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General Anesthesia for Carpal Tunnel Surgery

anesthesia for carpal tunnel surgery

Stages of general anesthesia for carpal tunnel surgery

For any major surgery, anesthesia is essential. When it comes to anesthesia for carpal tunnel surgery, you can have general or local anesthesia. Doctors most often perform open carpal tunnel surgery. That’s when they prefer using general anesthesia. But some doctors perform endoscopic carpal tunnel surgery. For that, doctors might choose to use local anesthesia. This discussion will focus on the most often used type: general anesthesia.

There are four “stages” of general anesthesia for surgery. Categorizing anesthesia in these stages is useful to doctors. It helps them better predict the course of surgery events. They stages cover the range from “induction” (going to sleep) to “emergence” (waking up).

  • Stage I: This starts with the induction of anesthesia. It ends with loss of consciousness. The patient can still feel pain in this stage. However, the actual carpal tunnel release surgery does not begin yet.
  • Stage II: It is also the “REM” stage. It includes the occasional dangerous response to stimuli during carpal tunnel surgery. Usually, these are vomiting or uncontrollable movements. Doctors can shorten this stage by giving the patient a barbiturate (like sodium pentothal) prior to giving the anesthetic agent.
  • Stage III: The surgical anesthesia stage is most important. It starts when the patient’s pupils constrict, with central gaze. Doctors desire this depth of surgical anesthesia. This is when muscles relax and breathing gets regular. Eye movements also stop. The actual carpal tunnel release surgery takes place at this time.
  • Stage IV: This stage of anesthesia for carpal tunnel surgery is abnormal and dangerous. It’s a super-deep stage which means an overdose occurred. Usually, the patient has a marked drop in blood pressure. Circulatory failure may occur. In fact, death can result if the patient is not revived quickly.

Types of anesthesia for carpal tunnel surgery

Doctors can use 2 major types of agents during general anesthesia for carpal tunnel surgery. They are inhalation and intravenous (IV) anesthetics. Inhalation anesthetics also go by the name “volatile” anesthetics. They are medicines which enter the body via the lungs. From there, the drug spreads through the blood and to all body tissues.

Doctors do not often use inhalation anesthetics alone. Instead, they often use them along with IV anesthetics. Doctors call a combination of inhalation and IV “balanced anesthesia”. Sometimes the IV medicine is mixed with opioids for pain relief. The IV may also include neuromuscular blockers to temporarily paralyze muscle.

Common inhalation anesthetics include:

  • Halothane: Most carpal tunnel surgeries uses this drug. It causes unconsciousness but only little pain relief. Doctors commonly administer it along with analgesic (pain relief) medicines. It may be toxic to the liver. Thus, doctors must monitor liver function. It has a pleasant smell and is often administered to children.
  • Enflurane: This is another good carpal tunnel surgery anesthetic. But is not as potent as halothane. But it produces a quick onset of anesthesia and usually a quicker recovery. It is not for patients with kidney problems.
  • Isoflurane: Unlike many other agents, isoflurane does not harm the liver. However, it may induce irregular heartbeats.
  • Nitrous oxide: Doctors use this gas with other drugs like thiopental to induce anesthesia. Nitrous oxide also has the quickest induction and recovery time. In addition, it is the safest inhalation anesthetic. That’s because it doesn’t slow respiration or circulation to the brain. However, it’s a relatively weak anesthetic. Thus, it is not common as a general anesthesia for carpal tunnel surgery or most other operations.
  • Sevoflurane: This drug works fast. It doesn’t irritate the airways. However, one of its metabolic products can cause kidney damage.
  • Desflurane: This is a version of isoflurane. But it may irritate the airways. However, it provides a quick recovery with few adverse effects. Unfortunately, it can cause increased heart rate. Therefore, doctors won’t use it in patients with heart conditions.

Common intravenous (IV) anesthetics include:

  • Ketamine: This drug produces different kinds of reactions compared to other IV anesthetics. It is similar to phencyclidine, a street drug that can cause hallucinations. Ketamine often causes sensory illusions and vivid dreams during post-operative recovery. Thus, doctors do not often administer it to adults or as anesthesia for carpal tunnel surgery. However, doctors commonly use this drug for anesthetizing children. It is also commonly employed in trauma patients. It’s especially preferred for patients in shock where anesthesia equipment is not available.
  • Propofol: This is common for adult use. Doctors administer it in patients in intensive care to produce unconsciousness. It helps the patient endure being in intensive care. It also helps them cooperate when using a breathing assist machine. Usually, propofol is not for children.
  • Etomidate: Doctors commonly use this short acting IV anesthetic. It provides general anesthesia during shorter procedures.
  • Thiopental: Some medicines can produce seizures. Doctors use thiopental to control them. Also, it can lower pressure on the brain. In addition, thiopental helps treat certain mental disorders.
  • Methohexital: This barbiturate derivative is short-acting. Also, it has a rapid onset of action. Its effects are similar to thiopental.


The types of agents used as general anesthesia for carpal tunnel surgery vary by doctor. Each agent has it’s advantages and disadvantages. Usually, doctors give a combination of inhalation and intravenous agents (“balanced anesthesia”). Ask your doctor which agents he or she prefers to administer during your operation, and why.

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