Which Type Of Anesthesia?

Question

On June 25th,I'm having a Brostrom Procedure done (lateral ankle stabilization),and I will probably get to choose the type of anesthesia,either general or spinal.Which one is better?I have never had surgery before if that makes any difference.

The reason that I say that I may get to choose is because the anesthesiologist may have a definite opinion on which one I should get,I'll go with that.

Answer 1

You have a lot of answers here form people who clearly know nothing about anesthesia.

I am an anesthesiologist, and I've had both general and spinal anesthesia myself. I have administered tens of thousands of generals, and many thousands of spinals.

If you are young and healthy, the anesthetic risks are low for either type of anesthetic.

Spinals (different from a spinal tap - that is a diagnostic procedure that uses a much larger needle) are wonderful anesthetics. It is an injection of numbing medicine into the sac of fluid that is below your spinal cord, and makes you numb from the waist down. We can alter the duration of the block by changing the specific drug, concentration and dose that is injected. Risks include bleeding and infection (risks any time a needle goes through skin), drop in blood pressure (easily treated) and spinal headache (less than 1% chance these days - we use small gauge needles with special points to avoid it). The benefit is a reduced chance of nausea and vomiting; NO pain (until the spinal wears off, but by then you can start on pain pills); no need to have someone breathe for you; you can talk to your surgeon, if you so desire; and you will feel SO MUCH BETTER afterward. We can always tell who had a spinal in the recovery room, because those are the people sitting up and looking comfortable. You can have some sedation along with your spinal if you want it.

If your surgeon is mega-slow, you might not want a spinal because it can be uncomfortable for the top half of you to lay in one position for 4 or 5 hours, and the drug could wear off if the anesthesiologist didn't plan on a marathon.

You'd also be fine with a general, but you will very likely have a tube of some sort (endotracheal or laryngeal mask airway) down your throat. There's also many more drugs involved, and a much higher chance that you'll puke afterward. We try to avoid that, but it happens, and the highest risk in is young females. You'll get pain medicine during the procedure, but we have to guess how much you'll need, and sometimes low blood pressure caused by the anesthetic gases limits the amount of opiate that can be given during the surgery. You can always have more in the recovery room, though. Risks of general include breathing problems, airway management problems, blood pressure issues (also treatable), nausea and vomiting, possibility of dental damage getting the breathing tube in, eye injury (we tape eyelids shut to prevent your eyes drying out), and the very unlikely heart attack / stroke / death thing.

In the end, it's your choice. If you get queasy just thinking about a needle, you might want a general. If you want to be a little more involved during the surgery, chat with the surgeon, and feel better afterward, go with the spinal.

Your anesthesiologist is trained to do both well.

Here are some podcasts that I did concerning anesthesia:

http://www.medicalminutepodcast.com/?cat=5

Good luck with your upcoming procedure!

Answer 2

It depends on the extent of the problem. I had a Brostrom repair done a couple of years ago and ended up under general anesthesia (due to other non-related complicating factors). Turns out that was the best bet since the surgery lasted longer then anticipated and the spinal would have worn off before they were done. Talk to your doctor about that possibility.

Answer 3

I have had both. I liked the spinal because I was alert and breathing on my own, etc. I have been re-admitted to the hospital twice after spiking a very high fever a day or two after surgery. They finally determined that this is just how my body responds to the anesthesia. A spinal has less risks. I didn't have this experience, but many patients have told me that they lost hair after a general anesthetic. Those are some heavy duty chemicals they put into your body.

Answer 4

pangolin gives the only well thought out answer of all those previous responses. there's no evidence that general anesthesia is better than spinals, nor vice versa. there are advantages and disadvantages to each one:

spinals will allow patients to be less groggy in the recovery room and have less chance of causing post-op nausea. however, the recovery period may be delayed because of unpredictable return of neurological function. inability to urinate is a common cause of prolonged recovery room stay after a spinal anesthetic. in studies, they've found that patients who had spinals woke up faster compared to those that had generals, but ended up staying in the recovery room longer on average because of the occasional prolonged block. also, there's a 1% chance of a spinal headache afterwards. spinals can also sometimes fail, although that's very uncommon.

both general and spinal anesthesia are very safe these days, and you really can't go wrong either way you go. the most important piece of advice i have to offer: if your anesthesiologist has a specific preference, you should do it the way he or she wants. don't try to make your anesthesiologist do something they don't want to do. it could be that if they have a strong preference one way, they might just not be any good at the other option!

Answer 5

This is a question you need to talk to your surgeon and anesthesiologist about.

If your surgery is 'just' a Brostrom, you could possibly have it done using local with sedation.

As for general anesthesia being safer than spinal anesthesia...well, I'm not an anesthesiologist but for this surgery I would pick a spinal.

Answer 6

General is always better for spinal needs the perfect technique to administer. The smallest mistake can some times lead to life long pain in the back with spinal.

General is the best option though pre and post operative care will be a little acute.

Answer 7

Before the procedure, you will have an opportunity to see (be seen) by your anestheologist. Discuss it with him or her. There is no clear better one. That's why there are so many options. What's best for you depends on your needs.

Answer 8

Both types of anaesthesia have possibilities of complications. Go with the general. It is more readily dealt with.

Answer 9

Get general. It is safer. The other may cause you headaches and you will lose motor functions until it wears off. Just much more dangerous.

Answer 10

You can't go wrong with general anesthesia.