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General Anaesthesia – Procedure, Risks and Uses

General anaesthesia induces a controlled state of unconsciousness, allowing painless surgery. It is carefully planned and monitored by a specialist anaesthesiologist throughout the procedure.

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Things worth knowing about "General Anaesthesia"

General anaesthesia induces a controlled state of unconsciousness, allowing painless surgery. It is carefully planned and monitored by a specialist anaesthesiologist throughout the procedure.

What Is General Anaesthesia?

General anaesthesia (also spelled general anesthesia) is a medically induced state of deep unconsciousness in which the patient feels no pain and does not respond to external stimuli. It allows surgical procedures and diagnostic interventions to be performed that would otherwise be impossible or intolerable. General anaesthesia is always planned, initiated, and monitored by a qualified specialist anaesthesiologist.

Components of General Anaesthesia

A complete general anaesthetic typically consists of three core elements:

Analgesia: Complete pain suppression achieved through opioids or other analgesic agents.
Hypnosis / Unconsciousness: Induction of a sleep-like state using hypnotic agents such as propofol or volatile anaesthetics.
Muscle Relaxation: Relaxation of skeletal muscles using neuromuscular blocking agents to create optimal surgical conditions.

Procedure of General Anaesthesia

Pre-medication and Preparation

Before the procedure, a detailed anaesthesia consultation takes place to assess pre-existing conditions, current medications, allergies, and previous experiences with anaesthesia. Patients are typically required to fast for at least 6 hours before solid food and 2 hours before clear liquids to minimise the risk of aspiration. A sedative pre-medication is often administered beforehand to reduce anxiety.

Induction of Anaesthesia

Induction is usually performed intravenously, most commonly using the short-acting hypnotic agent propofol in combination with an opioid. In children or in cases of difficult venous access, inhalational induction via a face mask using a gaseous anaesthetic agent may be used instead.

Maintenance of Anaesthesia

During the operation, anaesthesia is maintained either by continuous intravenous administration of drugs (TIVA – Total Intravenous Anaesthesia) or by inhalational anaesthetics such as sevoflurane or desflurane. Ventilation is secured via an endotracheal tube or a laryngeal mask airway, and all vital parameters are continuously monitored.

Emergence and Recovery

Once the procedure is complete, anaesthetic agents are discontinued. The patient wakes up in a controlled manner in the recovery room, where close monitoring continues until circulation, breathing, and protective reflexes have fully returned.

Indications

General anaesthesia is used for a wide range of procedures, including:

Major surgical operations (e.g. cardiac surgery, abdominal procedures, joint replacement)
Procedures where regional anaesthesia is insufficient or not feasible
Operations in children requiring complete immobilisation
Emergency surgery
Certain diagnostic procedures (e.g. bronchoscopy, MRI in uncooperative patients)

Risks and Side Effects

Modern general anaesthesia is considered very safe. However, side effects can occur:

Common: Postoperative nausea and vomiting (PONV), sore throat from the endotracheal tube, drowsiness, shivering
Uncommon: Blood pressure fluctuations, allergic reactions to anaesthetic agents, dental injury during intubation
Rare: Malignant hyperthermia (a life-threatening metabolic crisis), intraoperative awareness, severe anaphylactic reactions

Individual risk depends on age, pre-existing medical conditions, and the complexity of the procedure. The anaesthesia consultation serves to assess these risks on an individual basis.

Contraindications and Special Precautions

Absolute contraindications to general anaesthesia are rare. Relative contraindications requiring special care include:

Known or family history of malignant hyperthermia
Severe cardiopulmonary disease
Full stomach in emergency procedures (aspiration risk)
Known severe allergies to anaesthetic agents

References

Miller R.D. et al. - Miller's Anesthesia. Elsevier, 8th Edition, 2015.
World Health Organization (WHO) - Safe Surgery Saves Lives. WHO Guidelines for Safe Surgery, 2009. www.who.int
Butterworth J.F., Mackey D.C., Wasnick J.D. - Morgan and Mikhail's Clinical Anesthesiology. McGraw-Hill, 6th Edition, 2018.

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