Viewpoints What Is General Anesthesia?

On the surface, this would appear to be a simple, straightforward question, but the evolution of anesthetic agents and newer brain activity monitors have made this question somewhat more challenging. Local anesthesia provides analgesia only in a localized area. General anesthesia, in contradistinction, provides generalized analgesia in addition to generalized hypnosis. A simplified, working equation for general anesthesia may be hypnosis plus analgesia. Implicit in hypnosis is amnesia. Implicit in (adequate) analgesia is enough relaxation to perform cosmetic procedures. In this author's experience with hundreds of subpectoral breast augmentations and rectus imbrication for abdominoplasties, adequate analgesia has obviated the need for muscle relaxants.1 The patient safety benefits of propofol-ketamine anesthesia demand not perfection with local anesthesia but merely persistence.2 Conscious patients tend to say “ouch ” with inadequate local anesthesia. Currently, no monitors exist with which to measure analgesia levels in patients receiving general anesthesia who are unconscious. In 1996, the U.S. Food and Drug Administration approved the bispectral index brain monitor for measuring levels of hypnosis in patients receiving anesthetic agents. Over the years, bispectral index monitoring has been validated by over 3000 peer-reviewed, scientific articles.3 Other brain activit