Your Anesthesia Experience:

Your Anesthesia Experience: Key Topics

Our Approach

Your anesthesia will be provided by a physician specialist. Our focus is on your safety and comfort…and we strive to maximize both. We understand that undergoing surgery is a stressful time for our patients, and we make every effort to provide the finest care with compassion.

Preoperative Instructions

Whenever possible, your anesthesiologist will discuss preoperative instructions that are specific to you and your situation. The following points may be useful for general information.

1) Food and Liquids:

Food and liquids must be avoided for a period of time before anesthesia to maximize your safety. This is known by the abbreviation NPO (non per os, or nothing by mouth). A standard rule of thumb is “NPO after Midnight except for medications with a sip of water”.

You should thus NOT eat solid food after midnight on the day of surgery (unless you have been specifically instructed otherwise). Unless you have been told otherwise, you should also not drink fluids after midnight except for a sip of water to take necessary medications. (Your anesthesiologist may safely modify these orders based on your individual circumstance.) It’s truly a matter of safety.

The rationale of fasting before surgery is to reduce the chance of aspiration of stomach contents. Aspiration is a serious and potentially life-threatening complication where stomach contents pass back up into the mouth and pharynx and then enter the lungs and airways.

2) Medications:

Unless you have been specifically told otherwise, it is usually ok to take your regular medicines on the day of surgery. Exceptions may include any medications discontinued by your surgeon or primary physician (typically blood thinners and medicines which impair blood clotting such as coumadin, aspirin and ibuprofen). It is also usually best to avoid oral hypoglycemics (glucose-lowering pills for diabetic patients). Your anesthesiologist should discuss other specific medications with you directly.

3) Clothing:

As surgical suites tend to be quite cold, you may find it beneficial to dress warmer than you otherwise would. While you should certainly remain comfortable, starting off “not chilled” has potential advantages for making IV starts easier and reducing shivering. Your surgeon may have provided other instructions regarding dress.

4) Jewelry:

Jewelry should be removed prior to arrival, or preparations made to remove it preoperatively. This reduces the risk of burns that could be induced via the metal from instruments commonly used during surgery. Jewelry could present other risks as well, including injuries from compression or if swelling occurs.

5) Makeup and Lotions:

Makeup and lotions are usually best avoided on the day of surgery. If lotions have been used the night before surgery, it may be helpful to wash them off on the morning of surgery.

6) Beards and Mustaches:

Beards and mustaches typically present no problem during anesthesia. However, it is best to trim them (both in “margins” and “thickness”). Ideally, mustaches should not overhang the upper lip and obstruct visualization of the mouth.

7) Arrival Time:

Patients are customarily asked to arrive at their surgery center well ahead of the scheduled surgery time. Although inconvenient or annoying in some regards, it is a necessary procedure that allows for admission, paperwork, and preparation for surgery. Everyone appreciates your understanding and cooperation.

Options and Alternatives

The majority of procedures are done under General Anesthesia (with the patient “fully asleep”). Your anesthesiologist will be happy to discuss any feasible options and alternatives for your care. While you obviously retain ultimate control of your care, your anesthesiologist will recommend a plan suited to your particular circumstances based on extensive training, experience, and professional judgment.

Preoperative Evaluation

Patients who are at home on the night before surgery will typically receive a phone call from their anesthesiologist. This gives the anesthesiologist a chance to obtain information about you. It also gives you a chance to know who will take care of you, to discuss the anesthetic, and to ask questions. For those occasions where phone contact is not made for whatever reason, this preoperative discussion is done in the hospital on the day of surgery. Either way works fine, and you can rest assured that your anesthesiologist will take great care to explain everything to your satisfaction and to answer any questions you have.

Information helpful to planning your care includes: past medical history; prior surgeries; details about prior anesthetic experiences (especially any history of airway difficulties or difficult breathing tube placement); any family history of adverse anesthesia reactions such as high fevers (malignant hyperthermia); height and weight; allergies (to medications or any other substances); medication list; habits that could affect anesthesia (drug, alcohol, and tobacco use); and any current symptoms you are having.

Patients who are already in the hospital most often meet their anesthesiologist on the day of surgery. Sometimes a visit (in person or by phone) will take place the day before the surgery. Either way, your anesthesiologist will explain the anesthetic and answer your questions before surgery begins.

Prior to surgery, of course, your anesthesiologist will also speak to your surgeon about the procedure and any special considerations for your care. A chart review will convey important information about your medical condition, and the results of laboratory tests and studies will be noted.

Anesthesia Care and Monitoring

Your anesthesiologist will see you in the preop holding area. If an IV (intravenous catheter for fluid and medication administration) isn’t already started, one will be placed at that time. Other options for small children may be offered. Once all of the essential preparations have been completed you will be taken to the operating room.

Before your anesthetic is administered, you will be given supplemental oxygen to breath and monitors will be placed. Monitors routinely used include ECG (electrocardiogram to evaluate your heart rhythm), pulse oximetry (a finger clip evaluate your oxygen levels), and blood pressure cuff (to watch your blood pressure).

General anesthetics typically require the placement of a breathing tube or other device after the patient is asleep to facilitate respiration and administration of anesthesia.

Additional monitors may be placed depending on the patient’s medical status or the nature of the surgical procedure. Some of these monitors could include: arterial line (catheter in an artery to allow continuous blood pressure measurements), central venous line (for additional access and monitoring of blood volume status), pulmonary artery catheter(for information about heart pressures and function), or transesophageal echocardiogram (esophageal probe to take ultrasonic images of heart structure and function, mostly used in cardiac surgical cases).

Your anesthesiologist will discuss the specifics of your care and will be pleased to answer any questions or concerns that you have. He or she will monitor your vital parameters throughout the surgery to maximize your safety.

Postoperative Course

At the conclusion of surgery, you will be brought to the appropriate recovery area. Whether this is the recovery room or the intensive care unit, your anesthesiologist will ensure the transition of care. Medications to reduce pain and nausea will be available. Any special requirements will be attended to.

The family of the patient will be informed about when and where they may visit the patient. Remember that the postoperative care providers’ top priority and focus is on the patient, but every effort is usually made to reunite the family at the earliest appropriate convenience.

Modern anesthesia typically allows patients to wake up quickly. Most patients in the recovery room are awake enough to follow commands within minutes after surgery, and are more completely awake within an hour or so. Some degree of residual drowsiness may be noted depending on individual variation and the response to medications that may be required postoperatively. Patients going to the intensive care unit are more likely to be sedated for longer periods of time, depending on many variables.

Post-recovery instructions and the surgeon’s postoperative instructions (for activities, eating, etc) should be followed. At a minimum you should not drive or make important decisions on the same day after surgery. If your surgeon has approved eating and drinking postoperatively, we still suggest starting lightly (e.g., ice chips, juice, crackers, etc.) and advancing your diet slowly and gradually to reduce nausea.

Risks and Potential Complications

When preoperative consults are made ahead of time, preoperative instructions are provided. Please follow the guidelines described by your physician to enhance your safety.

For example, it is common to order nothing by mouth after midnight except for medications with a sip of water, unless otherwise modified directly by your anesthesiologist. The rationale of this recommendation is to reduce the chance of aspiration of stomach contents, a serious and potentially life-threatening complication.

Anesthesiology as a field has been at the forefront of proactive safety measures. Modern anesthesia is safer than ever before. Your anesthesiologist will take every measure to maximize your safety. As with any procedure, however, there are risks ranging from the very minor to the very severe, and complications can occur. A large part of the risk of anesthesia derives from preexisting medical conditions in our patients. Surgery and anesthesia, of course, do have inherent risks as well. The spectrum of anesthesia is very broad but

Relatively minor side-effects and complications are statistically more common than serious ones. Examples could include nausea and vomiting, shivering, sore throat, residual drowsiness, minor lip or dental injury, muscle aches, and bruising or swelling at the IV site.

Serious or life-threatening problems are fortunately very rare. Awareness under anesthesia, heart attacks or other heart problems, strokes, nerve injuries, lung and breathing problems, kidney and other organ dysfunction, complications from the breathing tube or invasive monitors, allergic and metabolic reactions, and other serious problems can occur.

Every precaution is taken to try to prevent problems before they arise. Your anesthesiologist will monitor you continuously and vigilantly. If unexpected problems do arise, your anesthesiologist will use all of the most advanced techniques to manage the issue. Once again, your safety is our top priority. We care about you.

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