Frequently Asked Questions About Anesthesia
- After you and your surgeon have agreed on the necessary surgical approach you will need to “pre-register” with the hospital or outpatient surgical center. Here you will be given special/specific instructions for the day prior and/or day of surgery. This will include what medications to continue till the day of surgery, how long to abstain from eating any kind of food and which medications need to be stopped and when.
- Your surgeon may send you for additional testing or ask you to follow up with your primary care doctor for medical assessment for surgery & anesthesia. This may include additional blood tests at a laboratory or even another medical specialist. All this is done to make sure you are medically ready for your anesthesia and surgery.
- On the morning of surgery you will meet with your anesthesiologist and discuss your medical history. At this time, based on your medical conditions and type of surgery, your type of anesthesia will be discussed. This is the time for you to discuss any questions or concerns regarding the type of anesthesia that will be used. It is important to be honest with your anesthesiologist, because certain medical issues and medications interact with anesthesia and can have catastrophic effects.
General anesthesia is usually a combination of inhaled anesthesia gases and intravenous medications. If you have no medical problems, modern anesthesia gases leave the body within 24 hours. Intravenous medications are filtered through the kidneys and/or liver and may take 24 to 48 hours. Within 72 hours all side effects associated with general anesthesia should be gone.
What are my chances of “waking up” during surgery or being “unable to move” but hearing and feeling everything?
- The use of sophisticated, advanced anesthesia monitors in operating rooms today, allow us to closely monitor the depth of your anesthesia. Scheduled (elective) surgeries under general anesthesia, would rarely ever encounter episodes of “awakening” or “awareness”. During emergency surgeries or heart surgeries, emergency cesarean sections or certain brain surgeries (referred to as awake brain procedures) the possibility of recall or awareness can occur.
- If after your elective surgery under general anesthesia you feel you were “awake” or have any “recall”, please let your surgeon know as well as our office, so that we can have your anesthesiologist meet with you and provide any necessary explanations/assistance.
Propofol is one of several medicines used both for conscious sedation and starting (induction) general anesthesia. It has a very high safety profile, is short acting and has an anti-nausea effect. All these characteristics make it the best medicine in its class, especially for out-patient surgery. It is meant to be used only by healthcare providers skilled in its use and with advanced airway management skills. In the hands of an anesthesiologist, it is as safe as any other medicine used during the course of anesthesia for a surgical procedure.
Learning about anesthesia
- An anesthesiologist is a physician. The training required to practice the medical specialty of anesthesiology involves four years of undergraduate college education (a BA or BS degree), four years of medical school (a MD or DO degree) and four years of postgraduate anesthesia residency training.
- At the completion of medical school, physicians undergo strenuous licensing tests for an unlimited scope of practice medical license (Nurses, podiatrists, optometrists and CRNAs have limited scope of practice licenses). After residency, anesthesiologists pursue Board Certification, indicating that they are Consultants in the field of Anesthesiology. All Sierra Anesthesia Partners are Board Certified.
- After you have met with your anesthesiologist in the preoperative clinical area and discussed your medical history and type of anesthesia to be used, both of you proceed to the operating room. Here, all the necessary monitors for your safety and well-being are applied. Your “vital signs” (blood pressure, breathing rate, heart rate, EKG and blood oxygen levels) are re-taken and reviewed. It is after this final check that you begin to “drift off”.
Once you are asleep, all further preparations for surgery are performed and surgery starts. As your surgery proceeds, the anesthesiologist is constantly monitoring and adjusting the “anesthetics” to keep you safe. The anesthesiologist’s constant presence and vigilance is the best monitor of all for your safety. At the completion of the surgery, he/she helps you “awaken” from anesthesia and makes sure your vital signs are stable. Once you are awake and your vital signs are stable, you are taken to the Recovery Room (PACU).
What is Anesthesia?
Anesthesia implies the state of “no sensation”. This temporary and reversible condition is drug induced.
Anesthesia may be used to:
- provide analgesia (minimize or eliminate pain and discomfort)
- Provide amnesia (short-term memory loss of the surgical event).
- There are several categories of anesthesia:
- Local Anesthesia
- Conscious Sedation
- Regional Anesthesia
- General Anesthesia
Risks and possible problems
Any death or major complication immediately before, during or immediately after surgery is important to share with your anesthesiologist. The main concern is a condition known as Malignant Hyperthermia which is a hereditary condition. It is extremely rare and can be fatal. Exposure to certain intravenous medicines (succinylcholine) and certain anesthesia gases (volatile agents) cause the body’s metabolism to go into toxic overdrive. If you have any questions please discuss these with your anesthesiologist. If you know you have a family history of malignant hyperthermia, please make your surgeon aware and contact our office at the above listed number.
- Interview process -During this consultation your physician will ask about:
- health problems
- previous surgeries/ any specialist following chronic conditions
- family history of disease
- comprehensive list of any and all medicines including vitamins and over the counter products
Types of anesthesia
Certain muscle relaxants used in surgery have to “wear off” while others may need to be reversed. Succinylcholine is a muscle relaxant used to help place a breathing tube after you are asleep. Its relaxant properties are reversed by certain enzymes (pseudoplasmacholinesterase) in our blood. This inherited blood enzyme deficiency occurs in about 1/2500 people. Please let your anesthesiologist know of these types of family histories. Any and all information makes your anesthesia experience safer.
- General Anesthesia means you are “put to sleep” or are “totally under”. At this time you are unconscious and immobilized. Since your protective airway reflexes (coughing, gag reflex) are inactive, a breathing tube is placed into your windpipe (trachea) to keep it open and protect your lungs from any potential stomach contents. In some cases, this tube may not be required (use of a LMA) thereby decreasing the “sore throat” sensation sometimes present after general anesthesia with a breathing tube. General Anesthesia is used for complex surgical procedures that take several hours. Examples would include laparoscopies for abdominal surgeries, robotic surgery, heart bypass procedures, total joint replacement, brain or spine procedures, etc.
- While you are under General Anesthesia your anesthesiologist is continuously monitoring your blood pressure, heart rate and rhythm, quality and rate of your breathing by monitoring the exhalation of your carbon dioxide, blood oxygen levels, temperature, urine output (on complex, long cases), concentration of anesthetic levels and brain activity (EEG) during certain cases. Every monitor has default alarms that sound loudly and can only be silenced when the necessary adjustments have been made.
- When the surgical procedure is finished, the anesthesia is “reversed”. After you awaken from General Anesthesia, you are taken to the recovery room (PACU). As you return to full consciousness, it is typical to feel disoriented, confused and groggy. Other common side effects include; sore throat, shivering (this is a very common side effect of General Anesthesia and can be treated with certain medications), dry mouth, nausea and vomiting and pain. During your stay in the recovery area these side effects are addressed prior to your discharge to the floor or home.
- When Regional Anesthesia is used to “numb” a single nerve or a bundle of nerves that can block pain in a hand, arm or leg it is referred to as peripheral nerve regional anesthesia. These blocks can be used for arm or leg surgery and provide good postoperative pain relief thereby decreasing the chance of nausea and vomiting (side effects) from general anesthesia and postoperative oral pain medications.
- If a Regional Anesthesia block is injected into the spinal fluid or placed into the epidural space it is referred to as central or neuroaxial regional anesthesia. These blocks can temporarily numb sensation and decrease voluntary muscle movement from the waist down to your toes. Frequently these blocks are used for patients in labor, C-sections, hernias and total joint surgeries (knees and hips).
- Often in addition to Regional Anesthesia, Conscious Sedation is added to help reduce anxiety and create a state of relaxation. Overall, decreased side effects are experienced in comparison to General Anesthesia. Please discuss with your anesthesiologist what to expect and the potential side effects specific to your Regional Anesthesia.
Local Anesthesia is used to “numb” a small area of your body and block the sensation of pain. Although the pain sensation is blocked, pressure at that area may still be felt. Local Anesthesia is utilized in the dentist office, for application or removal of stitches on parts of your body, cataract surgery and removal of small skin surface growths. You will remain awake and have complete memory of the event.
Conscious Sedation is also known as “twilight sleep” or “procedural sedation”. It utilizes similar medications used for General Anesthesia. The dosages are markedly decreased. All monitors (i.e. blood pressure, heart monitor, oxygen blood level monitor) used for General Anesthesia are also required during Conscious Sedation. During Conscious Sedation you will be sleepy and in a dream-like state. Typically, there is minimal awareness or memory of the procedure as well as minimal if any nausea or vomiting as compared to General Anesthesia. Short procedures like minor cosmetic surgeries, oral surgery, and the reduction of closed fractures, colonoscopies and endoscopies can easily be done this way. Conscious Sedation has minimal side effects in comparison to General Anesthesia.