- Is anesthesia safe…?
- Is awareness under anesthesia common…?
- Is nausea and vomiting common…?
- Why must I fast prior to surgery…?
- What is malignant hyperthermia…?
- How am I monitored…?
- What are some risks of anesthesia…?
- Will the anesthesia staff be with me at all times?
- How is my pain controlled after surgery?
- What follow up care do I receive?
- Which is better; general or regional?
- When can I eat and drink after surgery?
- What drugs do you use?
- How do you know ho much anesthesia to give me?
- Will I say anything embarrassing while sedated or asleep?
- When do I wake up after a general…?
- I have latex allergy. What precautions are taken?
- Will I need a blood transfusion?
- Do I have to have an i.v. (intravenous line)?
- Will I get medication to decrease anxiety, before surgery?
- Up to what time may I drink and eat prior to surgery?
- Are Herbs safe?
- How will I be billed?
Is anesthesia safe…? back to top
Serious complication rates have dramatically improved over the past 40 years. In the 1950’s the rate was 1:1560 anesthetics. The current rate ranges from 1:10,000 to 1:200,000. This decrease is a result of better drugs, equipment and personnel.
Is awareness under anesthesia common…? back to top
Despite the media attention the incidence of recall of events under general anesthesia remains a rare event. In the United States, the incidence is 30,000 cases per 15 million cases of general anesthesia per year of 0.2%. It is most common in cases where inhalation agents are given in reduced doses: trauma, cardiac anesthesia and obstetrics. Any case of awareness is taken very seriously by AAG.
Is nausea and vomiting common…? back to top
Nausea and vomiting represent one of the most common side effects of anesthesia with incidence of 20% to 30%. This is better than the days of ether anesthesia where the rate was over 50%. A previous history of nausea and vomiting, female sex, young age, obesity and type of surgical procedure influence the incidence. There are a variety of drugs available for combating this side effect. If you have had a serious problem with nausea and vomiting, please stress this at the preoperative interview. Your anesthetic plan will take this into account.
Why must I fast prior to surgery…? back to top
Anesthesia depresses the normal gag reflect that prevents solids and liquid matter from entering our lungs. The process of reflux of material from the stomach into the trachea and lungs is called aspiration. Fortunately, the incidence is quite low. According to recent studies, the rate is between 1-5 per hundred thousand anesthetics. Assuring tat the stomach is as empty as possible prior to anesthesia is a mainstay in aspiration reduction. This has been routinely accomplished by nothing to eat or drink after midnight, the day of surgery (NPO after midnight). In emergency operations, patients obviously have not fasted. In these cases we can alter the anesthetic delivery and induction to insure maximum safety.
What is malignant hyperthermia…? back to top
Malignant hyperthermia (MH for short) is a rate genetic disorder characterized by extreme body temperature elevation under general anesthesia. The incidence in adults is about 1 in 50,000 general anesthetics. Certain drugs such as the inhalation anesthetics and the drug succinylcholine are common triggers of this hypermetabolic state. The drug dantrolene is the antidote to this process. With dantrolene and other treatment measures the mortality has been decreased from 80% to 10%. Both Riverside and the Upper Arlington Surgery Center keep fresh supplies of this drug on hand for such an emergency. In patients with known MH or strong family histories, the triggering drugs are avoided during anesthesia. Since there is a strong inherited component, please let us know during the preoperative interview of MH in your family. For more information consult the Malignant Hyperthermia Association of the United States (MHAUS) website: www.mhaus.org.
How am I monitored…? back to top
The monitors we use under general anesthesia depend on both the type of operation and the patient’s medical condition. The minimal monitors under general anesthesia include: blood pressure, EKG, heart rate, temperature, stethoscope and two monitors of breathing. The pulse oximeter (placed on the fingertips) measures the oxygen saturation of hemoglobin (oxygen carrier) in your blood. This monitor has markedly improved the safety of anesthesia. The other monitor of breathing measures the carbon dioxide in your exhaled breath (capnometer). It helps us in adjustments of the respirator. For more complex procedures such as open heart surgery additional monitors of circulation such as continuous blood pressure and heart pressures. Your anesthesiologist will discuss placement of any invasive monitors with you prior to surgery.
What are some risks of anesthesia…? back to top
As indicated in the first questions, the most severe complication, death is very rate. The rate of other complications will vary with the health status of the patients and the magnitude of the procedure. The common side effects of general anesthesia include nausea, sore throat from the breathing tube, dental damage, muscle aches and shivering postoperatively. Side affects of regional anesthetics such as spinal and epidural anesthesia include spinal headache, nerve irritation, rare infection and back pain. (insert a link for the Anesthesia Consent Form)
Will the anesthesia staff be with me at all times…? back to top
A member of the anesthesia care team will be with you at all times in the operating room. This is a standard of care in our practice. Postoperatively, in the recovery room a registered nurse will provide your care. You will still be under the supervision of an anesthesiologist.
How is my pain controlled after surgery…? back to top
Planning for post-operative pain control begins during your surgery. There are multiple techniques to minimize pain.
- Local anesthetics can be injected into the surgical site at the end of the procedure.
- Intravenous agents such as narcotics and anti-inflammatory drugs are carefully dosed in the operating room and recovery room.
- An epidural catheter can be placed prior to surgery. Postoperatively, dilute solutions of narcotics and/or local anesthetics are dosed through the catheter. This technique is utilized commonly in major vascular surgery procedures. The epidural is left in up to 72 hours postoperatively.
- Narcotics can be injected with local anesthesia as part of a spinal anesthetic.
- A patient controlled analgesia pump (PCA for short) allows for self-medication. This device features a wrist watch like pump which delivers small doses of narcotic according to patient demand. The dosage amounts are adjusted in the device to prevent overdose.
Most often pain is controlled by several of the above approaches at once.
What follow up care do I receive…? back to top
As an inpatient you will be seen postoperatively by either our postoperative follow up nurse or your anesthesiologist. Any complications are reported to the anesthesiologist for further action. Outpatients are contacted by the hospital postoperatively. Again any complications are reported back to our group. Patients with emergent postoperative anesthetic concerns may call the Northeast Georgia Medical Center operator at (770) 535.3553 and ask for the anesthesiologist on call.
Which is better; general or regional….? back to top
This question is bound to stir up controversy. Many procedures such as heart surgery can only be done under general anesthesia. Peripheral procedures such as knee arthroscopy could be done under general or spinal/epidural. There have been many studies in the anesthesia literature examining the general vs. regional questions. Most show no difference in outcome. The final choice will rest on the patient preference and type of procedure. In the case of knee arthroscopy some patients prefer to remain awake so they can watch the procedure on the monitor. This is the perfect case to use a spinal or epidural. Outpatients can’t be discharged home until the block has totally won off. This is one major disadvantage of regional in this type of case. The possibility of headache after spinal anestjhes9ia is another issue. Your anesthesiologist will be glad to discuss the risks and benefits of regional versus general for the planned surgery.
When can I eat and drink after surgery….? back to top
This will vary with the procedure. Patients who have had minor outpatient procedures can eat and drink as tolerated after discharge. You should start with fluids and progress to a full meal. In cases such as major abdominal surgery, you cannot eat or drink until your bowel function returns to normal. This can take longer than 24 hours.
What drugs do you use….? back to top
Anesthetic drugs are unique in that they are seldom used outside of the operating room setting. For induction of general anesthesia, the intravenous agent Propofol is commonly used. It is shorter acting and associated with less nausea and vomiting compared with the many other choices. The general anesthetic state is maintained with a mixture of gases and intravenous agents. The trade names of the gases are Forane, Suprane and Sevoflurane. They are administered from machines called vaporizers. Other classes of drugs are also used. Narcotics are given as an adjuvant to the inhaled gases. The common ones used include Morphine, Dilaudid, Fentanyl and Sufentanyl. To facilitate the placement of the breathing tube after anesthetic induction, a muscle relaxant is given. There are many brand names and common ones used include Succinylcholine, Rocuronium and Vecuronium. The use of Succinylcholine can result in muscle pains postoperatively (myalgias).
How do you know how much anesthesia to give me….? back to top
Under general anesthesia we are guided by careful monitoring of your vital signs such as blood pressure, heart rate and respiratory rate. Increases in the preceding signs would indicate light anesthesia and the dose would be increased. The careful balance of drug dose to level of stimulus allows for more rapid emergence at the end of the procedure. The doses of local anesthetics in spinal or epidural blocks are guided in part by the height of the patient. For many nerve blocks the dose is guided by body weight.
Will I say anything embarrassing while sedated or asleep…? back to top
Patients become very drowsy under sedation and unconscious under general anesthesia. We never hear any sensitive information revealed.
When do I wake up after a general…? back to top
The awakening process begins when the gases are discontinued at the conclusion of surgery. The time to full arousal will depend in part on the length of the procedure. Most patients can follow commands within 10 minutes are fairly awake within an hour. Due to the residual effects of all the drugs, important decisions should not be made in the first 24 hours after general anesthesia.
I have a latex allergy. What precautions are taken…? back to top
It is important to inform your surgeon of this preoperatively. At Riverside we have a special cart stocked with latex free equipment. One important item is latex free surgical gloves. Latex allergy would be suggested by allergic symptoms (runny nose, itchy eyes, wheezing) during:
- Blowing up balloons
- Dental exams
- Contact with condoms or diaphragms
- Rectal or gynecological exams
- Exposure to rubber gloves
Will I need a blood transfusion….? back to top
Given the possibility of infectious transmission (hepatitis, AIDS, etc), blood products are given only if absolutely necessary. The decision to give blood is determined by many factors. A young health person is able to tolerate anemia (decreased blood counts) better than an elderly person with heart disease. We would therefore allow the healthy patient to lose more blood before transfusing. We can follow the blood counts during surgery to help us decide when to transfuse. The possibility of transfusion is higher in procedures that might involve significant blood loss such as spine fusion and open heart surgery. Techniques such as recycling your blood (cell saver) and pre-donation of your blood before surgery reduce the possibility of foreign blood transfusion.
Do I have an i.v…..? back to top
An intravenous line is placed prior to surgery in all patients who receive anesthesia. The line is used during surgery to administer medications and fluids. The skin I numbed prior to placement to minimize discomfort.
Will I get medication to decrease anxiety, before surgery….? back to top
In house patients are commonly given a small dose of sedative prior to transport to the operating room suites, if appropriate. Outpatients or same day admission surgery patients can be given small intravenous doses of sedation in the preoperative area. Our usual choice is Versed which is a short acting drug similar to Valium.
Up to what time may I drink and eat prior to surgery….? back to top
Many studies done in early 1990’s have shown that clear liquids empty rapidly from the stomach and need not be held for the usual eight hours prior to surgery. The current fluid and solid food policy is as follows.
- No solid food after midnight, the day of surgery.
- Clear liquids may be allowed for later surgeries at the discretion of your anesthesiologist.
If you would like to see the scientific basis of these rules, click on the following link: http://www.asahq.org/Practice/NPO/NPOguide.html
Are Herbs Safe….? back to top
Click on the following site for information from the American Society of Anesthesiologists concerning herbs. http://www.asahq.org/patientEducation/herbPhysician.pdf
How will I be billed….? back to top
The anesthesiologist and anesthetists providing your care are private practitioners just like your surgeon or obstetrician; therefore you will receive a separate bill for their services. As physicians independent of the hospital/clinic, their “participation” status with HMO’s, PPO’s and other third party payor organizations may be different from the Hospital and your surgeon/obstetrician. Please check with your insurance provider and our office concerning managed care network status prior to your procedure.
The anesthesia professional fee includes a preoperative evaluation, administration of your anesthetic and supervision of your recovery room stay. Because many factors influence the amount of your anesthesia bill, (type and length of surgery, and your physical condition), only an estimate can be determined prior to surgery. However, your charge for anesthesia during a procedure will be the same, regardless of the type of anesthesia administered. The “anesthesia” charge on your hospital bill is for hospital furnished supplies and equipment. If you or your surgeon request postoperative pain management using epidural analgesia, you will be charged for this service as a separate line item on your bill.
If you have any questions about your anesthesia fee, please contact our business office at (770) 532-7179.