We hope that the following information is helpful to you as you prepare for your surgery. Please ask questions. We believe that your anesthetic experience will be easier if you know what usually happens and what you should expect. Our aim is to provide you with the best possible care. Remember, the focus of anesthesia is on you, the patient.
After Your Surgery and Anesthesia
After the surgery is completed, you will be taken to the post anesthesia care unit (PACU), also called the Recovery Room. While in the PACU, you will be monitored and cared for by specially trained nurses. An anesthesiologist will direct the monitoring and medications needed for your safe recovery. Pain medications will be available to help ease discomfort. Your discomfort should be tolerable, but do not expect to be totally pain-free. Nausea or vomiting may be related to anesthesia, the type of surgical procedure, or pain medications. Medications to prevent or minimize nausea or vomiting can be administered at various times during the anesthetic process. After the recovery period is over, you will either be transferred to your hospital room or be dismissed to home.
If you plan to go home after surgery, you need to have a responsible adult to drive you home. This or another individual must be there to care for and watch over you the first night after surgery. Anesthetics can significantly affect your coordination and judgment for up to 24 hours. For this reason, please follow the discharge instructions, regarding such items as making important decisions, driving, and drinking alcohol, that you receive prior to your leaving the hospital.Risks Associated With Anesthesia
Although uncommon, complications or side effects can occur with each anesthetic option even though you are monitored carefully and your anesthesia care team takes special precautions to avoid them. There are frequent “minor” anesthetic risks, such as a sore throat or nausea after anesthesia. There are also infrequent problems, such as loosening or damaging a tooth. In addition, there are rare serious risks, such as heart problems, associated with anesthesia. Our aim is to inform you, but not needlessly worry you. Most people who are healthy have a low risk, but since anesthetics are powerful medications, there is no such thing as “zero” risk. If you have other medical problems, it may increase the overall risk, but this varies for every patient. Patients who are very young or very old may have increased risks for problems.
We have listed some, but not all, of the possible unpleasant things that could happen with the anesthetic process below. Remember, the vast majority of patient will not have any problems. Talk to us if you need to have any risks explained in more detail. We want to reassure you that the anesthesia team will be with you at all times—monitoring and caring for you throughout your anesthetic and surgery.
Examples of risks of general or regional anesthesia (nerve block) or MAC include: Bruises and abrasions, equipment complications, infection, tooth or gum damage, eye problems, lip cuts, sore throat, hoarseness, nausea or vomiting, cough, wheezing, dizziness, weakness, inhaling stomach contents, headache, backache, inability to urinate, reactions to local anesthetics, problems with blood supply, experiencing pain or being aware under anesthesia, high or low blood pressure, rapid or slow heart beat, lack of oxygen, birth defects or miscarriages in pregnant patients, angina, heart attack, stroke, heart failure, brain damage, nerve or spinal cord damage, paralysis, coma, or even death.
Examples of risks of monitoring various body functions include: Bruises, abrasions, bleeding, infection, blood vessel damage, nerve damage, lung problems.
Examples of reactions to transfused blood products includes: infections, hepatitis, or AIDS. Specific information is available to you about risks of blood products.
Examples of problems associated with positioning on the operating room table include:
prolonged pressure on a portion of the body causing skin, muscle, eye, or nerve damage.
Allergic reactions (minor or serious) to medications or other substances.
Remembering other talking or sounds while you are asleep under general anesthesia is very rare, but can occur. Remembering some talking or sounds while having only sedation (“MAC”) is common and expected.
Types of Anesthesia
There are several types of anesthetic techniques available. Sometimes there are several equally good choices for the anesthesia. Other times, a specific type may be required. The type of anesthesia selected for you will be based on the type of surgery you will undergo, your medical conditions, and your preferences and your surgeon. You should consider the advantages and disadvantages of each type as they apply to you, as well as our recommendations, before making a choice.
There are four anesthetic options:
• General anesthesia – This anesthetic choice produces unconsciousness so that you will not feel, see or hear anything during the surgical procedure. The anesthetic medications are given to you through an intravenous line or through a breathing mask or tube. A breathing tube may be inserted through your mouth and frequently into your trachea or windpipe after you are asleep to maintain proper breathing under anesthesia.
• Regional anesthesia – This technique produces numbness and loss of sensation with the injection of local anesthesia around nerves in a region of the body corresponding to the surgical procedure. Epidural or spinal anesthesia are produced by injections made with great exactness in the appropriate areas of the back and produce numbness of the abdomen and both lower legs. Other nerve blocks may be done with the nerves in the arms or legs to numb individual extremities. With regional anesthesia, sedatives can be given that will make you comfortable and drowsy Nerve blocks can also be administered to control the pain that may be experienced after surgery.
• Monitored anesthesia care (MAC) – With this approach, you usually receive pain medication and sedatives through your IV. The surgeon also will inject local anesthesia into the skin, which will provide additional pain control during and after the procedure. While you are sedated, your anesthesia provider will monitor your vital body functions.
• Local anesthesia – The surgeon will inject local anesthetic to provide numbness at the surgical site. In this case, there will not be a member of the anesthesia team with you.
Before receiving any sedatives or any anesthetics you will meet with a member of Anesthesiology, Chartered to discuss the most appropriate anesthesia plan. Our goal is to ensure your personal safety and comfort during surgery, and to provide optimal conditions for your surgeon to perform the procedure.
In the Operating Room
When you arrive in the operating room, you will be asked to state your name and describe the type of surgery that you are to undergo. Your anesthesia and surgical team will have you move from the cart onto the operating room bed. Various monitoring devices will be placed. These monitoring devices are very important and play a vital role in making anesthesia as safe as possible. These monitors include a blood pressure cuff, an EKG, and an oxygen sensor
If you have significant heart or lung problems, or are having a surgery that could be complex, other monitors may be used. These could include catheter placed in an artery to monitor blood pressure continuously or to allow frequent sampling of blood for analysis. Different catheters can be placed in the veins leading into the heart so that fluids and medications can be administered in appropriate amounts.
Aside from these advances in technology, the human factor is still the most important. A member of the anesthesia team will ALWAYS be there in the operating room, maintaining contact with you, and attending to your needs. He or she administers the appropriate amounts or concentrations of anesthetic, and monitors your body’s important functions, including blood pressure and breathing.
Day of Surgery
In the operating room preparation area, you will have the opportunity to meet your board certified anesthesiologist and other members of the anesthesia care team before you go into the operating room. He or she will review your health information and examine you. You will have the opportunity to discuss the various aspects of your anesthetic management and ask any questions.
You will have an intravenous catheter (an “IV”) place in a vein usually of the hand or arm. This IV will be used to administer various medications. You may receive a sedative through the IV tubing while in this holding room. If you have strong preferences about having or not having a sedative, please let us know. Monitoring devices, such as a blood pressure cuff, an EKG, and an oxygen sensor will monitor your condition.
Preoperative Reminders
You must not eat anything after midnight before your surgery. You may have water only up until 4 hours before your scheduled surgery. If your surgery is scheduled for later in the day, you may receive additional instructions.
It is very important that you follow these directions regarding when you should stop eating solid foods and when you should stop drinking liquids. If you do not follow the eating and drinking instructions faithfully, your stomach may not be empty. This may cause an increased risk of getting stomach contents into your lungs under anesthesia—a potentially life-threatening situation. Also, you are more likely to be sick after surgery if you have food remaining in your stomach.
Operating room schedules commonly change and it is possible you may have the opportunity to have your surgery earlier in the day. Unless you have had nothing to eat or drink for the required time, your surgery may be delayed or cancelled for your own protection.
If you smoke, please refrain.
You should take the medicine that you are told to take (with a small amount of water) on the morning of surgery.
Please use your inhalers and bring them with you on the day of surgery.
Please bring your CPAP machine if you plan to stay in the hospital overnight.
*Do not take any herbal or diet medications for at least one week before surgery.
Arrange to have someone drive you home if you are having outpatient surgery and stay with you until the next day.
If your condition changes or if you develop an illness, such as a cold or the flu prior to your surgery, please call the Outpatient Department at the hospital where your surgery is scheduled (Providence Medical Center at 913-596-5100 or Saint John Hospital at 913-680-6467) before you come in.
Before Your Surgery
Your medical condition must be assessed before you undergo surgery and anesthesia. Ideally, we want you in the best medical condition possible prior to the planned surgery. There are several ways we obtain the needed medical information, depending on your health history and the procedure that you are scheduled to undergo.
You may be asked to fill out a questionnaire that you receive at either your surgeon’s office or at the hospital about your medical history and previous anesthetics.
You may be telephoned at home prior to your surgery by the Pretesting Clinic nurses to obtain information and give you instructions.
You may be scheduled to visit the Pretesting Clinic at the hospital ahead of your surgery date. If you are to undergo a major procedure or have significant medical problems, you may need to come to the Pretesting Clinic to be evaluated and your medical condition assessed to help us plan the best possible care for you in the operating room.
A visit to the Pretesting Clinic will take approximately 2 hours. Please bring the names and phone numbers of any physicians that you see and a list of medications you take and the dosages and times that you take them. During your visit, you will be seen by the Pretesting nurses and by an anesthesia provider. Laboratory tests may be ordered. A chest X-ray and an EKG may be done. Occasionally, we may ask you to return to your primary physician to treat conditions such as high blood pressure. You might also need to see a specialist to evaluate a medical finding, such as an abnormal EKG, that might lead to increased risk of complications. If you have had recent tests done at another doctor’s office, please bring these results with you.
If you have particular concerns about anesthesia, you should discuss them with the staff in the Pretesting Clinic.
Pain Relief during Labor
The options for pain control during labor include breathing and relaxation techniques, intravenous “I.V.” medication, local anesthesia, and epidural or spinal blocks.
Intravenous Medication—Pain-relieving medications that are injected into a vein or muscle will help your pain but may not eliminate it completely. These IV meds are prescribed by your obstetrician. Because they sometimes make both you and your baby sleepy, they are mainly used during early labor.
Local Anesthesia—Other pain-relieving medications may be injected in the vaginal areas by you obstetrician at the time of delivery. These medications are local anesthetics. They provide a numbness or loss of sensation in a small area. Local anesthesia is often used to ease the pain of delivery or when an episiotomy incision is done to assist delivery. It does not, however, lessen the pain of contractions.
Epidural or Spinal Blocks—These nerve blocks can reduce the discomfort of labor and also can be used to provide anesthesia for Cesarean section. They are administered in the lower back, either by a specialist physician called an anesthesiologist or by a certified registered nurse anesthetist under the supervision of an anesthesiologist. Local anesthetics and other drugs are used for these procedures to reduce or “block” pain and other sensations over a wider region of the body.
The epidural block decreases sensation in the lower areas of your body, yet you remain conscious. The right time to administer the epidural block will vary from patient to patient. If you request an epidural block, your obstetrician and anesthesiologist will evaluate you and your baby, taking into account your state of health and past anesthetic experiences, the progress of labor and your baby’s responses.
General Anesthesia—is used when an epidural or spinal block is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness. This technique involves the placement of an endotracheal, or breathing, tube into the mother’s windpipe after you are anesthetized. The endotracheal tube is one of the extra precautions taken to prevent aspiration from occurring, meaning that some stomach contents could come up and then go into the lungs. This could cause a serious pneumonia. Other rare complications or side effects include, but are not limited to, injury to mouth, teeth, or throat, awareness under anesthesia, respiratory or cardiac problems.
Spinal—spinal anesthesia is administered using a much thinner needle in the same location of the back where an epidural block is placed. The main difference is that the needle penetrates the spinal sac and therefore, a much smaller dose of anesthetic medication is needed. The density of the block is more complete and the onset of numbness is quite rapid. The complications and side effects are similar to those of an epidural block.
Epidural—if you already have a labor epidural catheter in place and then need a cesarean delivery, it is usually possible to inject additional anesthetic medication through the same catheter to numb the entire abdomen for the surgical incision.
Anesthesia for Cesarean Births
Epidural, spinal, or general anesthesia may be given for cesarean section deliveries. Choices depend on several factors, including the medical conditions of you and your baby and, when possible, your preferences.
What are the risks of an Epidural
Although not common, complications and side effects can occur, even though you are monitored carefully and your anesthesia provider takes special precautions to avoid them.
These include, but are not limited to:
Decrease in your blood pressure
No or inadequate pain relief
Headache from the needle or catheter puncturing the spinal sac
Backache
Other rare complications include, but are not limited to:
Nerve damage resulting in persistent weakness or numbness
Bleeding
Infection
Seizures
Total spinal
How is an Epidural Block Performed
An epidural block is given in the lower back. You will either be sitting up or lying on your side. Before the block is performed, your skin will be cleansed with an antiseptic solution. The anesthesiologist or CRNA will use a local anesthetic to numb the area of your back where the epidural will be placed. A special needle is placed in the epidural space just outside the spinal sac. A tiny flexible tube called an epidural catheter is inserted through this needle. It is important to hold very still while the needle and catheter are positioned. Occasionally, the catheter will touch a nerve, causing a brief tingling sensation down one leg. Once the catheter is positioned properly, the needle is removed and the catheter is taped in place. A small dose of medication will be administered to check the position of the catheter. Additional medications are given as needed without another needle being inserted. The medication bathes the nerves and blocks out the pain.
Because the medication needs to be absorbed into several nerves, the onset is gradual, not immediate. Pain relief will begin to occur within 10 to 20 minutes after the medication has been injected. Although significant pain relief will occur, you still may be aware of pressure or discomfort with your contractions. You might notice some degree of temporary numbness, heaviness or weakness in your legs.
An epidural infusion may be administered through the catheter to provide continuous medication during your labor. Throughout your labor, your comfort and progress will be monitored frequently and medications adjusted accordingly. After delivery, the epidural catheter will be removed and, within a short period of time, sensations will return to normal.