: it is performed by injecting a small dose of local anesthetic into the subarachnoid space, where the liquid, which surrounds the spinal cord and nerves, is located. The pain signals from peripheral nerves are blocked before they reach the brain and the patient can be subjected to the intervention without experiencing any pain. Injecting the local anesthetic will temporarily abolish the sensitivity and motility of the lower limbs, which will be recovered in two to three hours.
§ Spinal analgesic anesthesia: it involves the administration of a small amount of an opioid drug in the subarachnoid space. This method reduces the pain associated with surgery, but leaves the motility of the lower limbs unchanged.
§ Epidural anesthesia: it involves placing a small catheter into the intervertebral space through which the local anesthetic is administered, which “wets” the nerve roots in the affected area. A good control of the painful symptomatology is obtained both during surgery and in the following days after the procedure, reducing the need for supplementary doses of painkillers. This technique involves the abolition of only pain sensitivity, while maintaining the motility of the lower limb.
How will I be evaluated by the anaesthesiologist?
The anaesthesiologist coordinates with the urology team in terms of patient management in preparation for surgery. The first assessment is done on an outpatient basis: performing blood tests and an electrocardiogram. The anaesthesiologist visits the patient, evaluates the condition, gathers information about therapy taken chronically, reviews medical records, not just ones related to the urologic disease, but particularly those relating to previous interventions and chronic diseases (cardiac, respiratory, metabolic, neurological, eye, etc.). The anaesthesiologist then decides whether further investigations are necessary to confirm the suitability of the intervention. Moreover, during the evaluation the anaesthesiologist should discuss with the patient whether to suspend or continue any on-going medical treatment.
How is the type of anesthesia chosen?
The anaesthesiologist agrees with the patient on the type of anesthesia that is best suited depending on the type of surgery and the patient’s clinical conditions, in particular cardiac, neurological, ocular, and respiratory functions.
§ What are the risks of anesthesia? All interventions that include anesthesia present a minimal risk that depends on the type of surgery and the patient’s health. The specific risks for each type of surgery and for each patient will be explained and considered case by case. Adverse events related to anesthesia procedures are rare in the general population; however, the anaesthesiologist must take all precautions to prevent any complications.
§ Is the injection for loco-regional anesthesia painful? The puncture site for regional anesthesia is like a stitch in any other part of the body, it is not painful, the patient only feels the tip of the needle, which may be discomforting, but only for a brief moment.
§ Is there a risk of being paralyzed by spinal or epidural injection? The evolution of techniques and materials allow us to ensure that the risk of paralysis associated with this procedure is almost non-existent.
§ Why should you sign the informed consent? Similar to all other medical decisions, whether interventional or diagnostic, the law provides that the patient must be informed about the anaesthesia and any related risks. Signing the document means that the patient is informed, but the consensus does not abolish the anaesthesiologist from responsibility in case of error. The patient may decide to withdraw their consent or re-discuss the anesthetic and procedure choice at any time.
§ Does the patient arrive in the operating room awake or asleep? The patient enters the operating room awake and cooperative, but it is possible that very anxious and agitated patients may require minimal sedation that is administered in the ward before surgery.
§ Will I feel pain during the procedure? In the course of general and loco-regional anaesthesia it is impossible to feel pain. It is possible that in the course of loco-regional anaesthesia the patient may have the feeling of being touched and this can cause discomfort, but not pain. Administering loco-regional anaesthesia to anxious patients may be associated with sedation.
§ Will I see something in the operating room? During surgery, a cloth placed between the patient and the surgeon, which, in addition to ensuring the sterility of the operating field, ensures that the patient, in case of operations under general or loco-regional anaesthesia, does not directly see the surgeon, the tools, and/or the intervention. For patients who wish to view the actions performed in videoscopy, they can follow the operation through a monitor.
§ Will I be left alone after anaesthesia? The anaesthesiologist will not lose sight of the patient for a moment and constantly monitor their health through monitors that detect the vital functions. During loco-regional anaesthesia, the patient can receive all the necessary attention and clarifications required by him.
§ Will I feel pain after the surgery? The anaesthesiologist sets a pain, anti-nausea and anti-vomiting medications for the days following surgery; this involves the administration of drugs at set times at which they can be associated with other painkillers at the patient’s request.
§ When will I be able to eat or drink after the surgery? After surgery, the patient may gradually begin to drink and eat. Patients start with liquids and only when these are well tolerated, and in the absence of nausea and/or vomiting, the patient may switch to solid foods.