Do injections require general anesthesia?

Injections That Require General Anesthesia

Most injections do not require general anesthesia, but certain procedures involving injections may require general anesthesia depending on the patient population, procedure complexity, and anatomical location.

Types of Injections That May Require General Anesthesia

• Intralesional injections for leishmaniasis may require general anesthesia in young children who cannot tolerate the painful procedure with local anesthesia alone 1
• Tympanostomy tube insertion in children often requires general anesthesia, though office-based procedures without general anesthesia are sometimes possible based on shared decision-making between clinicians and families 1
• Transcatheter aortic valve implantation (TAVI) procedures may require general anesthesia, particularly for the transapical approach, though some centers perform transfemoral implantation under moderate sedation with TEE guidance 1

Patient Factors That May Necessitate General Anesthesia for Injections

• Age: Young children may require general anesthesia for procedures that adults could tolerate with local anesthesia 1
• Cooperation level: Uncooperative patients may require general anesthesia for procedures that would typically be performed under local anesthesia 1
• Complex medical conditions: Patients with anticipated difficult airways during obstetric procedures may require special airway management techniques including general anesthesia 1

Specific Procedures and Anesthesia Recommendations

Leishmaniasis Treatment

• Intralesional pentavalent antimonial treatment is painful and requires local anesthesia in advance
• Young children may need general anesthesia for this procedure 1

Proximal Femoral Fractures

• Either spinal anesthesia or general anesthesia is recommended
• Simultaneous administration of both is not recommended due to risk of precipitous falls in intraoperative blood pressure 1

Nasal Procedures

• General anesthesia may be used for young children, uncooperative patients, or those requiring advanced cauterization techniques such as endoscopic cautery for posterior bleeding sites 1

Vasectomy

• Should be performed with local anesthesia with or without oral sedation
• General anesthesia should only be used if the patient declines local anesthesia or if the surgeon believes local anesthesia with or without oral sedation will be inadequate 1

Considerations for General Anesthesia Administration

• Propofol dosing: For induction of general anesthesia, most adult patients under 55 years and classified as ASA-PS I or II require 2-2.5 mg/kg of propofol when unpremedicated 2
• Elderly patients: Reduced dosages (1-1.5 mg/kg) are recommended for elderly, debilitated, or ASA-PS III or IV patients 2
• Pediatric patients: Most patients aged 3-16 years require 2.5-3.5 mg/kg of propofol for induction 2
• Cannabis users: May require higher doses of anesthetic agents including propofol, midazolam, ketamine, and fentanyl during general anesthesia 3

Alternatives to General Anesthesia

• Regional anesthesia: Healthcare professionals trained in regional anesthetic injection may consider providing regional anesthetic at the time of surgery and postoperatively to improve pain control and prevent delirium in older adults 1
• Paravertebral blocks: Can be an effective alternative to general anesthesia for breast surgery, with shortened recovery time and lower postoperative pain scores 4
• Combined approaches: Interscalene brachial plexus blockade combined with general anesthesia can reduce intraoperative doses of opiates and facilitate postoperative pain management for shoulder surgery 5

Environmental Considerations

• When choosing between general anesthesia techniques, consider that inhaled anesthetics have environmental impacts through greenhouse gas emissions, while intravenous anesthetics like propofol are ecotoxic for water and soils 1
• With equal clinical benefit for the patient, sevoflurane is preferred over desflurane or isoflurane for environmental reasons 1

Conclusion

While most routine injections can be performed with local anesthesia or moderate sedation, certain complex procedures, anatomical locations, or patient factors may necessitate general anesthesia for injections to be performed safely and effectively.