The Risks and Alternatives to Anesthesia

Are you considering elective surgery? Or do you need an essential surgery, like a hip replacement? A heart bypass? An operation to remove a cancerous growth? Most people who undergo major surgery like these will do so under general anesthesia.According to the World Health Organization, 230 million people have major surgeries that need to be carried out under anesthesia worldwide. In the United States alone, an estimated six million children, which includes 1.5 million infants, have surgery that necessitates going under general anesthesia each year.

What is Anesthesia?

General anesthesia is a combination of different medicines that make you unconscious. These medications put you in a sleep-like state so that you will not feel pain. General anesthesia is given via an IV directly into the vein and/or as a gas via a mask. If you have to go under general anesthesia, you may also need a breathing tube.Though anesthesia usually causes amnesia and most people won’t remember the surgery, some unexpectedly become aware and have traumatic memories of what they underwent. According to the Mayo Clinic, one to two people in every one thousand may partially wake up and experience “unintended intraoperative awareness.” To make the surgery less traumatizing, some anesthesiologists also administer a separate amnesiac.After the surgery, the anesthesiologist reverses the medications to help you return to consciousness. Waking up from anesthesia often isn’t easy. Most people will feel confused and disoriented at first.

The Most Common Side Effects of Anesthesia Are:

• Nausea
• Vomiting
• Chills

Other Side Effects From Anesthesia Include:

• Constipation
• Diarrhea (particularly if you’ve had abdominal surgery)
• Drowsiness or sleepiness
• Dry mouth
• Emotionality
• Hoarse or sore throat
• Itching
• Shivering

And, of course, once the anesthesia wears off completely, you will start to feel the pain from the surgery itself, which can often be excruciating.

Risks of Anesthesia

While major surgery can be life-saving for children and adults, anesthesia is not without risks. Between 3 and 16 percent of the people who have operations will experience complications during or directly after surgery. While death rates vary depending on the investigation, one study from France, published in 2006, found that approximately 5 patients in every 100,000 will die due to complications from anesthesia.When researchers from Columbia University examined anesthesia deaths in the United States over a six-year period, they found that:

• 47% were linked to anesthesia overdose
• 42.5% were linked to adverse reactions to the anesthesia
• 4% were linked to anesthesia administered during pregnancy

Cognitive Decline

Dr. William Gaunt says the risk of dying or having lifelong complications after general anesthesia is small. But Dr. Gaunt is concerned about the possible short and long-term negative effects on cognition.

“People who get major anesthesia, like a bypass surgery often have problems in the brain,” says William Gaunt, N.D., a retired naturopath based in Ocala, Florida. “There are frequently mental problems later: their memory. It’s not uncommon for them to have post-surgical problems. Some doctors are proactive in telling their patients but other doctors don’t.”Gaunt points to a study, published in the journal Anesthesia in 2018, where 964 participants from the Wisconsin Registry for Alzheimer’s Prevention took two cognitive tests over a four year period. At the beginning of the experiment, 670 study participants had normal memory and cognition. But of those, the ones who underwent surgery were nearly twice as likely to show signs of cognitive decline than the people who did not have surgery.Nearly 20 percent of the people who had surgery tested for abnormal memory by the end of the study period. In contrast, in the group that did not have surgery, only 10 percent developed abnormal memory.In August of 2021, a team of scientists from the University of California, Los Angeles explored the problem of cognitive decline associated with anesthesia in an article in JAMA.“Advances in surgery and anesthesia can improve function and quality of life for older patients,” these researchers wrote, “but not without risk to brain health. Postoperative neurocognitive decline is a meaningful concern to patients and represents a significant and expanding challenge to healthcare in the US and worldwide,” they concluded.

Alternatives to Anesthesia

So, what if you absolutely need an operation? And you don’t want to be put under general anesthesia? The first step is making sure you have informed consent, which means you understand all of the options. Informed consent, a process of communication between you and your healthcare providers so that, before you agree to their treatment protocol, you have understood everything it entails.

Medical ethics dictate that your doctor — whether a plastic surgeon, cardiologist, pediatrician, or other specialist — talks to you about the risks and benefits of the recommended procedure.

You can prompt this conversation by bringing in a list of questions:

1. What are the benefits to this surgery?
2. What about the risks of this surgery?
3. Tell me about my other options instead of doing the surgery?
4. What will happen if I choose not to do anything at this time?

Skipping (or Postponing) the Surgery

Unless you are in a life-threatening situation, postponing surgery is an option. If you are considering back surgery to manage pain and mobility, for example, you could give yourself three months to try other, less traditional treatments. These alternative treatments might include hyperbaric oxygen, which has been shown to be successful in healing both severe brain trauma and chronic pain; acupuncture treatments, which can help with spinal cord and other injuries; and therapeutic massage. Physical therapy can also be tremendously helpful, as can chiropractic care with the right chiropractor or doctor of osteopathy.Consider this: If you postpone the surgery to try other modalities and they aren’t successful, you can always reschedule the surgery. If, however, you have the surgery and suffer complications from the anesthesia (or for any other reason), you can’t undo what you have already done.

Regional Instead of General Anesthesia

Talk to your care team about alternatives to anesthesia. For many surgeries, regional anesthesia — such as nerve blocks and epidurals — will work just as well or better than general anesthesia.Why? Because patients who undergo surgery with just regional anesthesia tend to have fewer side effects, a quicker recovery, and less postoperative pain. So, ask your doctor about using an epidural, nerve block, or spinal anesthesia instead.Local anesthesia may not be an option for open-heart and other chest surgeries. However, doctors can perform many other surgeries — including ACL reconstruction, face lifts, joint replacements, and prostate surgery — without general anesthesia. One study from scientists at UCLA even found that conscious sedation was a safe option for patients undergoing aortic valve replacement surgery. If your surgeon or hospital insists there are no other options, get a second opinion.

Acupuncture as an Alternative to Anesthesia

Some medical doctors in the United States, including Mimi Wong, M.D. medical director of anesthesiology at SCL Health, a health system with eight hospitals and more than a hundred clinics located in Colorado and Montana, regularly use acupuncture during surgery. Using acupuncture is especially beneficial for chemically sensitive patients who cannot tolerate anesthesia.Acupuncture during surgery usually does not replace anesthesia. But it does allow doctors to use less. Doctors who are using acupuncture claim that it can help reduce side effects and also speeds up recovery.“A lot of people are anxious as they are coming into the operating room,” Dr. Rebecca Knight, a board-certified general surgeon based in Colorado who specializes in minimally invasive surgery and hernia repair, explained to a journalist. “It helps them relax.”

Post-Surgery Recovery

Even if your surgery is “routine” and “minimally invasive,” and even if you do find an effective alternative to anesthesia, recovering from surgery is not easy. You must be kind to yourself and give your body time.Set up a meal train for at least two weeks post-surgery. If you’re a parent, find family members, close friends, and paid caregivers to watch your children. Your body and your mind have been through an ordeal. Give yourself the gift of patience and self-love as you take the time you need to heal.Jennifer Margulis, Ph.D., is an investigative health journalist and science writer based in Oregon. She is the author of Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family (Scribner, 2015). She’s also a guest on THE FULLEST Podcast and regular contributor to THE FULLEST. Learn more and sign up for her free newsletter at www.JenniferMargulis.net.