ANESTHESIA IS A MAJOR PART OF YOUR SURGERY.

Before, during and after your operation, you will receive comprehensive anesthetic care to assure your utmost safety and comfort throughout the surgical experience. The Department of Anesthesiology utilizes an Anesthesia Care Team approach which includes anesthesiologists (MDs) and certified registered nurse anesthetists (CRNAs) working together in a collaborative fashion. We consider ourselves your “guardian angels” during surgery.

We will use state-of-the-art medical technology to minimize pain and anxiety and to maintain all your vital functions in a smooth and stable fashion. The specific anesthetic technique selected is individualized to your needs and is based upon many factors which include your medical history, your physical condition, the nature and extent of your surgery and, whenever possible, your personal preferences.

DURING YOUR SURGERY

The primary anesthetist who will be with you throughout your entire anesthetic in the operating room may be either an anesthesiologist, a nurse anesthetist, or both. During your operation, your vital functions will be closely monitored and medications and fluids will be administered as necessary. Since every individual is unique and responds differently to surgery, no two anesthetics are exactly alike.

DIFFERENT TYPES OF ANESTHETICS

There are three major classes of anesthetics and each (or a combination) may be appropriate for different situations:

General Anesthesia:

Drugs are administered intravenously or by inhalation to render you unconscious and cause your entire body to become insensible to pain during surgery. Common after-effects may include grogginess, nausea, and slight soreness in the throat.

Regional Anesthesia:

This approach numbs a major portion of your body using local anesthetic agents. Examples include spinal anesthesia and epidural anesthesia, which cause numbness in the lower portions of the body. Other examples include axillary block or intravenous regional techniques which produce numbness of the arm and hand.

Local Anesthesia:

Injection of local anesthetic drugs directly into the surgical area may suffice for minor procedures. While the surgeon will usually inject the surgical area with local anesthetic, the anesthesiologist or nurse anesthetist will provide any necessary sedation or other additional medications to assure that you are comfortable and as stable as possible.

Please note that intravenous sedative drugs are commonly used in conjunction with regional anesthesia and local anesthesia in order to help you relax or promote a light sleep during surgery.

If I have a general anesthetic, what drugs will be used?

Anesthesia is complex and usually involves multiple medications. Some anesthetic medications are injected intravenously and some are inhaled. The type and amount of medication depend on the individual patient’s needs including the patient’s condition, the surgical procedure being performed, and very importantly the patient’s physiologic responses to both anesthesia and surgery. The use of multiple agents in a balanced approach allows us to get the best effects of each drug without giving large doses of any one drug that could cause unwanted side effects. Every patient is unique and therefore every anesthetic is slightly different, tailored exactly to each individual patient’s needs based on careful measurements of physiologic variables during surgery.

If I have a local anesthetic, will I be awake?

Perhaps. We usually sedate patients to keep them relaxed and comfortable during local anesthesia. Depending on your preferences and the nature of the surgery, more or less sedation may be given. For cataract surgery, for example, we usually use minimal sedation – just enough to relax you a bit. For hernia surgery, more sedation is often necessary to assure that patients are very comfortable. So patients may or may not be awake, or often are intermittently awake, during surgery under local anesthesia. In addition, due to the effect of sedative drugs on memory, many patients who are awake and conversant during surgery under local anesthesia have no memory of the time during, or immediately before or after, their surgery. In all cases we will make sure that you are relaxed and comfortable.

If I have a regional anesthetic, will I be awake? The answer is essentially the same as above. Note that one exception is during caesarian sections under epidural or spinal anesthesia, when minimal or no sedation is used (to protect the baby from sedative effects) and the mother is quite awake. The anesthesiologist or nurse anesthetist will be there throughout the procedure to care for you and reassure you, and we can safely administer small amounts of sedation if needed. One beneficial aspect of minimal or no sedation during caesarian section is that the mother will usually have a clear memory of the birth of her baby.

How do you decide how much anesthetic to give me?

We base initial doses on your size, age, medical condition, and the procedure that will be performed. Subsequent doses are based primarily on our monitoring of your body’s vital functions including the heart, the circulation, your breathing, and your degree of muscle relaxation.

Will I have a breathing tube?

If you are having local or regional anesthesia, you will usually have oxygen delivered via small nasal “prongs” or a light plastic oxygen mask, without a breathing tube. If you are having general anesthesia you will usually have some sort of breathing tube. The two most common devices used are an endotracheal tube (ETT) which goes into the windpipe (trachea), or a laryngeal mask airway (LMA) which sits in the back of the throat just above the windpipe. Which device you have will be based on your procedure, your medical condition, and a number of other factors. You should feel free to discuss this with your anesthesiologist and nurse anesthetist if you wish. Major procedures in the abdomen and thorax virtually always require an ETT. Rest assured that you will be deeply asleep before a breathing device of any type is placed. (The only exception to this is in some unusual situations when we feel it is safest to numb your mouth and throat thoroughly with local anesthetic spray and then place the tube gently using a flexible fiberoptic scope, while you are well-sedated.)

Will I dream during anesthesia?

Dreaming during general anesthesia is uncommon, due to the fact that the anesthetic state differs from normal sleep. The stage of sleep where dreaming normally occurs, called REM (for rapid-eye-motion) sleep, is suppressed during general anesthesia. When dreams or dream-like memories do occur, they generally occur at the end of anesthesia when you are “waking up.” Such very brief dreams or dream-like memories are similar in content and tone to normal dreams, and studies have shown that they are reported as neutral or pleasant. During local or regional anesthesia with sedation, patients commonly drift off to sleep and dreaming is more common than with general anesthesia but rarely unpleasant. Certain drugs, such as propofol and ketamine, are more likely to be associated with dreaming. These drugs are commonly used because they have many beneficial effects, including allowing a rapid return to wakefulness with a positive mood and no nausea.

Will I “wake up” during general anesthesia? Awareness under general anesthesia is extraordinarily rare during routine elective surgery. We use many techniques to prevent this rare and very serious event from occurring – no one technique or monitor is sufficient. Clinical reports and research in this area have shown that patients who believe they were or might have been awake during general anesthesia benefit greatly from discussing this with their surgeon and anesthesiologist as soon as possible, and if necessary they can be promptly referred for therapy to prevent the incident from causing further distress. Waking up patients at the end of general anesthesia is intentional and necessary, and some patients may have brief recollection of the final waking-up stages, though this too is rare. The rare patient who remembers waking up at the end of a general anesthetic usually is not distressed by it.

How long will it take for me to recover from anesthesia?

This is highly variable and depends primarily on your condition before surgery and the type of surgery you are having. For short outpatient procedures, recovery from general anesthesia is often quite rapid (1-2 hours). For longer, major procedures, you may remain sleepy from your anesthesia for several hours or even overnight. Epidural anesthesia usually takes about 2 hours or so to wear off. Spinal anesthesia varies more and may in some cases take up to a few hours to wear off. Local anesthesia, even with significant sedation, usually affords the speediest recovery (often under an hour). For most patients, the biggest determinant of how long you will need to be in the recovery area will not be your anesthetic recovery time but rather your need for pain control or nausea control after surgery.

Will I vomit after surgery?

Sometimes patients are nauseated and may vomit after surgery. This is most common with abdominal procedures, gynecologic surgery, and eye surgery. It is more common in women than men, and more common in people who are prone to motion sickness. We take numerous measures to prevent nausea and vomiting after surgery, including using anesthetics that have an anti-nausea effect and administering anti-nausea medications before, during, and after surgery.

Is spinal anesthesia dangerous?

Spinal anesthesia has long been known to be extremely safe when practiced by skilled practitioners. Permanent paralysis or any damage to the spinal cord or spinal nerves after spinal anesthesia is extremely rare. Spinal anesthesia also has some distinct safety advantages over general anesthesia for certain patients undergoing certain types of procedures. Spinal anesthesia does not cause or exacerbate back pain any more than general anesthesia.

What is the difference between an epidural and a spinal anesthetic?

Spinal anesthesia involves injection of a very small dose of local anesthetic directly into the spinal fluid, using a very small needle. It is usually a “one-shot” approach without a catheter (tiny plastic wire-like tube) for repeat dosing. The lower part of your body will usually get very numb immediately. Epidural anesthesia involves placing a small catheter through a needle into a space called the epidural space, which can be thought of as a sheath around the spinal cord and spinal nerves. The needle is removed but the catheter stays in place in order to allow continuous or repeated dosing as needed. The onset of epidural anesthesia is slower than spinal anesthesia, about 10-20 minutes. Epidural anesthesia is most commonly used when repeated dosing is likely to be necessary (such as during labor, or for longer surgery) because the catheter makes repeat injections easy. The risks of spinal and epidural anesthesia are similar, and the procedures usually feel quite similar to the patient (numbing the skin of the lower back, placing the needle, injecting medication). In almost all cases, the skin and tissues beneath the skin are well-numbed using a tiny needle and local anesthetic, so that both spinal and epidural procedures are painless or cause only very slight discomfort.

AFTER YOUR SURGERY

In the post-anesthesia care unit (PACU or recovery room), an anesthesiologist will direct your medical care until you are discharged. Your recovery from anesthesia will be affected by the nature, extent, and duration of your surgery, as well as the type of anesthesia that you have had. Patients going home on the same day of surgery must meet established criteria before being discharged.

Because very small concentrations of anesthetic and sedative agents may persist in your body for up to 24 hours, it is important not to drive, operate dangerous machinery, or make major decisions for approximately 24 hours after your anesthetic.