Effects of Local Stand-by
This procedure provides a light sleep, anxiety relief, and amnesia (loss of any memories of surgery). Twilight sleep alone is not used to provide relief from surgical pain, it is always given in conjunction with a local or regional anesthetic. It also offers a limited recovery period, and it is usually associated with less nausea and vomiting compared to general anesthesia.
Candidates for Local Stand-by
Local stand-by procedures are used for simple or minor procedures or for those patients who prefer to be completely awake. Whether or not you have twilight anesthesia will depend on the type and length of the surgery.
The usual instruction is not to eat or drink anything after midnight before surgery. Most patients should continue to take regularly scheduled medications up to and including the morning of surgery. Prior to surgery, discuss all medications you take with your doctor.
The Local Stand-by Procedure
Some of the same drugs that are used for general anesthesia are also used for in this procedure, except in smaller doses. These drugs can either be administered through gases or intravenously. Breathing tubes are not usually used for this type of anesthesia.
During the procedure, the anesthesia specialist delivers different amounts of sedation and anesthetic medication through an intravenous (IV) line, while monitoring the patient’s comfort level and increasing and decreasing the medication as needed. Throughout the entire procedure, your vital signs and other bodily reactions will be monitored with a blood pressure cuff, heart rate monitor, pulse oximeter and an EKG machine. This is normally combined with an injection of local anesthetic at the surgical site for more pain control and also to lessen bleeding.
It is recommended that you have someone stay with you at least for the first 24 hours after your surgery. If your procedure requires anesthesia combined with any form of sedation, you will need someone to drive you home after surgery.
What is twilight anesthesia?
Twilight anesthesia involves the use of IV sedation. With twilight anesthesia, the patient is kept sedated throughout the procedure. After the procedure, the patient is easily awakened for a speedy discharge to recover at home.
Will I sleep talk while under twilight anesthesia?
There is a misconception that sedation acts like a “truth serum” and that it makes the patients divulge secrets and embarrassing personal details. The truth is, the sedated patients sometimes become a bit disinhibited and this could be an embarrassing experience. However, the amnesia effect means that you are unlikely to remember what you said.
Who administers anesthesia?
There are several specialists who can administer anesthesia. Usually, the doctor performing the surgery can administer local anesthetics. Monitored Anesthesia Care may be administered by a registered nurse, an anesthesiologist or a nurse anesthetist. General anesthesia though, requires an anesthesiologist or a nurse anesthetist.
Will certain drugs interact with the anesthesia?
Yes, many prescription medications, over the counter medications and herbal remedies interact with anesthesia and can even cause adverse affects during and after surgery. It is very important to discuss all medications and herbal remedies you are taking with your doctor before the surgery. Depending on your condition, the medicine may be discontinued prior to surgery, or the dosage of anesthesia may be adjusted to accommodate for the anticipated variations of medicine levels in your bloodstream at the time of your surgery. Do not stop taking a prescribed medication without discussing it with your doctor first.