Your Anesthesia Care Team
Our care team consists of an anesthesiologist and a CRNA (anesthetist) who work together to provide the best medical care possible during surgery as well as safe and effective relief from pain during your Post-Anesthesia Care Unit (PACU) stay. An anesthesiologist interviews all patients preoperatively to discuss the most appropriate anesthetic management; the final decision will be based on your general health, the type and duration of your surgery and your preference. During your surgery, a member of our care team will be with you at all times to monitor your comfort and safety.
Anesthesiologists are medical doctors who have completed a four-year undergraduate program, four years of graduate medical doctoral training and four more years of anesthesiology residency. They apply their specialized knowledge to ensure your comfort during surgery and to make informed medical judgements about your anesthetic care.
CRNAs are registered nurses with a Bachelor of Science in Nursing (BSN) who have completed an accredited graduate school of nurse anesthesia program and pass a national certification examination following graduation. These educational programs range from 24-36 months and include clinical training in university-based or large community hospitals. Successful completion of the exam earns the graduate the designation of CRNA or certified registered nurse anesthetist.
About My Anesthesia
You will be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under the effect of the anesthesic. Vomiting can cause food in the stomach to be inhaled into the lungs. This can lead to chemical burns or obstructions in your lungs that can cause life-threatening breathing problems. Take medicines that your provider told you to take with a small sip of water. Arrive at the hospital on time. Please inform your anesthesiologist if you think you may be pregnant or if you have had any recent changes in your health such as a cough, cold, shortness of breath, or chest pain.
What are the Risks of Anesthesia?
General anesthesia is extremely safe for healthy people. However, as with all medical or surgical procedures, anesthesia has inherent risks. You may have a higher risk of problems with general anesthesia if you abuse alcohol or other medications or if you have heart, lung, or kidney problems. Serious risks include harm to your vocal cords, heart attack, lung infection, mental confusion (temporary), stroke, trauma to the teeth or tongue, waking during anesthesia (rare) and death (extremely rare). Your anesthesiologist will have a conversation with you regarding these risks and answer any questions you may have the morning of the surgery. Prior to surgery, you will be asked to read and sign an “informed consent” document detailing these risks. Our care team is constantly monitoring your condition throughout surgery, and is prepared to deal with any anesthetic problems should they arise.
What Happens in the Recovery Room?
At the completion of surgery, you will be taken to the PACU to allow you to recover from your anesthetic while specially trained nurses monitor your vital signs, and make you as comfortable as possible. Your anesthesiologist is responsible for your safety in the recovery room and directs the nurses in the provision of your care. If your surgical procedure is being performed as an outpatient, your anesthesiologist is the physician who determines when you are ready to be discharged.
What about my Pain?
Unfortunately, surgical procedures are associated with some degree of pain. Your anesthesiologist has an intricate knowledge relating to pain control following surgery and can help provide pain relief in a multitude of ways. Multi-modal pain control with pain medications including anti-inflammatory medicines as well as different classes of narcotics are tailored for each individual before administration. In some instances, your surgeon may request the anesthesiologist to place a nerve “block”. This is usually done in the pre-operative area and will be discussed in detail with you the morning of the surgery. This involves using ultrasound guidance to place a small needle near the bundle of nerves that provides innervation to the area being operated on. This provides pain control that is far superior to pain medication alone. In certain thoracic or abdominal surgeries epidural analgesia may be requested by your surgeon. This involves placing a small catheter into the epidural space which lies just superficial to area where the nerves leave the spinal canal. This small catheter is then connected to a computer controlled pump which delivers an appropriate anesthetic mixture to control pain from the surgical site.
Under general anesthesia, you are completely unconscious and unable to feel pain during surgical procedures. General anesthesia usually uses a combination of intravenous drugs and inhaled gasses (anesthetics). General anesthesia is more than just being asleep; although the patient is unaware the anesthetized brain still responds to pain signals and stress from the surgery that is then treated by the anesthesia provider. While you’re unconscious, the anesthesia provider monitors your body’s vital functions and manages your breathing. The morning of the surgical procedure your anesthesiologist will discuss the appropriate choices of anesthesia for your case.
Regional anesthesia involves making a portion of the body insensitive to pain by temporarily “blocking” large groups of nerves by the injection of local anesthetics. There are several forms of regional anesthetics, which include:
Also known as neuraxial anesthesia, a spinal or epidural anesthetic is used for lower abdominal, pelvic, rectal, or lower extremity surgery. This type of anesthetic involves injecting anesthetic medication into the spinal or epidural space, which surrounds the spinal cord. The injection causes numbness in an area of the body supplied by the nerves that are blocked by the anesthetic. Usually, but not always, a spinal anesthetic involves a single injection of a medication, while an epidural anesthetic involves placement of a small catheter into the epidural space. Epidural anesthesia may also be used for the purpose of controlling pain both during and after surgical procedures, including those involving the upper abdomen or chest, or for management of lower extremity procedures.
Nerve blocks involves the injection of local anesthetic near the location of a nerve or group of nerves that provide sensation to a specific region of the body, usually one of the limbs. Depending on the type of medicine administered, you may expect the affected body part to be numb for up to 24 hours or more after the surgery.
Some examples of surgery which might involve the use of a nerve block are: rotator cuff repair, anterior cruciate ligament (ACL) reconstructions, shoulder surgery as well as many orthopedic fracture repair procedures.
The use of ultrasound-guidance has improved the quality, effectiveness and safety of many nerve blocks.
Sometimes referred to as “conscious sedation” monitored anesthesia care encompasses the use of a variety of medications, usually given intravenously, to produce varying levels of sedation during surgical procedures. Because this is not considered true general anesthesia, patients may or may not experience awareness and memory of aspects of intra-operative events. An anesthesia provider will be with you at all times to monitor your well-being, and adjust the level of sedation as needed. In addition to the sedation you will receive, your surgeon will often use local anesthetics in the body region where you are being operated upon. The advantage of this type of anesthesia, as opposed to general anesthesia, is that there are typically fewer side-effects such as nausea, sore throat, and memory impairment, as well as the ability to avoid the use of a breathing tube. It is important to remember that the level of anesthesia you receive is tailored to your changing needs during your surgery, and at some point it may become necessary to institute full general anesthesia. Possible side effects include nausea/vomiting, temporary memory impairment and respiratory depression which may necessitate general anesthesia.