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Do they put you to sleep for cyst removal?

Having a cyst removed can be an anxiety-provoking experience for many patients. A common question is whether you are put to sleep, meaning under general anesthesia, for the procedure or not. The answer depends on several factors.

What is a cyst?

A cyst is a closed sac or pocket of tissue that is filled with fluid, air, or other material. Cysts can form anywhere on the body and vary greatly in size. Some common types of cysts include:

  • Epidermoid cysts – Firm bumps that form under the skin, often on the face, neck or trunk
  • Pilar cysts – Small, round bumps that grow on the scalp
  • Ganglion cysts – Lumps that develop near joints or tendons, often on the wrists or hands
  • Baker’s cysts – Swellings that form behind the knee, caused by joint swelling that protrudes into tissues

Most cysts are benign (non-cancerous) and cause no symptoms other than the visible bump under the skin. However, sometimes cysts can become inflamed, painful or infected. Large cysts may interfere with daily activities or rupture. For these reasons, doctors often recommend surgically removing problematic cysts.

Cyst removal procedures

There are several ways cysts can be surgically excised. The specific technique used depends on factors like the size and location of the cyst:

  • Fine needle aspiration – Using a needle and syringe to drain fluid from a simple cyst. Local anesthesia is used.
  • Incision and drainage – Making a small cut to open and drain an infected or inflamed cyst. Usually local anesthesia.
  • Excision – Cutting out and removing the entire cyst. Local or general anesthesia.
  • Marsupialization – Making a small slit to drain the cyst over time. The outer wall of the cyst remains. Local anesthesia.

The most invasive option is complete surgical excision. This requires cutting out the entire cyst through an incision. Stitches are then used to close the site.

Local vs general anesthesia

Whether you are put under general anesthesia for cyst removal depends on the location and complexity of the procedure:

  • Local anesthesia – Numbs only the area around the cyst, you remain awake. Used for small or superficial cysts.
  • General anesthesia – You are fully asleep and unconscious. Needed for larger, more complicated cysts, especially deep ones.

Here are some general guidelines doctors follow when deciding on using local vs general anesthesia for cyst removal:

Cyst Factors Type of Anesthesia
Small cyst Local anesthetic is often sufficient
Superficial cyst Local anesthetic frequently used
Large or deeply embedded cyst General anesthesia usually recommended
Complicated location like the face General anesthesia may be preferred
Significant anticipated blood loss General anesthesia often used
Multiple cysts being removed General anesthesia typically used

Some examples of common cyst removal procedures include:

  • Epidermoid scalp cysts – Often removed with local anesthesia since they are superficial.
  • Ganglion wrist cysts – Can usually be excised with local anesthesia.
  • Ovarian cysts – Require general anesthesia due to size and location in abdomen.
  • Pilonidal cysts near coccyx – Frequently done under general anesthesia.

Advantages of local anesthesia

There are several potential benefits to having cyst removal performed with local rather than general anesthesia when possible:

  • Faster recovery – Effects wear off quickly once procedure is over.
  • Lower costs – General anesthesia is more expensive.
  • Less risks – Avoid risks of general anesthesia like breathing issues.
  • Go home sooner – Discharge from facility is faster.
  • Less drug effects – Avoid prolonged grogginess from general anesthesia.

Reasons general anesthesia may be preferable

However, for some cyst removals general anesthesia is the better option for reasons such as:

  • Complex procedure – Deeper dissection or longer time requires unconsciousness.
  • Patient comfort – Being awake may cause significant pain or anxiety.
  • Ideal surgical conditions – Muscle relaxation helps access deep cysts.
  • Location – Face, hands, genitals are too sensitive for local anesthesia.

How the decision is made

The anesthesia provider, often an anesthesiologist, will meet with you prior to the cyst removal procedure. They will take your health history into account and perform an exam. Factors they consider include:

  • Your age, weight, BMI
  • Your medical conditions like heart disease, diabetes, sleep apnea
  • Medications you take including supplements
  • History of anesthesia problems
  • Drug allergies or sensitivities
  • Previous surgeries

The surgeon will also discuss details of the cyst removal with the anesthesiologist including:

  • Exact cyst size and location
  • Whether the cyst appears superficial or deep
  • If the cyst fluid can be aspirated ahead of time
  • If the cyst appears uncomplicated or more complex
  • Expected difficulty and duration of the procedure

Considering all these factors together with your preferences, a customized anesthesia plan can be made.

Key points

  • Small, superficial cysts can often be removed under local anesthesia.
  • Large, complicated or hard-to-reach cysts will require general anesthesia.
  • Your health history and the doctor’s exam determines the best anesthesia choice.
  • An anesthesiologist tailors the anesthesia plan to your specific situation.

What happens during general anesthesia for cyst removal

If the decision is made to use general anesthesia for your cyst removal, here is a overview of the process:

Before surgery

  • You meet with your surgical team and anesthesiologist to discuss the procedure.
  • Consent forms and paperwork are completed.
  • The surgical site is marked if applicable.
  • You are told when to stop eating and drinking prior to surgery.

Pre-operative area

  • You change into a hospital gown.
  • An IV line is started, usually in your arm.
  • You may be given medication to help you relax.
  • Monitors are placed to track your oxygen, breathing, and heart rate.

Operating room

  • You are moved to the operating table.
  • Devices to monitor your vitals are attached.
  • You are given oxygen through a face mask.
  • Anesthesia medications are injected through the IV.
  • Once asleep, a breathing tube may be inserted.

During the procedure

  • You are fully unconscious and unaware during the surgery.
  • Your anesthesia provider ensures proper sedation levels, pain control, breathing, and heart rate.
  • The cyst is surgically removed by the doctor.

End of surgery

  • The breathing tube is removed once surgery is complete.
  • You are moved to the post-anesthesia care unit while anesthesia effects wear off.
  • Most patients go home once fully awake and able to drink fluids.

With general anesthesia, you are monitored continuously throughout the procedure and kept completely comfortable. You wake up with the cyst successfully removed.

Recovering from general anesthesia

Most people recover quickly from general anesthesia. Here’s what to expect:

  • You wake up in the recovery room feeling groggy.
  • Nausea or vomiting may occur as anesthesia wears off.
  • You may feel disoriented and chilly.
  • Sore throat or hoarseness from the breathing tube.
  • Drinking and eating can help you feel better.
  • You can usually go home once awake and stable.
  • Rest at home the remainder of the day.
  • Refrain from driving, alcohol and big decisions for 24 hours.
  • Feel back to normal in a day or two.

Call your doctor if you have any concerns after the procedure such as bleeding, fever, worsening pain or swelling. Most people recover fully within a week.

Potential risks of general anesthesia

General anesthesia is very safe but does carry some risks, which may include:

  • Allergic reaction to anesthesia drugs
  • Nausea and vomiting
  • Breathing problems
  • Heart rhythm issues
  • Confusion or memory issues
  • Sore throat
  • Dental injuries

Some other very rare risks include brain damage, stroke or death. Your anesthesiologist takes precautions to minimize any hazards. The overall risk is still low compared to the risks of the surgery itself.

Who should not have general anesthesia?

Certain medical conditions may increase anesthesia risks. General anesthesia is avoided when possible in people with the following issues:

  • Unstable heart disease
  • Severe lung disease
  • Certain genetic muscle disorders
  • Malignant hyperthermia susceptibility
  • Allergy or sensitivity to anesthesia drugs

For some patients, an alternative to general anesthesia may be used such as:

  • Regional nerve block
  • Conscious sedation with local anesthesia
  • Spinal or epidural anesthesia

Your doctors will determine if alternatives are appropriate or if general anesthesia can be done safely under special precautions.

Questions to ask your anesthesia provider about general anesthesia

Here are some important questions to consider asking your anesthesiologist before having general anesthesia for cyst removal:

  • Do I have any conditions that may complicate anesthesia?
  • How will my airway be managed during surgery?
  • Will I need an IV or any pre-procedure medications?
  • What type of anesthesia drugs will be used?
  • How will my pain be managed during and after surgery?
  • How long will it take the anesthesia to wear off?
  • What side effects may I experience afterwards?
  • How long do I need to fast before the procedure?
  • What can I do to prepare for anesthesia and surgery?

Conclusion

Having a cyst surgically removed is often a straightforward outpatient procedure. However, whether general anesthesia is required depends on several factors related to the cyst itself and your medical history.

Smaller, superficial cysts can typically be removed using local anesthesia alone to numb the area. Larger, more complicated cysts in hard to access locations will often necessitate general anesthesia where you are fully asleep.

The anesthesia provider evaluates your health, age, medications and the details of the cyst removal to create a customized anesthesia plan. They determine if local, general or other forms of anesthesia are most appropriate.

General anesthesia provides reliable pain control, sedation and stillness that allows the surgeon to safely and completely excise a complex cyst. While risks of anesthesia exist, they are uncommon with today’s advanced safety practices. Talk to your anesthesia team if you have any concerns before your procedure.