Are there different types of anesthesia that can be used when having an endoscopy done? 

ﾠTheﾠchoices for anesthesia when having an endoscopy range from none, all the way to general anesthesia. It is well to keep in mind that ﾓendoscopyﾔ includes both fairly minor, short procedures, such as sigmoidoscopy (examination of the rectum and lowest part of the colon) and also much longer, more uncomfortable procedures such as ﾓERCPﾔ (endoscopic retrograde cholangiopancreatography). Among the most common procedures are gastroscopy (examination of the stomach and duodenum) and colonoscopy (looking at the entire length of the rectum and colon). Given the variety of endoscopies, as well as the variety of patients, the type of anesthesia will also vary. So, the type of anesthesia administered depends on the intensity and duration of the endoscopic procedure, the age of the patient (children usually need much more anesthesia than adults), the setting in which the procedure is done (e.g. doctorﾒs office vs. hospital clinic), the tolerance for discomfort of the individual patient, the skill of the practitioner giving the anesthesia, and, not least, the speed and skill of the endoscopist. In addition some patients have medical conditions that make specialized anesthesia care, including general anesthesia with a breathing tube, necessary. In most cases, general anesthesia is unnecessary, and various endoscopies are done with a combination of local anesthesia (sprayed in the throat, in the case of a gastroscopy, for example), with intravenous sedation. A variety of different drugs are used for this purpose. This sedation should be accompanied by standard monitors of breathing, blood pressure, oxygen levels, and so on. If you are concerned about the discomfort of an endoscopy rest assured that with appropriate anesthesia care you should be able to have a safe and relatively pleasant experience. 

How do you know how much medicine to put into a shot to give to a patient? 

ﾠThat is a very big question! Drug dosing depends on the effects of the drug on the body (the science of pharmacodynamics), and the effects of the body on the drug (pharmacokinetics). It`s what medical professionals go to school for a long time to learn. As far as anesthetic medications are concerned, keep in mind that these drugs are all "poisons" which can suppress vital functions of the body such as breathing and heart function. Don`t try this at home!! 

I had surgery about 2 1/2 years ago and had an IV in topside of my right hand. My surgery was early morning and I woke up during the night after the surgery with my hand and arm hurting - I called the nurse and my hand and arm up to my elbow looked like they were going to explode they were so swolen. They immediately removed the IV. Afterward the veins in my hand were so large and hard for weeks then where the IV had been the veins began to shink to almost nothing. When looking at my arm (palm up) the veins look lumpy particularly if I place my hand lightly on my arm. I mentioned to my regulard doctor and he said it was scaring of the veins and nothing to worry about. Ever since the surgery, my hand gets so cold and my hand and forearm hurt almost as if the circulation is poor and it is more uncomfortable in the cold weather months - sometimes at work I turn on a portable heater and place my hand close to it (I work inside in computer department). Any thoughts on this, I have concerns if there could be serious damage to the veins in my hand and arm. 

It sounds as though your IV "infiltrated" or became "interstitial". In other words, the intravenous catheter became misplaced, and the intravenous fluids entered the tissues of your hand arm. This is a recognised complication of intravenous infusions. Most times there is no permanent injury. The fluid gets absorbed into your system, and the swelling goes down. The lumpiness of the veins suggests you had in addition some degree of phlebitis or thrombophlebitis. Please see the article referenced below for more information. Your current, persistent, problems are a bit more worrying. You may have developed what used to be called reflex sympathetic dystrophy, now named Complex Regional Pain Syndrome, a strange set of symptoms that can occur after various kinds of injuries to an extremity. It is characterized by pain, swelling, color change and occasionally sweating, tremor or decreased strength and range of motion of the extremity. Often, the psyche of the patient is affected. The RSD Association website and related sites may offer useful information. However, you should see an experienced Pain Medicine specialist and possibly other specialists for accurate diagnosis and treatment of the condition. Should the diagnosis of RSD (CRPS) be confirmed, occupational therapy and rehab of the upper extremity will be the mainstay of therapy with occasional interventions by the pain doctor as needed. 

I had a hip replacement one month ago. I seem to have lost my sense of taste since this surgery. It is slowly coming back but not yet back to my baseline. Is this possibly due to the anesthesia? If so, can you explain the pathophysiology. Thanks in advance. 

Although this is not the first time I've been asked this question I'm still not aware of any links between anesthesia and the loss of the sense of taste after surgery. I suspect this is a random coincidence and I cannot explain, even in theory, how it might occur. Hip replacement surgery is usually done with regional (epidural or spinal) anesthesia, not general anesthesia, which would make it even harder to explain any connection. 

Many surgical procedures which formerly required hospitalization for a week or more are now being done as same day surgery. Obviously, some of this can be explained by new surgical techniques (laparoscopy and arthroscopy, for example) which result in smaller wounds, but even open surgery is being done on a one-day basis. The human body, per se, has not changed, so what has changed enough to account for such rapid discharge? I suspect that anesthesia and anesthesiology are largely responsible for the rapid growth of one-day surgery. Is that a valid assumption? If so, what is it about your field that lets patients be ready for discharge so soon? I recall having a relatively minor operation years ago under general anesthesia. I was in no condition to go home for 5 days, but now people go home after the same procedure in five hours! Can you enlighten us on this wonderful turn of events in surgery, in general, and anesthesiology in particular? 

Thanks for your interesting question. There are at least four reasons why hospital stays have shortened and so much surgery (60-65% or more) is today done on an outpatient basis. The last several years have seen tremendous pressures on healthcare providers to reduce costs. When hospitals began to be given a fixed amount of payment for most surgical procedures they looked at unnecessarily lengthy hospitalizations as one of the first targets for improving the bottom line. The second reason, as you point out, is the arrival of new surgical techniques such as minimally invasive (or so-called `keyhole`) surgery. The removal of the gall bladder used to require a 4 - 7 day admission to hospital, usually beginning the night before the procedure. We now routinely send our patients home after laparoscopic surgery just a few hours afterwards. There has also been a recognition that prolonged bed rest and immobilization after surgery is unnecessary and in fact slows the healing process and increases certain complications. So patients are encouraged to be up and about as soon as possible. Better techniques of post-surgery pain relief help in this area. And when patients do get home, they are offered various types of support, such as home nursing, to replace the care that would have been given in hospital. Finally, anesthesiologists can take credit for having introduced newer drugs and techniques, which hasten recovery. Modern day anesthetic agents shorten recovery times and are associated with fewer side effects, such as nausea, which would prevent a patient from going home. The safety of anesthesia has also improved greatly and we are more confident of sending even very elderly or medically complex patients home after a short recovery period without risking complications.