Expert: Ronald Levy, M.D. - 7/22/2010

Question
Dear Dr. Levy,

I found your profile while surfing the web looking for more information about general anesthesia.

I'm 16yrs old and will be put under for about an hour and a half while an oral surgeon pulls all 4 of my wisdom teeth and puts in a TAD (temporary anchorage device) which is a small screw that will work together with my braces to correct my overbite. I've never been under anesthesia before --never had surgery. I haven't even been in hospital except for one or two short visits to the ER.

What concerns me the most is that, I don't know the surgeon, anesthesiologist or other people who will be working on me while I'm asleep --I'll be totally defenseless, won't be able to breath on my own, and hoping that they do their job correctly! I've had consultations with several other doctors to confirm that I do need the surgery done and that it's best to be put under while they do it. I agree that I should be anesthetized, but that doesn't make me any less nervous! I'm afraid that I will wake up during surgery and be unable to say anything, or worse that I won't wake up at all. I know the statistics are really slim to nil that anything bad will happen but I'm afraid I'll be that one of a thousand or million. Unreasonable, I know, but I'm really concerned about all of this. I've also read online that it's possible to be sick after waking up --I absolutely HATE being throwing up so this makes me worried too!

Please let me know how everything usually goes step-by-step...I want ALL the details! Why do I need to undress before surgery? I have low blood pressure (usually about 100/70), will this make me at risk during the surgery? What if my pressure goes TOO low? Is it true that I will need help in breathing? Will that need go away as soon as I wake up? How will they make sure I'm asleep throughout the surgery? What will they do to wake me up? How long after surgery can I eat again? And will Mom be able to be there throughout the surgery?

My surgery is in about a week and a half on August 2nd, so I'm hoping to hear from you by then!

Sorry for such a long message and for so many questions but I want to know as much as possible. Thanks in advance for taking the time to answer!

Concerned,

Jessa (in Bermuda)

Answer
Assuming this is in a hospital and not a doctor's office, what generally happens is you come in on the morning of surgery and the nurse or the anesthesiologist starts an IV on you. You do need to change into a hospital gown but they may let you leave your underwear on. They do this for several reasons; 1) so your clothes don't get dirty with betadine, blood, etc. and 2) so it is easier to place monitors (e.g. EKG pads) on you. Then the anesthesiologist will speak with you preop to answer any final questions you may have. They will give you some sedation in your IV then take you back to the OR. Then they will place monitors to watch your heart rate, blood pressure and oxygen saturation. Then they will give you oxygen to breath through a mask and through the IV they will give you medicine to go to sleep. That medicine might burn a little but that is normal. After you are asleep they put a tube down your trachea to help you breathe but they take it out before you wake up (so you won't even know you had it). Your blood pressure is not a problem as they will monitor and treat it if it goes too low. There are many ways to make sure you are asleep and the anesthesiologist will use one or more of these as he sees fit. Your mother will be with you up to the holding area but she will not be in the room during the surgery. You will see her again in the recovery room. As for when you can eat, that's really up to the surgeon. From an anesthetic point of view, you can eat immediately but your surgeon may have their own protocols.

The main point is that you really have nothing to worry about. If you are healthy, your risk of anesthetic complications is negligible. The trip to the hospital is probably more dangerous that the anesthetic.

Hope this help,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston