1. What is an anesthesiologist?
Anesthesiologists are physicians who have specialized training in providing pain control and caring for the general well-being of the patient in the operating room. They monitor your vital signs (heart rate, blood pressure, respiratory rate, etc.), administer medications to ease pain, provide relaxation, and monitor your fluid requirements. At a minimum, anesthesiologists have completed four years of college, four years of medical school and four years of internship/residency before starting to practice in our group. Many of our anesthesiologists have completed additional training and fellowships in such areas as chronic pain management, pediatrics, cardiothoracic and obstetric anesthesia.
2. Is there anything else that anesthesiologists do?
Anesthesiologists also fulfill a role outside of the operating room with their knowledge of pre-operative patient assessment and planning, analgesia for labor and delivery, critical care in the intensive care unit and recovery room, postoperative pain management and management of chronic pain syndromes.
3. What is the pre-surgical screening for? Why are there so many questions?
The pre-surgical screening serves a dual purpose. First, it is a chance to gather important information about you and your medical condition in order to ensure your safety and comfort. In addition, it is a chance for you to ask any questions you might have about what is going to happen, make decisions about your options and give informed consent.
4. What is informed consent?
Informed consent means that you have been presented with the options for anesthesia, the common and serious risks and the expected benefits of each option. In addition, you will be given a chance to ask questions which may arise from these discussions. Informed consent is usually given in writing and requires a signature by you or someone on your behalf.
5. What do I need to tell the anesthesiologist?
It is important that you are complete and honest when answering questions prior to surgery. These questions relate to your general health and any specific medical conditions that may present a risk to you. You should be prepared to discuss your health history, the history of your blood relatives (if known), whether you are taking any medications including over-the-counter products, smoking, drug use, past experiences with surgery and anesthesia, etc.
6. What kind of anesthesia will I have?
The type of anesthesia will be chosen based on the type of surgery, your medical condition, the surgeon’s requirements and your preferences. There are four types of anesthesia commonly employed: general, regional, monitored anesthesia care (MAC) and local.
7. What does the anesthesiologist do during the surgery?
The anesthesiologist is responsible for your comfort and safety. In addition to giving you the medications needed for the anesthesia, the anesthesiologist monitors your vital signs (such things as heart rate, blood pressure, oxygen content, body temperature, breathing...) and alters them as necessary. He or she is also in charge of intravenous fluids that you might receive and, if necessary, blood transfusions. If your surgery or medical condition requires the placement of special monitors (arterial or central catheters) they will also be placed by your anesthesiologist. Lastly, any other medical conditions that you might have (diabetes, asthma, hypertension, heart problems) will be treated by the anesthesiologist while you are in his/her care.
8. Will I need to receive blood for the surgery?
Whether you will need a blood transfusion will depend primarily on your medical condition and the type of surgery you are having. Often the need for a blood transfusion is known before the surgery. Sometimes unexpected events occur during surgery and the need for an emergency transfusion may arise. This should be a topic of discussion with your surgeon and anesthesiologist.
9. Do I have to have a breathing tube?
General anesthesia may weaken your ability to breathe on your own. There are different ways to assist your breathing - one of which is the breathing tube (known as an endotracheal tube). There are many situations when the placement of the tube is the safest and most reliable method to assure adequate breathing and to protect your lungs from stomach acid. There are alternatives in other cases including breathing through mask or other devices. You can discuss this issue with your anesthesiologist to see if these might be applicable.
10. Can I request the specific type of anesthesia that I want?
To some degree you can. Your anesthesiologist will review your planned surgery and your medical condition. Then he or she will be able to discuss your options and preferences with you.
11. What are the common risks of anesthesia?
Today, the common complications of anesthesia are not particularly dangerous and the more serious complications of anesthesia are very rare. The most common complications include nausea, vomiting, sore throat, blood pressure changes, and pain. These are usually mild, not dangerous and easily treated with medication. The more serious complications include dental injury, nerve injury or paralysis, allergic reactions, adverse reactions to unknown genetic conditions, stroke, heart attack, etc. some of which can lead to serious disability or death. These can occur in some cases regardless of the experience, care and skill of the physician. Careful monitoring by your anesthesiologist, new medicines and monitoring tools have helped to make anesthesia extremely safe.
12. Why can’t I eat or drink before the anesthetic?
Anesthesia depresses the normal gag reflex that prevents solids and liquid matter from entering our lungs, so there is a risk of vomiting and aspiration if there is anything in the stomach when anesthesia is administered. Aspiration means that the contents of the stomach end up in the lungs and this can be life-threatening. According to recent studies, the rate is 1-5 per hundred thousand anesthetics (1- 5:100,000). This is why it is most important to follow the instructions given and to tell your anesthesiologist if you have had anything to eat or drink (including a sip of water or coffee).
- Adults and Children over 2: STOP solids and liquids at midnight when your surgery is scheduled before 12 noon the day of surgery. You may have clear liquids up to 7:00 am the morning of surgery if your surgery is scheduled after 12:00 noon.
- Children 2 Years and Younger: STOP solids (including formula) 8 hours before surgery, breast milk 4 hours before surgery, and clear liquids 2-4 hours before surgery.
Clear Liquids Include the following:
• Apple Juice/Cranberry Juice
• Tea/Coffee without Cream or Sugar
• Apple Juice/Cranberry Juice
13. Why do I have to remove my jewelry for surgery?
This is not an anesthetic concern but your surgeon may need to use a special instrument to stop bleeding during your surgery. If you are wearing metal jewelry that is in contact with your skin, or have body-piercings, it could cause an electrical burn in the area. Additionally, swelling may occur during prolonged surgery causing rings to become tight, constricting the blood flow to fingers and toes.
14. Will I be aware of what is happening during a general anesthetic?
This is an extremely rare but not impossible risk of anesthesia. In most instances, your anesthesiologist is able to give you sufficient medications to eliminate this possibility. In some severe emergencies, or in certain types of high-risk surgeries and sets of patient circumstances, it may not be possible to administer sufficient medication to both maintain life and eliminate this possibility in its entirety. The likelihood of "awareness under anesthesia" is very low. Anesthetic medications are given continuously during the operation based on your responses to our monitors and observations. We will usually know when you need deeper anesthesia long before you could become aware. If you have particular concerns about awareness, or feel you have experienced awareness during a prior operation, please discuss this with your anesthesiologist. There is additional monitoring available which may be helpful if this is an overwhelming concern.
15. Do I need to quit smoking before surgery?
Tobacco smoking produces long-term effects on your blood streams oxygen carrying capacity. Ideally, you should quit smoking 6 – 8 weeks before surgery to reverse the multiple physiologic impairments that smoking produces. However, smoking cessation even 24 hours before surgery can result in a substantial benefit. This permits a reduction in the carbon monoxide level in the blood stream which improves the oxygen carrying capacity, especially to the heart and vital organs. We recommend that you quit smoking for as long a period as you can tolerate prior to surgery, with a minimum of 24 hours. For the highly addicted patient, even this may be difficult to achieve. This is an individual decision, but there are real benefits to those who can stop. You may wish to use a nicotine patch or other substitute to help you during this period. You may just wish to use this “forced” opportunity to quit smoking altogether!
16. What will happen when I wake up after surgery?
You will be monitored for a period of time in the recovery room, where we will continue to give you medication if necessary to alleviate your pain. Side effects such as nausea and vomiting continue to be a possibility within the first 24-48 hours following surgery, although a number of newer drugs have significantly reduced their incidence. Some people, however, are more prone to these symptoms and will therefore have to be monitored for a longer period of time.
17. Will there be other side effects?
It is not uncommon to have a sore throat for a few days, especially if you had a breathing tube placed. Dental injuries are also a possibility, especially if you have been less diligent about preventive dental care and/or have artificial dental devices such as caps or bridges. This is not necessarily related to anything that the anesthesiologist did. In some instances, it may be impossible to insert a breathing tube quickly, especially in someone with a small mouth, without touching any teeth. Just as frequently, dental injuries may occur during the “wake-up” phase, when you may roll over or bite down on a tooth that is fragile, causing it to crack or break. Again, these situations are rare, but certainly not impossible.
18. What methods of analgesia are available for pain relief when I am in labor?
Your obstetrician may provide intravenous medications to help relax you and provide pain relief. If you wish for a more complete method, anesthesiologists may be called in to provide regional anesthetics in the form of an epidural, a spinal or both.
19. What is a labor epidural?
It is a local anesthetic delivered through a small catheter placed in the small of the back near the spinal canal. It is generally considered one of the most effective methods available to patients desiring pain relief but wanting to be awake and able to participate in the birth.
20. What is a spinal?
It is similar to an epidural but, because anesthetic is injected directly into the spinal canal, the effects are felt faster. During labor, it is more difficult to move and push via this method due to greater numbness. For this reason, the epidural is the more popular method to treat labor pain.
21. Who should not consider these methods of pain relief or anesthesia?
People on blood thinners or with a history of bleeding disorders, those with nervous system disorders, with an infection in the back or those with a history of back surgery and/or spinal abnormality may not be good candidates for these methods of pain relief or anesthesia.
22. What are the risks of epidural analgesia for childbirth?
Epidural anesthesia has a good track record for safety in the laboring patient. In our practice, we do several labor epidurals each day, and it is most uncommon for patients to encounter serious complications from them.
Risks include severe headaches, inadequate pain relief, and/or allergic reaction to the medication. Epidurals may inhibit the ability to push in some patients, which may increase the chances of a forceps delivery (a procedure which carries its own set of risks). The most common complication is a fall in the mother's blood pressure. If the blood pressure drops to a sufficient degree, the circulation to the placenta may be compromised, causing less oxygen to be delivered to the fetus.
For this reason, after you get an epidural we monitor the baby's heart rate closely as well as of the mother's blood pressure. If any significant changes occur, we have drugs immediately available to help restore blood pressure. Other measures such as supplemental oxygen and positioning the mother on her side (alleviating potential compression of the major blood vessels) are also taken. These interventions are nearly always effective. There have, however, been isolated cases in which the administration of an epidural was followed by low maternal blood pressure and a drop in the baby's heart rate that did not recover with therapy, precipitating an emergency C-Section.
Other complications occur rarely which include headache, inadequate pain control, total spinal anesthesia, seizure, and nerve damage. A spinal headache occurs in about one to two percent of persons; five to ten percent of patients with epidurals may perceive their pain relief as inadequate. Trauma to nerves resulting in abnormalities of sensation or strength, usually in the legs, seems to happen about once per ten to twenty thousand epidurals and normally is not permanent although recovery times can be prolonged (in the range of weeks to months). A few patients sustain nerve problems as a result of vaginal delivery. Nerve injury can be caused from pressure by the fetal head on the nerves that run through the pelvis to the legs, or sometimes by the stretching of nerves if the legs are held back during pushing. Fortunately, most patients rebound from nerve injury without developing permanent problems. Accidental injection into blood vessels resulting in seizures, inadvertent injection into the spinal canal causing temporary but full-body numbness, a broken needle or catheter which may require surgical removal, post delivery back pain, weakness or paralysis of the lower part of the body, bleeding and/or infection are all possibilities although very rare.
23. Will the epidural affect the baby?
Most babies born to mothers that have received an epidural are vigorous with good Apgar scores. The drugs that we use in epidurals do not enter the fetus in significant amounts, and what little does get across resolves after a matter of hours.
24. How soon will a labor epidural work?
When you have been prepared for your epidural, the anesthesiologist will be notified and will come as soon as he or she is able. After a brief screening interview, you will be positioned either on your side or sitting according to the preference of the anesthesiologist. The procedure for inserting the epidural will then begin. For patients with normal anatomy, this usually takes only a matter of minutes, but if the patient has an abnormality of the spine or is significantly overweight the procedure can become technically difficult and may take longer to complete. Once the epidural catheter has been successfully placed the initial dose of anesthetic medication is injected and pain relief generally ensues within five or ten minutes. Our goal is to deliver an infusion of anesthetic solution that will provide continuous pain relief throughout the remainder of the patient's labor. The patient may additionally administer supplemental doses of pain medication buy pushing a button (Patient Controlled Epidural Analgesia). Most patients attain satisfactory control of their labor pain with this technique. Occasionally it becomes necessary to replace the epidural catheter if it appears to have become dislodged and is no longer delivering the medication effectively.
25. Can an epidural cause me to have back pain?
Back pain is a common finding in patients who have had vaginal delivery, regardless of what form of pain control is used, i.e., with or without the use of epidural anesthesia. One study examined the number of patients who complained of back pain after childbirth and found that there were equal numbers of patients with back pain after vaginal delivery in both epidural and non-epidural groups. Furthermore, there were fewer backaches among patients who had had a C-Section, and backache among C-Section patients was equally likely after general anesthesia as after epidural. This strongly suggests that, while back pain is often seen after vaginal delivery, epidurals are not a contributing cause for most patients.
26. Does it hurt when placing an epidural?
Most patients do not experience significant discomfort during the insertion of epidural catheters. After cleansing the skin, a local anesthetic is usually injected to numb the area where the epidural will go. Local anesthetics such as this ordinarily will give a stinging or burning sensation during injection. For the average patient, this is the most uncomfortable part of the procedure, and lasts only a few seconds.
After the skin is numbed, the actual insertion of the epidural needle is typically limited to sensations of pressure or pushing, and perhaps “gritty”, popping sensations as the needle is advanced through the tissues. These sensations are entirely normal to feel and should not serve as cause for alarm. Any discomfort during this phase is usually limited to a mild ache and is easily tolerated by most patients. Of course, every individual has a unique tolerance to pain and some persons seem to have more discomfort during the procedure than others. If you are unable to tolerate the needle placement the epidural will be stopped.
27. Will an epidural increase my chances of needing a C-Section?
There is controversy regarding the question of whether or not the use of epidural anesthesia predisposes patients to C-Section. Numerous studies have been done to answer this question, with conflicting results. Some studies have shown that patients with epidurals are more likely to deliver by C-Section than those without. However, others have noted that the introduction of epidurals into an obstetric practice did not increase the C-Section rate. At this point in time, the answer to this question remains obscure. However, the fact that no indisputable effect has been consistently demonstrated suggests that the contribution of epidural anesthesia to the probability of C-Section, if it exists at all, is probably small.
28. What medicines should I take before anesthesia?
In general, it is good to continue inhalers and most eye drops, and to continue most blood pressure, heart and breathing pills. Diuretic or “water” pills should not be taken. Usually, diabetic patients should not take either blood sugar lowering pills or insulin on the day of surgery. Usually all anticoagulants (Coumadin, warfarin, Ticlid, Lovenox, enoxapralin, aspirins and non-steroidal anti-inflammatory drugs- Motrin, Advil, Ibuprofen) need to be discontinued prior to surgery.
However, since each patient's medications are different and surgical times vary throughout the day, it is important to discuss this during your pre-anesthesia interview or telephone call. You will be provided with complete instructions at that time.
If you have any questions, please call Martha Jefferson Hospital at 982- 8237 or the Outpatient Surgery Center at 293-4995 for clarification.
29. What should I do if I might be pregnant?
Surgery on any patient who is or might be pregnant requires careful consideration by your surgeon, anesthesiologist, and obstetrician. The safest option for a pregnant patient is to postpone elective surgery until after delivery. If you are or may be pregnant at the time of your scheduled procedure, be certain to discuss this with your surgeon and anesthesiologist as early as possible before your surgery.
30. Does my child have to have an IV?
Most often, yes, but it is usually done after the child is asleep from inhaled anesthesia gases. Occasionally it may be necessary to have the IV in place prior to going to sleep, for instance, when there is concern over the risk of pulmonary aspiration. Your anesthesiologist will make that determination when your child is assessed preoperatively.
31. Is it safe for children to have general anesthesia?
Yes, indeed. The risk of serious complications occurring in otherwise healthy children as a result of exposure to anesthesia is very low.
32. Will my child suffer from pain or nausea afterwards?
Pain and postoperative nausea may occur to varying degrees after many types of surgery; however, in most cases these effects can be foreseen and appropriate medications can be given while the child is asleep so that the impact of these conditions may be blunted. If further therapy is needed, it will be addressed during the recovery room stay.
33. Can I be present while my child goes to sleep?
Yes. One adult is allowed into the OR for the induction of anesthesia.
34. How long will it be until the effects of the anesthesia wear off?
By and large, the effects of the anesthetic agents will be dissipated before the patient is discharged from the recovery room. However, there may be a lingering effect from pain medications given during or after surgery. Usually these medications have a time span in the range of three to four hours.
35. Is there anything we should be on the lookout for after we get home?
Not as a routine. The anesthesiologist will not discharge the patient from the recovery room until he or she has determined that further observation for anesthesia-related complications is not warranted.
36. How will I be billed?
As individuals or as a private group, services are billed separately from the hospital. You will however be billed by the hospital for your anesthesia drugs and supplies. We do participate with most of the same insurance plans as your hospital and surgeon. Depending on your insurance, you may have some out-of- pocket expense for our professional services.