Types of Anesthesia

I was recently asked by a patient, "How many types of anesthesia are there?" It's an interesting yet odd question because I wasn't sure how to answer it. One interpretation might be that anesthesia can be delivered as a general anesthetic, through a neuraxial technique (like an epidural or spinal), through a regional nerve block, through local anesthetic, or as IV sedation. But I'm not sure that's how I think about it. In my mind, anesthesia is a sophisticated art and science where the nuances, details, and decisions matter, and that is what distinguishes each individual anesthetic.

Although the vast majority of anesthetics are performed with a limited number of medications and agents, the tailoring of an anesthetic to a patient, surgeon, and procedure is rarely "cook-book." I was talking to an anesthesiologist at a different institution and we were surprised how differently we do our anesthetics. Most of it is institution-specific; the culture of a place affects the medical decision making. At this hospital in New York, for example, anesthesiologists use a lot more laryngeal mask airways and rarely use long-acting opiates like hydromorphone. When I moved from an academic hospital to private practice, I adjusted my anesthetic techniques to the medications that were available. It's a good reminder that there's no "one right way" to anesthetize a patient, and that a lot of different factors influence our decision making.