What factors determine what type of anesthesia is used?

What factors determine what type of anesthesia is used?

Samuel Seelig (Anesthesiologist, Los Angeles, California) gives expert video advice on: What are the risks of general anesthesia?; Is it true that some people remain aware during surgery, despite anesthesia?; What is the safest method of anesthesia? and more...

Some operative procedures by definition must be done under general anesthesia. For example, open craniotomies, coronary artery bypass graphs with an open chest, or an emergency caesarean section, can only be done under general anesthesia for the safety of the patient. Regional anesthesia is difficult to perform on morbidly obese patients, so they would probably have a general anesthetic for most of their procedures. The choice of anesthesia is dictated by the patient's medical history and the medication that the patient takes. For example, if the patient is on anticoagulants or has a bleeding disorder, you would not do a regional anesthetic because you do not want to put a needle in the spinal canal and chance bleeding in that area. The choice of anesthetic is a coordination between the surgeon, the anaesthesiologist and the patient, all within the common sense ground rules of why it's appropriate for the procedure.