| Anesthesia in General What is an anesthesiologist?
Anesthesiologists are physician specialists who have the critical responsibility for your welfare before, during, and after surgery. This care includes medically evaluating you before surgery (preoperative), consulting with the surgical team, providing pain control and support of life functions during surgery (intraoperative), supervising your care after surgery (postoperative), and medically discharging you from the recovery unit.
An anesthesiologist’s education is rigorous. After completing college and medical school, he or she enters a four-year anesthesiology residency training program.
All of our anesthesiologists are active members of the American Society of Anesthesiologists and are either certified or in the process of obtaining certification through the American Board of Anesthesiology. Many of our physicians have completed subspecialty fellowships in anesthesia which require additional years of training.
What kinds of anesthesia are there?
“Anesthesia” means “without feeling” and can be local, regional, or general. Each type of anesthesia serves a specific purpose and demands special training and skill.
In local anesthesia, an anesthetic drug is injected into the tissue around a nerve, numbing the specific area requiring minor surgery. You may be fully awake or sedated. It is a very safe procedure.
In regional anesthesia, your anesthesiologist makes an injection near a cluster of nerves to numb the area that requires surgery. You may remain awake, or you may be given a sedative and lose consciousness. There are several kinds of regional anesthesia. Two of the most frequently used types are spinal anesthesia and epidural anesthesia. They are generally recommended for childbirth, thoracic (chest), and abdominal surgery.
In general anesthesia, you will “go to sleep”, become unconscious, and have no awareness or any other sensation. During surgery, you are carefully monitored, and treated by your anesthesiologist, using state of the art equipment to track your major bodily functions. A breathing tube may be inserted during surgery. The length and level of anesthesia is calculated and adjusted precisely. At the conclusion of surgery, your anesthesiologist will allow you to emerge from anesthesia and then accompany you to the recovery unit.
What are the risks? All operations and all anesthetics carry some risks, depending on the type of surgery performed and the patient’s medical condition. Fortunately, adverse events are rare.
Tips:
To reduce anesthetic risk:
1. Provide complete information about your health and medical history
2. Strictly follow the fasting guidelines
3. Use only authorized medications, drugs, vitamins, herbs, and supplements
Be informed! Consult with both your surgeon and your anesthesiologist about any risks associated with your specific situation. If you decide to consult the Internet for information, be sure to locate reputable, respected sources or follow the links included on this page.
Will I get a spinal headache? Headaches were once a common occurrence following spinal anesthesia, but not anymore – today's slender spinal needles rarely cause this problem.
Conversely, epidural anesthesia is performed with a larger needle. However, since the medicine is injected just outside the membrane holding the spinal fluid, it is unlikely that the epidural needle will puncture that membrane. Puncture of the membrane can cause a severe, headache. Fortunately, there are several different treatments that can effectively alleviate this situation.
Preparation
Fasting Guidelines: What are the diet restrictions before my anesthesia?
Fasting before surgery is absolutely essential for your safety. After midnight on the night before your surgery, you should not eat or drink anything. Under certain circumstances, your anesthesiologist may give you permission to drink clear liquids up to a few hours before anesthesia. Elective surgery may be cancelled if fasting instructions are not followed.
Tip:
Simplify your diet as the date of your surgery approaches. Limit your intake of caffeine, sweets, greasy foods, and alcohol.
Can I take my usual medicines?
It is extremely important that your surgeon and your anesthesiologist have a complete list of your medications. They will help you determine which ones you can safely take at the time of surgery. Do not interrupt medications unless you are instructed otherwise.
Tip:
It is not unusual to become a bit distracted as the date of surgery approaches, so start making a list of your prescriptions and other important personal medical information well ahead of time.
Will dietary supplements and herbal medicines affect my anesthesia during surgery?
Anesthesiologists have discovered, through first-hand experience and through ongoing medical research, that certain vitamins, dietary supplements, and herbal medicines interact with certain anesthetics. In fact, supplements and herbs may prolong the effects of anesthesia, increase risk of bleeding, or raise blood pressure. Give your doctor a complete list before surgery, so that there are no unexpected complications during surgery (e.g., Echinacea, ginseng, ginkgo biloba, St. Johnswort, ginger, etcetera).
The Day of Surgery
What happens on the day of surgery?
Step One: Stay Calm
Breathe deeply and relax as much as you can. If possible, bring a close friend or family member along for support.
Step Two: Checking in
Once you check into the hospital or surgery center and your paperwork has been completed, you will meet with a preoperative nurse. He or she will briefly review your medical history, record your vital signs, and ask you to change into a hospital gown. You will then be taken to a preoperative waiting area.
Step Three: Preoperative Interview
Your anesthesiologist will meet with you to:
• Review your medical and surgical history
• Perform a focused physical examination
• Discuss any medical conditions needing attention during surgery
• Order final lab work, if necessary
• Explain the plan for your anesthetic as well as alternatives and risks
• Address your questions and concerns
The anesthesiologist may place an intravenous catheter (IV) and may also give intravenous medication to help you relax.
Step Four: During Surgery
The anesthesiologist is responsible for your safety, comfort and wellbeing throughout the surgical procedure – directing and regulating your anesthetic, managing vital functions, and, when necessary, managing fluid and blood replacement.
Recovery
Where and how will I wake up?
You may be drowsy and mildly confused as you awaken from general anesthesia or sedation. Your initial recovery will take place in a specialized area called the post-anesthesia care unit (PACU) or recovery room. Nurses with specialized training or ICU experience will closely monitor your vital signs and overall condition. Your anesthesiologist will check in to see how you are doing and whether you need any further pain medication. You will stay in the PACU until you meet the criteria for discharge to your hospital room or home.
Will I have pain or nausea when I wake up?
Despite all efforts to prevent these unwanted consequences of surgery and anesthesia, it is possible that you will experience pain or nausea in the PACU. If you experience pain or nausea, alert the nursing staff immediately. Some individuals are more prone to these symptoms than others. Fortunately, there are postoperative medications available to control pain, nausea and vomiting.
Note that a sore throat after anesthesia is not uncommon, and should disappear within a day or two. If you experience a persistent sore throat, please contact our office or your surgeon for advice.
Pediatric Anesthetics
What are the risks?
It can be especially stressful when babies and small children have serious health problems and need surgical treatment. Rest assured that the administration of anesthesia, even to infants, can generally be accomplished safely, with only minor side effects, and usually without major complications. However, even with the most competent administration of anesthesia, serious and potentially life threatening complications can and do occur. We recommend speaking frankly about your concerns with the anesthesiologist.
Tip:
Have your child bring along a comforting soft toy to cuddle.
How will my child go to sleep?
We’ve found that younger children are most comfortable falling asleep by breathing oxygen and anesthesia vapors through a mask. Older children often prefer an IV because it is a faster way to fall asleep. If the older child is afraid of the IV catheter insertion, inhalation induction may be preferred.
Tip:
Your emotional composure will affect your child’s level of anxiety as the date for surgery approaches. Try to project calm – your child will feel calmer too.
Obstetric Anesthetics
How is pain managed during childbirth?
Expectant mothers want information regarding all aspects of delivery, including pain management. Whether you will be having a vaginal or cesarean delivery, regional anesthesia (either epidural or spinal) is frequently part of the birth process. Your obstetric anesthesiologist, working closely with your obstetrician, may administer a regional anesthetic injection to numb the lower part of your body and abdomen for pain control during labor and/or anesthesia during a cesarean delivery.
With epidural anesthesia, a thin hollow catheter is left in the epidural space at the base of the spine so that repeat doses of medication can be administered as needed. After the initial injection, it may take up to 30-40 minutes for you to feel the full effect, which will last for approximately 4-6 hours. You may feel drowsy, but will not lose consciousness.
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