Frequently Asked Questions
May I choose my anesthesiologist?
This question is a very common one as today more and more patients search for medical specialists. Many people find their doctors through recommendations from other doctors or through family and friends and the same situation exists when choosing your anesthesiologist. You do have a choice as to who your anesthesiologist will be. However, you must make that choice known in advance so that arrangements may be made to honor your request. In most situations where no request exists, the surgeon who has scheduled the operation will arrange the services of an anesthesiologist with whom he or she is familiar. However, if for any reason you are not comfortable with the recommended anesthesiologist, you may request a different anesthesiologist.
Are there different kinds of anesthesia?
There are three main categories of anesthesia: general, regional and local. Each has many forms and uses.
In general anesthesia, you are unconscious and have no awareness or other sensations. There are a number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein. During anesthesia, you are carefully monitored, controlled and treated by your anesthesiologist, who uses sophisticated equipment to track all your major bodily functions. A breathing tube may be inserted through your mouth and frequently into the windpipe to maintain proper breathing during this period. The length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesiologist will reverse the process and you will regain awareness in the recovery room.
In regional anesthesia, your anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake, or you maybe given a sedative. You do not see or feel the actual surgery take place. There are several kinds of regional anesthesia. Two of the most frequently used are spinal anesthesia and epidural anesthesia,, which are produced by injections made with great exactness in the appropriate areas of the back. They are frequently preferred for childbirth and prostate surgery.
In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery, for example, on the hand or foot.
May I request what type of anesthesia I will receive?
Yes, in certain situations. Some operations can be performed using different anesthetic procedures. Your anesthesiologist, after reviewing your individual situation, will discuss any available options with you. If there is more than one type of anesthetic procedure available, your preference should be discussed with your anesthesiologist in order for the most appropriate anesthetic plan to be made.
What happens after I lose consciousness during general anesthesia?
Beginning Phase. A great deal besides surgery takes place between the beginning of your anesthesia and your return to consciousness in the Post Anesthesia Care Unit. Your anesthesia probably will be started with an "induction agent": a common one with which you may be familiar is sodium thiopental (Pentothal). You may have heard that this induction agent is used as a "truth serum", that is a myth. The real truth is that thiopental is used basically during the first step (induction) of your anesthesia when you "drift off to sleep" and lasts only a few minutes.
In order to keep you anesthetized, your anesthesiologist administers and regulates additional and more potent medications that are necessary to maintain your anesthesia for the rest of the procedure. Some of these medications are injected into your veins and others, such as nitrous oxide, are inhaled through your lungs because they are gases. Inhaled gases are administered to patients who receive general anesthesia with "oxygen" being the most important gas. These gases are administered either through a mask or a special breathing tube which is inserted into your windpipe (trachea) depending upon your surgical procedure and physical condition.
Middle Phase. Exactly which medications will be administered to you during anesthesia will be determined by your physical responses and how they will be affected by the type of surgery you are having and by your medical status. Therefore, your anesthesiologist will carefully tailor your anesthetic just for you. Some of these medications will be the actual anesthetic agents that help you to remain unconsciousness and experience no sensations, while others are administered to regulate your vital functions such as heart rate and rhythm, blood pressure, breathing, and brain and kidney functions.
Your anesthesiologist constantly is monitoring, evaluating and regulating your critical body processes because they can change significantly during the operation due to the stress and reflexes from surgery itself, the effects of the anesthetic medications and your medical condition. For example, in most operations specialized equipment is used to actually control the patient's every breath. (This is because certain medications temporarily decrease breathing capability, which is further reduced by necessary muscle relaxants.)
Your anesthesiologist also is responsible for and will treat any medical problem which you may develop during surgery such as a bleed pressure problem. However, your anesthesiologist wants to help prevent any medical problems by using and interpreting today's sophisticated monitory equipment and knowing when and how to treat your body's responses to surgery.
Recovery Phase. When surgery is completed, the recovery phase is carefully timed and controlled. Anesthetic agents are discontinued and new medications may be given to reverse the effects of those administered previously. Body temperature, breathing, bleed pressure, and other functions begin to normalize. Before your total recovery, you may receive some medications to decrease postoperative discomfort. All of this is calculated precisely under the supervision of your anesthesiologist to permit you to return to consciousness in the recovery room unaware of what has occurred during the operation.
Why are so many questions asked about my past and present medical condition?
Because anesthesia and surgery affect your entire system it is important for your anesthesiologist to know as much about you as possible.
You already realize that your anesthesiologist is responsible for your anesthesia to make you comfortable, but in addition, he or she is responsible for your medical care during the entire course of surgery. Therefore, it is important to know exactly what medical problems you have and any medications you have been taking recently since they may affect your response to the anesthesia. You also should inform your anesthesiologist about your allergies, any hard drug or alcohol usage, and past anesthetic experiences.
Your anesthesiologist must be very familiar with your medical condition so that the best anesthetic and medical care may be provided throughout your operation. This important knowledge will allow your anesthesiologist, as a doctor, to continue your current medical management into surgery which will help prevent complications, and expedite diagnosis and treatment of any medical problems should they occur. Your continued medical management during surgery is necessary to help facilitate your speedy recovery.
Why talk about drinking and smoking?
Cigarettes and alcohol affect your body just as strongly and sometimes more than any of the medically prescribed drugs you may be taking. Because of their various effects on your lungs, heart, liver and bleed, to name a few, cigarette or alcohol consumption can change the way an anesthetic drug will work during surgery, so it is crucial to let your anesthesiologist know about your consumption of these substances. This is also true, especially true, for so-called "street drugs"-marijuana, cocaine, amphetamines and the rest. People are sometimes reluctant to discuss these things, but it is worth remembering that such discussions are entirely confidential between you and your doctor. Your anesthesiologist's only interest in these subjects is in learning enough about your physical condition to provide you with the safest anesthesia possible. So, in this case honesty is definitely the best policy, and the safest one.
What are the risks of anesthesia?
All operations and all anesthesia have some small risks, and they are dependent upon many factors including the type of surgery and the medical condition of the patient. Fortunately, adverse events are very rare. Your anesthesiologist takes precautions to prevent an accident from occurring just as you do when driving a car or crossing the street.
The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your anesthesia.
To help anesthesiologists to provide the best and safest patient care possible, national standards have been developed by the American Society of Anesthesiologists to enhance the safety and quality of anesthesia. Specific standards already have been developed regarding patient care before surgery, basic methods of monitoring patients during surgery, patient care during recovery, and for conduction anesthesia in obstetrics. New standards continue to be developed to further ensure patient safety. These standards, along with today's sophisticated monitoring and anesthesia equipment as will as improved medications and techniques, have contributed enormously toward making anesthesia safer than ever before.
If I have an underlying medical problem how will it be handled during surgery?
Frequently, people requiring surgery may also have some underlying condition such as diabetes, asthma, heart problems, arthritis or others. Having taken your medical history prior to the operation, your anesthesiologist has been alerted and will be well prepared to treat such conditions during surgery and immediately after. As doctors, anesthesiologists are uniquely suited to treat not only sudden medical problems related to surgery itself, but also the chronic conditions that may need attention during the procedure, because their medical training involves a firm grounding in the principles of internal medicine and critical care.
Why are patients not allowed to eat or drink anything before surgery?
For most procedures it is necessary for you to have an empty stomach so that the chances of regurgitating any undigested food or liquids is greatly reduced. Some anesthetics suspend your normal reflexes so that your body's automatic defenses may not be working. For example, your lungs normally are protected from objects, such as undigested food, from entering them. However,this natural protection does not occur while you are anesthetized. So for your safety you may be told to fast (no food or liquids) before surgery. Your doctor will tell you specifically whether you can or cannot eat and drink and for how long. In addition, the anesthesiologist may instruct you to take certain medications with a little water during your fasting time. For your own safety, it is very important that you follow these instructions carefully about fasting and medications: if not it may be necessary to postpone surgery.
What is Spinal anesthesia?
Spinal anesthesia is placed in the low back (lumbar region). After a sterile prep and draping, local anesthetic is placed in the skin to numb the area where the Spinal needle will be placed. The Spinal needle passes between the vertebrae of the Spinal column through the dural membrane where the cerebrospinal fluid is located. Once the placement of the needle is accomplished medicines including a local anesthetic and sometimes a narcotic are dispensed via the needle. The needle is then removed. The entire process usually takes anywhere from 5-20 minutes.
What is Epidural anesthesia?
Epidural anesthesia is most commonly placed in the low back (lumbar region). Unlike spinal this technique may also be accomplished in the mid-back (thoracic region) for surgery in the area of the chest. After a sterile prep and draping, local anesthetic is placed in the skin numb the area where the epidural need will be placed. The needle for epidural passes between the vertebrae of the spinal column to the epidural space. Once the position is verified, a very small catheter (tube) is paced via the needle. The needle is then removed and the catheter remains in the epidural space. The catheter is then taped to the patients back. Local anesthetics and narcotics given epidurally via this catheter.. The procedure usually takes 10-25 minutes.
What is it like to have a spinal or epidural? Is it painful?
In order to place the spinal or epidural the patient must have a n IV placed. The patient is placed on various monitors (pulse oximeter, BP, EKG). The patients are then positioned in either the sitting or lateral position. Once the local anesthetic is placed in the skin there should be a pressure sensation when the spinal or epidural needles are placed. As these needles are being placed sometimes a patient may feel a strong tingling in the area of the hip or shooting down the leg. This is usually only a transient sensation of the involved area. This is followed by a loss of strength. The time period is anywhere from 5-25 minutes.
Will I have to stay flat for many hours after a spinal?
No. Not usually. With the use of smaller, sharper and disposable needles, you do not have to stay flat. You do need to stay in the bed until you recover fully from the effects of spinal anesthesia. i.e. You have got the full strength back.
Will I get a headache?
Postdural puncture headache occurs infrequently with these techniques. The risk seems to be higher with younger age and larger size of the needle. The risks is about 1% with epidurals and 3% with spinals. This is believed to be due to a leak of cerebrospinal fluid from the needle hole in the dura. The occurrence of this is greatly reduced by using a smaller needle when possible. If this headache does occur it may be treated initially with hydration and pain medicines. If the headache does not resolve it would be treated with an epidural blood patch. This is essentially using the patients own blood to block the leak via the epidural technique.
Is there a risk of being paralyzed or permanent damage?
The risks of paralysis is extremely low. The actual incidence of neurological dysfunction resulting from bleeding complications is estimated to be 1 in 150,000 for Epidurals and 1 in 220,000 for Spinal anesthetics.
What are the risks of Spinal and Epidural anesthesia?
The risks for Spinal and Epidural anesthesia may include low blood pressure, which is the reason the patient is routinely hydrated prior to the placement of either of these forms of anesthesia. Some of the time it is necessary to treat it with medication this is regularly by the anesthesiologist.
Postdural puncture headache occurs infrequently with these techniques. The risks is 1% with Epidurals and 3% with Spinals. This is believed to be due to a leak of cerebrospinal fluid from the needle hole in the dura. The occurrence of this is greatly reduced by using a smaller needle when possible. If this headache does occur it may be treated initially with hydration and pain medicines. If the headache does not resolve it would be treated with an epidural blood patch. This is essentially using the patients own blood to block the leak via the epidural technique.
Backache is an infrequent problem. It most likely is due to ligament strain due to profound muscle relaxation or surgical positioning.
Other complications that can occur include, but are not limited to, infection, nerve damage (including paralysis, loss of bladder and bowel function, loss of sexual function), allergic reactions, seizures, cardiac arrest and death. Although the result of these are severe they occur very rarely.
Will I be awake during the surgery?
The patient will usually be sedated via intravenous medications during the surgery and many times before placement of the spinal or epidural. It is possible to sedate the patient so that they will be comfortable and without anxiety during the surgical procedure. It is the understanding of the anesthesiologist that most patients do not want to know what is going on while surgery is being carried out. In fact, a lot of patients even may not remember receiving a spinal or epidural anesthetic.
Is Spinal or epidural used along with general anesthesia?
In surgery on the blood vessels, the chest and for postoperative pain control spinal or epidural may be used along with general anesthesia. There are some great benefits from these techniques which include decreased blood loss during surgery, decreased risks of phlebitis, and a reduced risks of stress reaction as a direct result of the patient having surgery.
In the case of spinal, when narcotics are added, this can give a patient anywhere from 12-24 hours pain relief after surgery. Epidural is much longer pain control because a small catheter is placed in the back and this may be used for 1 to 4 days post operatively.
Some of the side effects of the narcotics that the patient would receive via these techniques include itching, nausea, vomiting, and/or diminished respiratory rate. Other medications may be administered to relieve these symptoms.
When is a patient not a candidate for a spinal or epidural?
The patient may not be a candidate for these techniques if one is 1) allergic to certain local anesthetics or narcotics, 2) have disease of the nervous system, 3) have a bleeding tendency or coagulation disorder, 4) have an infection of the lower back area, 5) have had previous lower back surgery, 6) have a spinal deformity, 7) are morbidly obese, 8) cannot cooperate or get into the proper position.