Pre-op
Considerations
What
is an Anesthesiologist?
How
safe is anesthesia and what are the risks?
Fasting
Guidelines
Do
I need an intravenous (IV) catheter before I go to sleep?
Types of
Anesthesia
What
types of anesthesia are available?
What
Risks are Involved with the Use of Anesthesia?
What
causes a spinal headache?
Pediatric
Anesthesia
What
are the risks for my child during anesthesia?
How
will my child go to sleep?
What
will you do if my child is anxious before surgery?
Recovery
from Anesthesia & Surgery
Where will
I wake up?
How will I
wake up?
Will
I experience nausea after anesthesia and surgery?
Will
I have pain when I wake up?
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| Pre-op
Considerations
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What is an
Anesthesiologist?
An anesthesiologist is a physician who has completed
four years of undergraduate education (college), four years of medical school
and at least four years of residency training. The anesthesiologist is a
physician specialist responsible for the anesthetic care, life support and pain
management for patients undergoing surgery, childbirth and various medical
procedures. Additionally, anesthesiologists are involved in the management of
critically ill patients and patients with chronic pain syndromes. Upon
completion of specialty training, the anesthesiologist becomes eligible for
board certification by the American Board of Anesthesiology. The physicians in
Valley Anesthesiology Consultants are board certified or in the certification
process.
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How safe is
anesthesia and what are the risks?
The administration of anesthesia, even to patients
with serious health problems, can generally be accomplished safely without
major complications and only minor side effects. However, even when carefully
and competently administered, serious and potentially life-threatening
complications can and do very rarely occur. During the last twenty years
improved understanding of how the body reacts to anesthesia and surgery, more
sophisticated monitoring devices and better anesthetic agents have dramatically
improved anesthetic safety. Anesthetic mortality, as high as 1:15,000 prior to
1980, is now less than 1:200,000 for patients in good health undergoing
elective procedures.
The risk of anesthetic administration is determined
by the patient’s health status, the nature of the surgical procedure and if the
care is being provided electively or because of a surgical emergency. If you
want to know more about the risk of anesthesia in your case, your
anesthesiologist can make the best assessment during your pre-anesthetic
evaluation.
Anesthetic risk can be reduced by providing complete
information about your health to your anesthesiologist and by carefully
following our fasting (also called “NPO” or “nothing by mouth”) guidelines and
instructions regarding any medication you are taking on a regular basis.
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Fasting Guidelines
An appropriate fasting period prior to elective
procedures performed during anesthesia is essential for patient safety. The
objective is to empty the stomach so the risk of inhaling stomach contents into
the lungs is reduced. This is a serious potential complication called pulmonary
aspiration and in severe cases can be fatal. In emergencies special precautions
are taken but elective surgery will be cancelled if the fasting instructions
are not followed.
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Do
I need an Intravenous (IV) catheter before I go to sleep?
Most adults will have an IV catheter inserted prior
to their anesthetic for the induction of anesthesia, fluid therapy and for the
administration of medication. Children also require IV catheters, but they are
usually placed after the child goes to sleep.
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| Types
of Anesthesia |
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What types of
anesthesia are available?
You will have one of three kinds of
anesthesia during surgery. Monitored anesthesia care (MAC) is
often used for surgery that is short and does not require the surgeon to cut
muscle or bone. Sedatives and pain killers are given through an IV. The area
around the surgical site is numbed with a local anesthetic. You may choose to
remain awake or sleep lightly. If you are uncomfortable, your anesthesiologist
can usually make you sleepier or the surgeon can inject more local anesthesia.
Regional anesthesia is often used for surgery on the arms, legs,
lower abdomen and during childbirth. A local anesthetic is injected to block
nerve impulses in a nerve or group of nerves coming from the site of the
surgical procedure. The area will begin to feel numb within minutes. Sedatives
are typically administered through an IV catheter. With regional anesthesia,
you may remain awake or choose to sleep lightly. General anesthesia
is most often used for more extensive surgery, such as abdominal, heart, brain
or chest surgery. You are unconscious throughout the surgery.
In certain situations a combination of general
and regional anesthesia may be appropriate.
Following your pre-anesthetic evaluation, your
anesthesiologist will recommend an anesthetic choice for the case, taking into
account your health status and preference and the nature of the surgical
procedure.
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| What
Risks are Involved with the Use of Anesthesia? |
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Fortunately,
anesthesia complications are rare. It is important for you to inform your
anesthesiologist of any medications you are currently taking or may have taken
in the past. When certain drugs are combined in the body it could lead to
possible drug reactions. Inform your anesthesiologist about any reaction you
may have had during previous surgeries. Any excessive drug or alcohol use may
cause damage to vital organs such as the kidneys, liver or heart. This could
affect your ability to tolerate anesthesia and is an important topic to discuss
with your anesthesiologist.
Risks and complications may include, but not be
limited to lung, heart, liver or neuro functioning. Headaches occur in a very
small percentage of patients after spinal anesthesia.
A discussion of the risks and complications with your
anesthesiologist is necessary for your informed consent.
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What causes a spinal
headache?
When the spinal needle passes through the membrane
that contains the fluid surrounding the spinal cord, it may create a passage
for spinal fluid to leak out. If enough of the fluid leaks out, the patient may
experience a headache. Thanks to the improved design of today's spinal needles
it is rare to have this problem after a spinal anesthetic. Epidural anesthesia
is performed with a larger needle than spinal anesthesia and the medicine is
placed outside the membrane holding the spinal fluid. The likelihood of
headache is higher if the epidural needle should puncture the membrane. If a
patient develops a severe headache, the anesthesiologist can place a sterile
blood ‘patch’ with the patient's own blood to ‘seal’ the leak.
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| Pediatric
Anesthesia |
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What are
the risks for my child during anesthesia?
As with adults, the administration of anesthesia,
even to very small babies with serious health problems, can generally be
accomplished safely and usually without major complications and only minor side
effects. However, even when anesthesia is carefully and competently
administered, serious and potentially life threatening complications can and do
rarely occur.
The risks of anesthesia in children are similar to
those for adults, although the nature of anesthetic complications may differ.
Respiratory complications are low but more frequent in children than adults.
Discuss your concerns about the risks associated with anesthesia in your
child’s case with the anesthesiologist.
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How will my child go to
sleep?
With younger children, the most frequent type of
induction (putting the patient to sleep) is by breathing oxygen and anesthesia
gases through a mask. Flavored masks are usually available. The older child may
select an IV because it is a faster way to go to sleep. If the older child is
afraid of the IV catheter insertion, an inhalation induction is the most common
option.
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What
will you do if my child is anxious before surgery?
Medication is available that can sedate your child
after you are at our facility and before the operating room prior to the start
of the anesthetic. Pre-medication can be given by mouth or through an IV
catheter.
Many parents ask to be with their child in the
operating room when the child falls asleep. This is possible only at some
facilities. If this is your interest, talk to your child’s anesthesiologist, as
parental presence will only be beneficial to your child in some situations.
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| Recovery
from Anesthesia & Surgery |
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Where will I wake up?
Recovery from anesthesia takes a variable amount of
time depending on the type of medications used, type and duration of surgery
and the patient. You will awaken and recover from the anesthesia in a
specialized unit called the post-anesthesia care unit (PACU). Nurses with
specialized training or ICU experience will be with you to closely monitor your
vital signs and overall condition. You will stay in this unit until you have
met criteria for discharge to your hospital room or home.
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How will I wake up?
You will be drowsy and have mild confusion as you
emerge from general anesthesia. If you have either pain or nausea, tell your
nurse and medication will be administered until you are comfortable. You may
feel drowsy or tired for a couple of days or longer depending on your surgery.
A sore throat occasionally is experienced after anesthesia, but should resolve
within 24-48 hours.
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Will
I experience nausea after anesthesia and surgery?
Some patients experience nausea after anesthesia and
surgery. This may be related to the anesthetic, the surgical procedure itself
or multiple other factors. If you have experienced this after a previous
surgery or anesthetic, it is important that you tell your anesthesiologist so
that appropriate medication can be given. If you experience motion sickness,
inform your anesthesiologist.
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Will I have pain when I
wake up?
Most surgical anesthetics provide some relief of
postoperative pain because narcotics (pain killers) are often given as part of
the anesthetic. When you arrive in the recovery room, you may require more
medication. If you experience pain, let your nurse know immediately.
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There are no guarantees either expressed or
implied. The patient's actual experience may be different from those presented
here. Please discuss your questions and any concerns with your
Anesthesiologist.
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