I am a board-certified anesthesiologist in Lake Tahoe, California. I write from the perspective of both a doctor and a patient.
From the bygone days of chloroform and ether, the use of anesthesia gas has come a long way. Our current inhaled anesthetic agents are much more safe, more pleasant, and predictable.
Most general anesthetics in adults are induced through the use of intravenous medications. After unconsciousness is achieved, a breathing tube or mask is placed and anesthesia gas is administered through it to maintain the unconscious state during the entire surgery.
In children, anesthesia gas, given in a mask over the nose and mouth, may be used to initiate general anesthesia to avoid the trauma of placing an IV (intravenous) line while still awake. The anesthesia gas is then continued, at lower doses, to maintain general anesthesia.
What Are Anesthesia Gases
The inhaled anesthetics, referred to as "volatile anesthetics," are supplied in liquid form. They are added to vaporizer canisters, which convert them to gas. The concentration of the gas to be delivered is set on a dial at the top of the canister.
The concentration of the anesthesia gas is adjusted by the anesthesiologist throughout your surgery based on your needs. Your need is determined by a bunch of factors including your vital signs, your age, weight, medication history, and the surgical procedure itself.
At the end of the surgery, the anesthesia gas is turned off, and you wake up once your body has metabolized and/or eliminated the gases (and other drugs you have been given),
The most common volatile anesthetics in use in the United States are desflurane, sevoflurane, and isoflurane.
How Do Inhaled Anesthetics Work?
The gas anesthetics are inhaled, either spontaneously (on your own), or with the assistance of a ventilator (breathing machine). Once in the lungs, the gases are passed from the air sacs into the bloodstream as blood flows through the air sacs. The blood circulates and delivers the anesthetics to the brain and the rest of the body.
The brain is the important active site of action - where the anesthetic effect is exerted. The spinal cord receptors are probably also affected and contribute to the anesthetic activity.
How Does Anesthesia Work in the Brain?
Once in the brain, we don't really know how anesthetics reliably induce unconsciousness, lack of sensation, inability to see, hear, feel, or anything else. There are theories and some clues, but we don't really understand the full mechanism of action.
What we do know is that the inhaled anesthetics have some chemical characteristics in common and their potency and other traits can be predicted, very generally, from these properties. So, it's possible that the anesthesia gases have similar or overlapping mechanisms of action.
In other ways, the structures and characteristics of the gases are quite different, so other researchers are examining the possibility that more than one mechanism is at play. It is also possible that each anesthesia gas affects more than one pathway in the brain, making the discovery of those mechanisms more difficult.
So, what we don't know is exactly what the anesthesia gas molecules do once they reach the brain. We don't know how the gases interact with brain cells, which receptor they are targeting, or in what manner. It is now known that anesthesia gases interact with other types of body cells as well, such as the spinal cord and muscle.
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Some common theories (very simplified) include the Meyer Overton Hypothesis. This theory states that anesthesia gases interact with the lipid membrane of cells in the nervous system. The more lipid soluble the gas, the more likely it is to interact with the lipid layer of the cell wall. Thus more lipid solubility predicts more potency of the gas.
Other theories that may include or be distinct from the lipid solubility correlation suggest specific receptors for anesthesia gases, protein binding, action at specific ion channels, action at certain types of neurotransmitter receptors, and so on...
Research continues so that specific anesthetics can be developed that may be even more specific, safer, and with fewer side effects.
Below are schematic examples of a couple of hypotheses of anesthetic action.
How Do Anesthesiologists Decide How Much Gas to Give?
In practice, we don't talk about anesthetic potency by discussing lipid solubility. Instead, we use a term called MAC. MAC stands for minimum alveolar concentration. The MAC value is determined for each anesthetic gas. It is defined as the minimum concentration of gas in the lungs that will prevent movement, in 50% of patients, to a surgical stimulus.
At the top of each vaporizer canister is a dial. This dial has numbers on it that include values that are within the range of anesthetic concentration that might be given. The MAC value provides a reference value or starting point for the administration of gas. The anesthesia is adjusted up or down by turning the dial. As already mentioned, the anesthetic need and administration are determined by many, many factors. Knowing how much anesthesia gas to give and at what points during the surgery is part of the science - and art - of anesthesia.
Why Don't We Wake up During Anesthesia Sleep?
While we may refer to anesthesia as "sleep," general anesthesia is actually unconsciousness, more like a coma. By the definition of general anesthesia, you will not feel, or respond to surgical stimulus or pain. Waking up from general anesthesia requires a sufficiently low level of anesthesia gas and other medications.
Despite the fact that we don't know exactly how these gases work, they have been proven over time, and millions of uses, to be reliable, effective, and generally safe. Of course, there are side effects and risks, as with any medical intervention, but in all my years of giving anesthesia, I've never had anyone decide to have their surgery without anesthesia.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Linda Robinson from Cicero, New York on October 28, 2015:
Absolutely fantastic wonderfully written and so much essential information for anyone that has ever faced the unknown of surgery and some things prior to anesthesia and what you can except to help put your fears to rest. So very nice meeting you doctor. Linda
Marcy Goodfleisch from Planet Earth on July 29, 2012:
Thanks for adding this information! I'd never before heard it compared to the coma state, and that makes sense. Maybe you could do an entire hub on why we don't feel pain (even if it's not entirely known)? You have a wealth of information - and you are so generous in sharing!
TahoeDoc (author) from Lake Tahoe, California on July 28, 2012:
editing to say "general anesthesia is more like a controlled, reversible coma than sleep." Don't want to scare anyone- patients reliably wake up from this state of unconsciousness unless something is seriously wrong (VERY rare).
TahoeDoc (author) from Lake Tahoe, California on July 28, 2012:
Marcy- thanks for commenting and you have done me a huge service. In my draft of this (in my head, where I keep my drafts :) ), I was intent on including a comment or two about anesthesia "sleep". General anesthesia is more like a coma than sleep. Pain is blocked by the anesthesia. And, as per this hub, we don't know exactly how- if it's just a function of the unconscious state, or if pain receptors are specifically blocked or if some other mechanism is involved… I will put that info in the body of the hub. Thank you for the reminder with your insightful (as always) comment!
Marcy Goodfleisch from Planet Earth on July 28, 2012:
It amazes me that we (humans) have learned how to put people to sleep in order to perform surgery or procedures. What a miracle.
One thing I don't understand, and I may have missed it here or in another of your excellent hubs, is how anesthesia keeps you from feeling pain? I know there are some topical things used, but normally, wouldn't we wake up from the pain if something serious happened to us?
Outstanding hub - many votes up!!!