Anesthesia for Surgery: What to Expect Before, During & After

What Is General Anesthesia?

General anesthesia is a medically induced state of controlled unconsciousness, amnesia, pain relief, and muscle relaxation that allows patients to undergo surgical procedures without awareness or discomfort. It is administered by specialized physicians called anesthesiologists who monitor vital signs throughout the entire procedure.

General anesthesia, sometimes simply called "being put under" or "sedation," represents one of medicine's most significant advances. Before its development in the mid-1800s, surgery was a terrifying experience that patients endured while fully conscious. Today, millions of surgeries are performed safely each year under general anesthesia, with patients having no memory or awareness of their procedures.

When you receive general anesthesia, a carefully balanced combination of medications produces four essential effects. First, you lose consciousness—falling into a deep sleep that is different from natural sleep because you cannot be awakened by normal stimuli. Second, you experience amnesia, meaning you will have no memory of the surgical procedure. Third, you receive powerful pain relief (analgesia), ensuring that even though your brain is deeply sedated, your body does not respond to surgical trauma. Fourth, if needed for your particular surgery, your muscles become completely relaxed to allow the surgical team optimal access.

The anesthesiologist—a physician with extensive specialized training—carefully controls the depth and duration of this state. They use sophisticated monitoring equipment to track your heart rhythm, blood pressure, oxygen saturation, carbon dioxide levels, and even brain wave activity. This continuous monitoring allows them to adjust medications in real-time, ensuring you remain safely unconscious throughout your procedure while avoiding giving more medication than necessary.

How General Anesthesia Differs from Other Types

It's important to understand that general anesthesia is just one of several anesthesia options. Local anesthesia numbs only a small area—such as when a dentist injects numbing medication around a tooth. Regional anesthesia blocks sensation to a larger area of your body; examples include spinal anesthesia (commonly used for cesarean sections) and nerve blocks. With regional anesthesia, you remain awake but cannot feel the surgical area. Sedation makes you drowsy and relaxed but typically doesn't render you completely unconscious.

Your anesthesiologist and surgeon will discuss which type of anesthesia is most appropriate for your specific procedure, taking into account the nature of the surgery, your overall health, your preferences, and safety considerations. For many major surgeries—including most abdominal, chest, and brain operations—general anesthesia is required.

How Do I Prepare for Anesthesia?

Preparing for anesthesia involves fasting (no solid food for 6 hours, clear liquids for 2 hours before surgery), disclosing all medications and health conditions to your anesthesiologist, following specific instructions about which medications to continue or stop, and arranging transportation home afterward.

Proper preparation for anesthesia is crucial for your safety. The weeks, days, and hours before your surgery all involve important steps that help ensure the best possible outcome. Your surgical and anesthesia teams will provide specific instructions, but understanding the reasoning behind these guidelines helps you follow them correctly.

The preoperative process typically begins when you meet with your anesthesiologist—either in a preoperative assessment clinic days before surgery, or on the day of your procedure. During this consultation, the anesthesiologist reviews your complete medical history, examines you, and develops an anesthesia plan tailored to your needs. They assess your overall fitness for surgery and identify any factors that might require special precautions.

You should arrive at the hospital or surgical center at the time specified by your surgical team—typically one to two hours before your scheduled procedure. This allows time for necessary preparations including paperwork, changing into a hospital gown, placing an intravenous (IV) line, and final consultations with your surgical and anesthesia teams.

Why Fasting Before Anesthesia Is Critical

One of the most important preparation requirements is fasting before surgery. This isn't arbitrary—it serves a vital safety purpose. Under general anesthesia, your normal protective reflexes are suppressed, including the gag reflex that normally prevents stomach contents from entering your lungs. If you have food or liquid in your stomach during anesthesia, there is a risk of regurgitation and aspiration—when stomach contents enter the lungs, potentially causing a serious and sometimes life-threatening pneumonia called aspiration pneumonitis.

Standard fasting guidelines, endorsed by major anesthesia societies worldwide including the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC), specify:

• 6 hours minimum without solid food, including milk, orange juice with pulp, and any food items
• 2 hours minimum without clear liquids—water, black tea or coffee without milk, clear apple juice, sports drinks
• Breastfed infants: 4 hours before anesthesia
• Formula-fed infants: 6 hours before anesthesia

If your surgery is scheduled for the morning, this typically means no eating after midnight the night before. For afternoon surgeries, you may be able to have a light early breakfast. Always follow the specific instructions provided by your surgical team, as some procedures may require longer fasting periods.

Managing Your Medications Before Surgery

Your anesthesiologist needs to know about every medication you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. This information is crucial because many medications interact with anesthetic agents or affect your body's response to surgery.

Some medications need to be stopped before surgery:

• Blood thinners (warfarin, aspirin, clopidogrel) may need to be stopped several days before surgery to reduce bleeding risk—but only if your doctor advises this
• Certain diabetes medications may need dose adjustments since you'll be fasting
• Herbal supplements like ginkgo, garlic, ginseng, and St. John's wort can affect bleeding or interact with anesthetic drugs

Other medications should typically be taken with a small sip of water even on the morning of surgery:

• Blood pressure medications (except diuretics, which your doctor may have you skip)
• Heart medications
• Thyroid medications
• Seizure medications
• Acid reflux medications (proton pump inhibitors)

Never stop taking any medication without consulting your doctor. The risks of stopping certain medications—particularly heart or seizure drugs—may outweigh the risks of taking them before surgery.

What to Tell Your Anesthesiologist

Before your procedure, your anesthesiologist will ask detailed questions about your health. Being thorough and honest with your answers is essential for your safety. Key information includes:

• All current medications, supplements, and recreational drugs
• Previous reactions to anesthesia (in yourself or family members)
• Allergies to medications, latex, or other substances
• Heart conditions, high blood pressure, or history of stroke
• Lung conditions including asthma, COPD, or sleep apnea
• Diabetes and kidney or liver disease
• History of smoking or alcohol use
• Tendency to get motion sick or nausea after previous anesthesia
• Loose teeth, dental crowns, or dental problems
• Difficulty opening your mouth or any neck problems
• Pregnancy or possibility of pregnancy

Physical Preparations the Day of Surgery

On the day of your surgery, there are several practical preparations:

• Remove jewelry including rings, earrings, and body piercings
• Remove nail polish so the oxygen monitor on your finger works properly
• Leave valuables at home
• Remove contact lenses and bring your glasses instead
• Avoid makeup and lotion
• Wear comfortable, loose clothing
• Shower as instructed—some facilities provide special antibacterial soap

What Happens During Anesthesia?

During general anesthesia, you receive intravenous and/or inhaled medications that induce unconsciousness within seconds. Your anesthesiologist then maintains your anesthesia, monitors your vital signs continuously, manages your airway with a breathing tube or mask, and adjusts medications throughout surgery to keep you safely asleep.

Understanding what happens during anesthesia can help reduce anxiety about your procedure. The anesthesia process has three distinct phases: induction (going to sleep), maintenance (staying asleep during surgery), and emergence (waking up). Throughout all three phases, your anesthesiologist remains at your side, managing your care.

In the Operating Room

When you enter the operating room, you'll notice it's cool and filled with equipment—monitors, surgical instruments, and the anesthesia machine. The surgical team will help you onto the operating table. You may receive a warm blanket, as operating rooms are kept cool to reduce infection risk.

The anesthesia team will attach monitoring equipment:

• ECG electrodes on your chest to monitor heart rhythm
• Blood pressure cuff on your arm
• Pulse oximeter on your finger to measure oxygen levels
• Sometimes additional monitors for brain activity, muscle relaxation, or more detailed heart function

If you don't already have an IV line, one will be placed—typically in your hand or arm. The IV allows rapid administration of medications and fluids throughout your procedure.

Going to Sleep (Induction)

Before anesthesia begins, you'll breathe pure oxygen through a mask for several minutes. This "pre-oxygenation" fills your lungs with oxygen reserves, providing a safety margin during the transition to anesthesia when you briefly stop breathing.

Induction of anesthesia typically happens remarkably quickly. The anesthesiologist will say something like "You're going to feel sleepy now" and inject anesthetic medication through your IV. Within about 15-30 seconds—sometimes less—you'll lose consciousness. Many patients remember counting backwards or feeling a cool sensation in their arm, then nothing until waking up in recovery.

The medications used for induction vary based on your health and the planned procedure, but commonly include propofol (which causes the most rapid unconsciousness), opioid pain medications like fentanyl, and sometimes muscle relaxants. Inhaled anesthetics can also be used for induction, particularly in children who may be afraid of needles.

Airway Management

Once you're unconscious, your protective reflexes—including your ability to breathe independently and keep your airway open—are suppressed. Your anesthesiologist must take over these functions. Depending on the surgery's length and type, this might involve:

• Face mask – For very short procedures, the anesthesiologist may simply hold a mask over your face to deliver oxygen and anesthetic gases
• Laryngeal mask airway (LMA) – A soft, flexible device inserted into the throat that sits above the voice box, providing a clear airway without entering the trachea
• Endotracheal tube – A plastic tube inserted through your mouth and into your windpipe (trachea), providing the most secure airway protection, especially for abdominal or chest surgery

These airway devices are placed after you're fully unconscious, so you won't feel or remember this. The endotracheal tube is connected to a ventilator that breathes for you during surgery. This is why you may have a mild sore throat after surgery—from the tube's presence.

Maintaining Anesthesia During Surgery

Throughout your surgery, your anesthesiologist maintains your unconscious state using a combination of techniques. Balanced anesthesia—the modern approach—uses multiple drugs in lower doses rather than relying heavily on any single agent, reducing side effects while maintaining excellent anesthesia quality.

Maintenance typically involves:

• Inhaled anesthetic gases (sevoflurane, desflurane, or isoflurane) delivered continuously through the breathing circuit
• Intravenous medications including propofol, opioids, and muscle relaxants as needed
• Fluids to maintain hydration and blood pressure

Some procedures use Total Intravenous Anesthesia (TIVA), relying entirely on IV medications without inhaled agents. TIVA is particularly useful for certain procedures and in patients with specific conditions.

Your anesthesiologist continuously adjusts medication doses based on your vital signs and the surgery's progress. They might give more medication during particularly painful parts of the procedure, or less as surgery nears completion to allow you to wake up promptly.

Constant Monitoring and Vigilance

Throughout surgery, your anesthesiologist never leaves your side. They monitor:

For complex surgeries, additional monitoring might include arterial lines for continuous blood pressure measurement, central venous catheters, transesophageal echocardiography (heart ultrasound), and brain function monitors. The level of monitoring is tailored to your specific surgery and health status.

What Happens After Waking Up from Anesthesia?

After surgery, you'll wake up in the Post-Anesthesia Care Unit (PACU) or recovery room where nurses monitor your vital signs, manage pain and nausea, and ensure you recover safely. Most patients spend 1-2 hours in recovery before either going home (for outpatient surgery) or being transferred to a hospital room.

The end of anesthesia—called "emergence"—is a carefully managed process. As surgery concludes, your anesthesiologist gradually reduces anesthetic medications, allowing you to regain consciousness. The breathing tube is typically removed once you can breathe adequately on your own and your protective reflexes have returned.

Many patients have no clear memory of waking up from anesthesia. You might have fragmented memories of being in the recovery room, hearing voices, or feeling someone holding your hand. This memory gap is normal and expected—the anesthetic medications affect memory formation even as you're beginning to wake up.

The Recovery Room Experience

In the PACU, specialized nurses monitor you closely as anesthetic effects wear off. They check your vital signs frequently, assess your pain level, and watch for potential complications. You may feel:

• Groggy and confused – This is normal and resolves as medications wear off
• Cold or shivery – Operating rooms are cool, and anesthesia can affect temperature regulation
• Thirsty – From fasting and breathing dry medical gases
• Nauseous – A common side effect that can usually be treated effectively
• Sore throat – From the breathing tube, typically mild and temporary
• Some pain – Managed with medications; always tell your nurse if pain is significant

Recovery room nurses will offer you sips of water once you're alert enough to swallow safely. They'll help you become more oriented—reminding you where you are, that surgery went well, and what to expect next. If you have pain or nausea, they'll provide medications to help.

The length of your recovery room stay depends on several factors: the type and duration of surgery, how quickly you recover from anesthesia, whether you have any complications, and whether you're going home or being admitted to the hospital. Most patients stay in the PACU for one to two hours.

Going Home After Outpatient Surgery

For outpatient (same-day) surgery, you'll be discharged home once you meet certain criteria:

• Vital signs are stable
• You're awake, alert, and oriented
• Pain is controlled with oral medications
• You can keep down clear liquids without vomiting
• You can walk safely (if able before surgery)
• You have a responsible adult to take you home

Common Side Effects After Anesthesia

Most anesthesia side effects are temporary and mild:

• Nausea and vomiting: Occurs in about 30% of patients. Your anesthesiologist may give preventive medications if you're at high risk. Post-operative anti-nausea medications are very effective.
• Sore throat: Occurs in about 40% of patients who have a breathing tube. Usually resolves within 24-48 hours. Throat lozenges and warm drinks help.
• Muscle aches: Some patients experience muscle soreness, possibly from lying still on the operating table. Usually resolves within a few days.
• Confusion or memory problems: Temporary confusion is common immediately after waking. In elderly patients, cognitive changes can sometimes persist for days to weeks (postoperative cognitive dysfunction).
• Shivering: Very common after anesthesia. The recovery room has warm blankets and sometimes warming devices.

What Are the Risks of General Anesthesia?

Modern general anesthesia is very safe, with life-threatening complications occurring in approximately 1 in 10,000 to 1 in 200,000 procedures in healthy patients. Risks increase with age, obesity, and pre-existing medical conditions. The most common complications are temporary and minor, such as nausea and sore throat.

Understanding anesthesia risks helps you have an informed discussion with your medical team. While no medical procedure is without risk, the safety of modern anesthesia has improved dramatically over the past several decades due to better medications, advanced monitoring technology, and improved training standards.

The overall risk of dying from anesthesia in a healthy patient is extremely low—estimated at about 1 in 100,000 to 1 in 200,000 procedures. To put this in perspective, you face similar risks driving a car for several hundred miles. For patients with significant medical conditions or undergoing emergency surgery, risks are higher but still relatively low given the benefits of the procedure.

Factors That Increase Anesthesia Risk

Your anesthesiologist assesses your individual risk based on several factors:

• Age: Very young infants and elderly patients have somewhat higher risks
• Obesity: Affects airway management and medication dosing
• Heart disease: The heart must adapt to the stress of surgery and anesthesia
• Lung disease: Affects breathing and oxygenation
• Sleep apnea: Increases airway management challenges and post-operative respiratory risks
• Diabetes: Affects wound healing and infection risk
• Smoking: Increases respiratory complications
• Emergency surgery: Less time for optimization and preparation

Awareness During Anesthesia

One concern many patients have is "waking up" during surgery—called anesthesia awareness. This is rare, occurring in approximately 1-2 cases per 1,000 surgeries. When it does occur, it usually involves brief, vague awareness without pain. True awareness with pain and explicit recall is extremely rare.

Modern brain monitoring technology can help detect inadequate anesthesia depth. If you've experienced awareness during previous procedures, or are particularly anxious about this possibility, discuss it with your anesthesiologist who can take additional precautions.

How Is Anesthesia Different for Children?

Children receive anesthesia using the same principles as adults but with specialized techniques and dosing. Parents can usually stay with children until they fall asleep. Inhaled anesthesia through a flavored mask is often used to avoid needle anxiety. Children typically recover quickly but may be irritable or confused when waking up.

Pediatric anesthesia requires specialized training because children are not simply small adults—their physiology differs in important ways. Fortunately, serious anesthesia complications in children are very rare when care is provided by trained pediatric anesthesiologists.

Fasting Guidelines for Children

Children follow similar fasting guidelines but with some adjustments:

• Breast milk: 4 hours before anesthesia
• Infant formula: 6 hours before anesthesia
• Clear liquids: 2 hours before anesthesia (some institutions allow 1 hour)
• Solid food: 6 hours before anesthesia

Making Children Comfortable

Hospitals have developed many strategies to reduce children's anxiety:

• Parent presence: Many facilities allow parents to stay until the child falls asleep
• Child life specialists: Trained professionals help prepare children through play and age-appropriate explanations
• Distraction techniques: Videos, games, or virtual reality during induction
• Premedication: Calming medication (often midazolam) given before going to the operating room
• Flavored masks: Anesthesia masks can be scented with pleasant flavors like strawberry or bubblegum
• EMLA cream: Numbing cream applied to the skin before IV placement

Recovery in Children

Children often wake from anesthesia with what's called emergence delirium—a period of crying, confusion, and sometimes thrashing that can be distressing to watch but is not painful for the child and resolves within 15-30 minutes. Parents should be prepared for this possibility. Holding and comforting your child helps, even if they don't seem to recognize you initially.

How Can I Feel Safe Before Anesthesia?

Feeling anxious before anesthesia is normal. You can feel safer by asking questions, understanding your anesthesiologist's role, knowing that you're constantly monitored, and recognizing that modern anesthesia has an excellent safety record. Pre-operative sedation can help reduce anxiety for very nervous patients.

It's completely normal to feel nervous about going under anesthesia—you're entrusting your unconscious self to others. Understanding the process and knowing that an entire team is dedicated to your safety can help ease anxiety.

Your Anesthesiologist's Training and Role

Anesthesiologists complete extensive training: four years of medical school, followed by four years of specialized anesthesia residency, and often additional fellowship training in subspecialties. They are experts in:

• Airway management and breathing support
• Cardiovascular physiology and support
• Pain management
• Critical care medicine
• Pharmacology of hundreds of medications

Throughout your surgery, your anesthesiologist's sole focus is YOU—monitoring your vital signs, adjusting medications, managing any problems that arise, and ensuring your safety. They never leave the operating room while you're under anesthesia.

Questions to Ask Your Anesthesiologist

Don't hesitate to ask questions during your preoperative consultation:

• What type of anesthesia will I receive?
• How will you manage my pain during and after surgery?
• What are the specific risks for someone with my health conditions?
• What should I expect when I wake up?
• How will my nausea be prevented or treated?
• Will you be with me the entire time?

A good anesthesiologist welcomes questions and takes time to address your concerns. If something isn't clear, ask for clarification—your comfort and understanding matter.