The everyday use of the word anesthesia means "no feeling."  Pain is a rather complex phenomenon that includes both physical (pain) and emotional (distress) components.  To effectively control pain during surgery, anesthesiology care addresses both aspects.  This means that during anesthesia, techniques are used so that the patient will not "feel" discomfort and will not be "distressed" by the experience of having the procedure.  To help you understand some of the differences, benefits and choices related to the types of anesthesia available, a little background information might be helpful.

The Body's Sensory and Control System
Your body has an amazing ability to control and monitor itself. Constantly changing electrochemical signals are transmitted along a network which interconnects every area of the body to the spinal cord and brain.  This network is, of course, called the nervous system.  Along with other mechanisms such as hormone production, the nervous system enables your body to maintain moment-to-moment control of all life functions.

The nervous system carries many types of messages throughout your body.  Some messages are a response to injury that are translated by your brain as pain sensations.  These pain signals travel incredibly fast from the tip of your nerve endings to your spinal cord, and on to various areas in your brain where they're processed into sensations, emotions, thoughts and actions.

Relieving Pain
The three different types of anesthesia - local, regional, and general - interrupt pain signals at specific points.  Imagine your nervous system as a telephone system in an office; your brain is the switchboard, your nerves are the telephone cables, and the parts of your body that are experiencing pain are the telephones.

• Local Anesthesia
  For example, your foot may need minor surgery and your doctor has decided that local anesthesia will be sufficient.  Local anesthesia only will numb a small area, such as part of your foot.  The numbed nerves do not allow the 'pain signal' from your foot to be sent through the nervous system.  It is as if the phone is 'off the hook' and the phone message cannot be sent.
  
  
• Regional Anesthesia
  Perhaps you need surgery to repair a hernia and regional anesthesia is chosen.  Regional anesthesia is used to eliminate pain in a larger part of the body by temporarily blocking large groups of nerves or the spinal cord so that the pain signal cannot reach the brain.  If a telephone cable broke, all the phones in one area of the office would temporarily stop operating and no messages from that entire area could be sent to the switchboard.
  
  
• General Anesthesia
  Finally, you may need a major operation.  Your anesthesiologist decides that general anesthesia is best.  General anesthesia temporarily makes you unconscious so that your brain does not perceive any pain signals from the nervous system.  During that time, no messages are processed, and you cannot experience pain or other conscious sensations.  It is as if the switchboard operator is on a coffee break and is not there to connect the phone calls.

Minimizing Distress
The relief of physical pain goes a very long way toward minimizing the overall distress experienced during surgery. Situational stress can produce a response similar to pain.  For instance, both pain and anxiety are able to cause blood pressure to rise or heart rate to increase.  Managing the psychological or emotional aspects of surgery are important to the patient.  Keeping your vital signs and bodily functions within a safe range is a primary responsibility of your anesthesiologist.

• Anxiety Control
  It is common for patients to need some amount of anxiety management immediately before and during their procedures.  The anesthesiologist may manage these patients with medication that reduces anxiety and promotes a relaxed state of mind.  Anesthesia care by the anesthesiologist includes vital sign monitoring, vigilant observation of the effectiveness of medications, and immediate availability to provide additional medication.  The patient is relaxed enabling the surgeon to use local anesthesia for surgical pain control.  The relief of anxiety is called anxiolysis (anxio = anxiety, lysis = cut away).
  
  
• Sedation/Analgesia
  Depending on the procedure planned, some patients may require or benefit from a greater degree of medication.  The method that is most common and easiest to adjust as the procedure goes along employs intravenous medications.  Degrees of sedation are possible however, the patient's automatic control mechanisms for breathing, blood pressure, and pulse remain in control with this technique.  Once an IV is in place, the anesthesiologist uses sedatives to produce drowsiness & reduce anxiety and pain medication (analgesics) to reduce discomfort.  The combined effect may also temporarily produce amnesia. In this way, not only is the patient comfortable and able to cooperate with the surgeon, the likelihood of unpleasant memories is reduced. The surgeon will usually inject local anesthesia for surgical pain control.  Anesthesia care by the anesthesiologist includes vital sign monitoring, moment-to-moment adjustment of amounts of medications, and vigilant observation of the effectiveness of medications, and supervision of recovery and discharge.
  
  
• General Anesthesia
  It is common for some specific procedures to require general anesthesia.  Other procedures may not require general anesthesia though they are readily accomplished with this technique.  So far as pain relief and stress management, general anesthesia provides the dual effect of eliminating the sensation of pain and alleviating the psychological experience of the procedure. When a patient receives general anesthesia, the body's automatic control mechanisms are depressed or overridden.  The anesthesiologist may insert a breathing tube, take over control of breathing, and adjust the blood pressure level and pulse to provide conditions necessary for the procedure. In most cases, the first item of business is starting an IV.  Medications given through the IV quickly induce general anesthesia which is then usually maintained with anesthetic gas added to the oxygen supply.  Each breath delivers an amount of anesthetic that is adjusted throughout the procedure.  When the procedure is complete, the anesthetic is turned off and the patient awakens while breathing the oxygen alone.  Pain medication given through the IV during the procedure and/or local anesthesia injected while asleep help the patient wake up comfortably.  Anesthesia care by the anesthesiologist includes vital sign monitoring, moment-to-moment adjustment of amounts of medications and anesthetic, and vigilant observation of the effectiveness of medications, and supervision of recovery and discharge.