The risks of general anesthesia


General anesthesia is a process in medicine in which a patient is put into an artificial deep sleep by an anesthetist (anesthetist) and at the same time the sensation of pain and consciousness are suppressed using drugs.

However, the drugs that induce deep sleep also suppress the human breath drive, so that artificial ventilation is necessary for the duration of the anesthesia. This is made possible by so-called intubation, a short process in which a tube is inserted into the patient's windpipe and is connected to a ventilator.


General anesthesia is a relatively safe and very frequently used procedure in Germany. Objectively speaking, because of the continuous measurements of blood pressure, pulse and heart rate, general anesthesia is the time in a person's life when they are most closely monitored. However, every general anesthetic carries some not inconsiderable risks.

Overall, the risk of dying from anesthesia is now 1 in 1,000,000 (one in a million). This probability is therefore not significantly greater than that of death while awake.
The frequently circulating figure, according to which 43,000 people die under anesthesia in 10 million operations per year in Germany, should be treated with caution: These patients die during anesthesia, not necessarily because of it.
In the vast majority of cases, the cause of death is likely to be incidents during the operation or previous illnesses.

Read more on the topic: Fear of anesthesia / general anesthesia

Do I have to be sober before general anesthesia?

Before a planned (elective) procedure, special attention is paid to the Respect for patient sobriety, to the To minimize the risks of induction of anesthesia.

Especially that Vomit and subsequent penetration of Stomach contents into the airways (aspiration)when inserting the tube for ventilation, a life-threatening complication represent.
Especially since it becomes one through the anesthesia Attenuation of the reflexessuch as the cough, swallow or gag reflex.

One applies 6 hours after the last consumption of solid food, fruit juices, coffee with milk or porridge as an empty stomach.
To 2 hours Clear liquids such as water, coffee without milk or unsweetened tea can be consumed before the procedure.

Is general anesthesia possible despite a cough?

to cough can have many different causes, but occurs often in the context of infectious diseases on.
In a conversation with the doctor before the operation, in addition to medication, allergies and chronic previous illnesses, acute illnesses such as infections are also asked about. The upper respiratory tract, such as the throat and nasopharynx, is often affected by this, causing inflammation and swelling of the mucous membrane there.

Depending on the extent and root cause can thereby Increase risk of anesthesia.
At simple infections, such as. a flu-like infection without fever and without sputum no reason to postpone the procedure.

At Fever, sputum, purulent secretion or severe impairment of general well-being should the However, the procedure was postponed until 3 weeks after the symptoms had subsided become. Particularly when it comes to operations in the upper respiratory tract, it must be weighed whether this can take place.
There is one increased risk for one Glottic spasm (laryngospasm) and one Spasm of the bronchial muscles (bronchospasm), Which Emergency situations represent.

For these reasons, it is important to tell the doctor about any infections or other illnesses before the procedure.

You can find more information on the subject here: General anesthesia for a cold

Occasional side effects

One of the occasional adverse effects of anesthesia with a Frequency from 1:10 to 1: 100 counting Bruising or minor bleeding, after puncturing one Veinnecessary to administer the anesthetic. It often happens too Trembling and freezing such as Nausea and Vomiting after anesthesia. In the Wake up phase after the end of anesthesia cry and scream children quite often. Elderly people and patients who participate in a dementia suffer, it often becomes severe for several hours Confusion and aggressive behavior. You can also have sore throat and throat as well Pain when swallowing occur.

Rare complications

Further Risks of general anesthesiathat statistically at every hundredth to thousandth anesthesia occur are Respiratory and circulatory problems, possibly also Infections in the area of ​​the puncture site (possibly up to Abscesses or Necrosis).

Furthermore are hoarseness (mostly temporarily), a headache and itching known as risks.
Also to Cardiac arrhythmias (which, however, usually pass) or milder allergic reactions can occur, as well as to so-called bronchospasm, a spasmodic obstruction of the airways. Occasionally during the intubation process (see above) the teeth of the patient injured.

Is the patient during anesthesia stored unevenly, it can too Strains and storage damage come, as a result of which temporary Sensory disturbances and paralysis may occur.

Very rare risks

in the Under general anesthesia the following risks occur with a Incidence from 1: 1000 to 1: 10,000 - so very rarely - on: Awareness (This means the unwanted wakefulness during anesthesia).

Many patients have before Awareness during the procedure with simultaneous inability to communicate the greatest fear. However, the anesthetists can estimate the depth of anesthesia very well and vary it, so this concern largely unjustified is.
The risk of awareness is around ten times higher in children than in adults. For both age groups, however, it was ten times what it is today in the 1970s.

May be Saliva or stomach acid flow into the lungs (so-called aspiration) what a lung infection or one Lung abscess may result.
For this very reason, anesthetists prefer to have the patient before the anesthesia is initiated sober in the sense of an empty stomach is, i.e. did not eat or drink anything about 6 hours before the procedure. This minimizes the risk of decreasing stomach contents.
Furthermore, there are also states prolonged confusion of the patient after the anesthesia has been terminated with such a frequency.

General anesthesia is brought about in connection with an operation and the person affected during this procedure Foreign blood transfusedso it can too more severe infections come when the blood for example with Hepatitis viruses was contaminated.

In difficult cases it can be during the Intubation happen that of Larynx, the vocal cords, the throat or the windpipe get hurt what Hoarseness or shortness of breath entails. If necessary, can permanent voice damage up to loss of voice be the consequence.

Occur in very serious cases persistent shortness of breath or severe allergic reactions on. Accidentally uses an anesthetic to induce general anesthesia artery instead of one vein dotted, it can be life-threatening Overreactions of the cardiovascular system come.

Very rare risks of general anesthesia are those associated with less than in every ten thousandth anesthesia occur. This is one of the Cardiovascular arrest, the instant one Resuscitation measures requires, as well as the Apnea, to which the same applies.
It can also be used for Formation of so-called thrombi (Blood clots) that can block a blood vessel - in this case one speaks of a so-called. embolism. This can lead to severe organ damage.

Also the risk of a sepsis (Blood poisoning) exists at this frequency, as does infection with life-threatening viruses such as the HI virus, that is the immune deficiency disease AIDS triggers, or other viruses, provided to the patient during general anesthesia Foreign blood transfused becomes.

The most severe allergic reactions are described with the same frequency, as well as Organ damage or a heart attack.
If there are errors in the course of a venipuncture, for example a Irreversibly damaged nerve then can be paralysis or permanent Sensory disturbances stay behind. If an artery is accidentally punctured instead of a vein (see above), this can happen significant bleeding as a result.

In particularly unfavorable cases, the drugs that are supposed to induce anesthesia and insensitivity to pain can life-threatening metabolic disorders as a consequence, which is not uncommon in a so-called malignant hyperthermia ends. This is understood to mean one of these Increase in body temperaturethat especially the brain and the Kidneys in the worst case, can show irreversible damage.
Read more about the topic here: Malignant hyperthermia


Risks to the elderly

General anesthesia is always a serious interference with the natural processes in the body. Healthy young people usually survive this procedure very well, while older people suffer more from adjustment difficulties. The individual risk depends less on actual age than on previous illnesses, which are much more common in old age.

Many elderly people take medication daily for cardiovascular disease, lung damage and many other diseases that increase the risk of anesthesia. An example of such drugs are blood thinners, which often have to be discontinued before operations.

This can lead to thrombi during the operation and thus to heart attacks or strokes. Liver or kidney damage can also lead to complications during anesthesia, as the anesthetic drugs are broken down differently and the kidneys also have an influence on blood pressure.

Furthermore, many elderly people are diabetics, so that blood sugar must be checked closely. Overall, the anesthesia must therefore be planned much more precisely than in a healthy person. Some elderly people also develop continuity syndrome after general anesthesia, a severe confusion that can last for a few days. In most cases, closer monitoring is required postoperatively and the daily medication must be reset.

Here you can find out more about: Anesthesia in older people

Risk to children

Basically, the risk of general anesthesia does not only depend on age, but also on general condition and previous illnesses. In children, an area of ​​risk is planning anesthesia, as children are not just little adults. Your liver and kidney performance can be very individual, which leads to a more complex dosage of anesthetic drugs.

Furthermore, the ventilation situation in small children can be difficult. It is helpful here if an operation is accompanied by an experienced pediatrician who can support the anesthetist. Children can compensate for blood loss very well and long before they suddenly develop circulatory problems. This makes it difficult for the anesthetist to see if the circulation is getting into trouble and to take countermeasures in a timely manner. Some studies say that general anesthesia can damage children's memories, but the ability to repair is also very pronounced in young children.

Read more about the following topics here: general anesthesia in children and anesthesia in children

Risk of general anesthesia for caesarean section

With a caesarean section, as with other operations, there are the normal risks of general anesthesia. However, especially with an emergency caesarean section in a foreign hospital, there are the additional risks of an emergency operation. These are that the patient may not have fasted and that the anesthetist does not have time for individual anesthesia planning. It is therefore important that expectant mothers always have their maternity record ready, as this contains all the important health information about mother and child. This can reduce the risk of anesthesia.

Risks of general anesthesia for wisdom tooth surgery

Wisdom tooth operations under general anesthesia are the same as with any other general anesthetic. However, since those affected are mostly healthy, young people, the risks are low. There is a greater risk of rebleeding specifically for dental operations under general anesthesia, as vasoconstricting anesthetics cannot be used with general anesthesia. In addition, those affected more often suffer from wound pain and swelling of the cheeks than those who receive local anesthesia.

Risks of general anesthesia for heart failure

The risk of general anesthesia increases considerably if the person concerned has previous cardiovascular diseases. The anesthetics themselves can lead to complications during anesthesia, both through their direct effect on the heart and through interactions with daily medication.

Furthermore, volume administration through infusions is stressful for those affected with a weak heart. The anesthesia can also activate the unconscious nervous system and thereby trigger cardiac arrhythmias and cardiac arrest. Due to these increased risks, careful planning of the anesthesia and close monitoring during the operation is necessary.

Risk of general anesthesia in dementia

The risks of general anesthesia in people with dementia arise primarily in the planning of the anesthesia. The collection of important information, such as medication and previous illnesses, is only possible through third parties.

The necessity of staying sober is also difficult to explain to those affected, which is why risk anesthesia can quickly occur. In addition to these increased risks from dementia itself, those affected often have various other diseases of various body systems due to age, which they often do not know themselves. A flare-up of dementia is also reported more frequently after general anesthesia. However, this can also be a relapse syndrome after a few days, which occurs more frequently in dementia patients. The dementia can worsen acutely after the operation, which is due to the anesthesia.

Risk of death

The risk of dying from general anesthesia is now very low thanks to modern monitoring technology. Depending on the statistics, the numbers are between 0.008% and 0.009% and thus not significantly higher than with other methods. The very old people with previous illnesses and infants and young children have a slightly higher risk. In order to minimize the risk, a detailed preliminary talk about planning the anesthesia is necessary, in which the person concerned should answer all questions honestly.


To all of these To minimize or eliminate risks will, with the exception of emergencies, a consultation carried out between anesthetist and patient, in which this the Medical history examined (especially with regard to drug intolerance) and also the physical condition recorded by the patient in order to be able to assess whether general anesthesia is too great a physical strain. For this purpose, the anesthetist can also use more precise examination methods such as one Pulmonary function test or one Ultrasound of the heart use to get an impression.

To ensure overall that the patient after the end of general anesthesia adequately cared for and monitored is a basic rule that the one after the end of the not alone for the first 24 hours should be. Because of the drowsiness and confusion after the anesthesia has been withdrawn, which can last for several hours in some, one should under general anesthesia after outpatient procedures Never drive a car or operate a machine yourself. As a rule, a person who has just been operated on is therefore at least an hour and possibly longer after the end of anesthesia monitored in a recovery roomuntil his motor and mental functions are largely intact again.

If there are too many risks overall, partial anesthesia, known as Local anesthesia (local anesthesia). Two other methods are also common, the Spinal- and the Epidural anesthesia.