Anesthesia

You should always talk to your physician and anesthesiologist when you have questions relating to your surgery.  Some hospitals and academic medical centers offer pre-op anesthesia clinics to help patients prepare for surgery.  To help you prepare for your surgical experience, we offer a general picture of the hospital procedures that typically occur before surgery.

See also Obstetric Anesthesia.

When arriving at the hospital or surgery center most surgical patients have quite a few questions for their healthcare providers.  Patients wonder what kind of anesthesia will be used, whether they should take their regular medication, what relaxation medication they will receive on arrival to the hospital, and how their surgery will be done.  With so many things to think about it is no surprise that errors in communication can occur.  These errors in communication can, in turn, increase the risk of medical error.  In an effort to improve health care quality we have designed a roadmap that shows what typically happens as you work your way through the hospital or surgery center in order to have a procedure. 

The pathway described here is general and the guidelines are also general.  Patients should ask their physicians and anesthesiologists for the exact guidelines that they will use.  However, you may find that reading this outline will enable you to write down questions that come to mind so that you can ask your doctor and make good decisions.  It is always a good idea to write down any questions before you meet your doctor as important questions often get forgotten in the middle of a doctor patient encounter. 

We also recommend that you download and fill out the downloadable Medical Record.  By arriving at the hospital or surgery center with your information written down, you lessen that chance that an important piece of information is missed.  You may receive relaxation medication when you arrive so having the information written down will give you an extra sense of security.

Pre-Surgery

Before you come to the hospital your Anesthesiologist may want you to take some or all of your usual medications. It is best to ask your anesthesiologist the day before surgery to clarify which medications he or she wants you to take.  In general it is recommended that patients take their usual blood pressure, pain, anxiety, and "acid reflux" medications with a sip of water.  If you regularly consume caffeine you may want to take this as well.  There are several over the counter caffeine pills.  If you know that you get a headache in the absence of caffeine it may be a good idea to take it in pill form to prevent a headache.

At the Hospital

Upon arrival at the hospital or surgery center a Nurse or assistant will begin to collect your medical information and confirm the site of the surgery or procedure.  Having your medical record filled out will be very helpful at this point.

Many patients have some anxiety before a procedure and so are given a medication that has relaxing effects.  After your medical information is taken, your physician or anesthesiologist may order a pre op medication that will have a relaxing effect.  One example of this is a class of medications called benzodiazepines.  Valium and midazolam are common examples of this medication. Often patients are given valium in the pre op area before a surgery.  This medication creates a calming experience for many patients.  Because your memory may be less than 100% after you receive this kind of medication it is a good idea to make contact with your anesthesiologist the day before the procedure.  That way you can ask any questions that you might have in a more sober frame of mind. 

Being Prepared

One very good way to make sure that your health care providers have all of your health information is to document it before your surgery.  One very good way to do this is to fill out the downloadable Medical Record and fill it out at home before your surgery.

If you meet your Anesthesia care providers for the first time on the day of the surgery it may be a good idea to be extra prepared.  It may be helpful to have some questions written down or of course have the medical record filled out.  The anesthesia providers will speak with you before your surgery. During this discussion, you will review the exact procedure you are scheduled for and will be told about the anesthesia choices.  At this point you will also have the option of receiving additional premedication.

Once you meet your anesthesiologist or nurse anesthetist it is always a good idea to confirm a few times the exact procedure that is to be done and then clarify the type of anesthesia that will be used.  To help you clarify these issues we have developed a patient checklist an anesthesia checklist and a nurse checklist, all of which go along with the Medical Record.  You can print these out and take them to the hospital.  These forms may be help you organize and structure your conversation with your anesthesia professional and other health care providers.  Occasionally medical errors are made due to poor communication and poor pre op planning.  Filling out your medical record and checklists will help improve communication and in this regard may prevent mistakes.  In the medical world an ounce of prevention is better that any cure!

Types of Anesthesia

Once you have reviewed your medical history you will have the opportunity to discuss the different forms of anesthesia with your anesthesia professional.  
In this regard, depending on the procedure there are many choices. 

These include:

• Local Anesthesia
  
• Conscious Sedation
  
• Monitored Anesthesia Care
  
• General Anesthesia
  
• Regional Anesthesia

Within the category of regional anesthesia several options exist including Epidural Anesthesia, Spinal Anesthesia, and Nerve Block Techniques.

Safety & Anesthesia

Regardless of which form of anesthesia is used in your case, it should be comforting to know that safety in Anesthesia is at an all time high.  Safety is enhanced because anesthesia professional have standard monitors that are used on all patients regardless of which form of anesthesia is used.  These monitors are used during anesthesia to track patients’ vital signs during the procedure. They are recommended for use in every anesthesia case by the American Society of Anesthesia. 

In certain circumstances, special monitors known as invasive monitors may be used to get sophisticated evaluation or the blood pressure and functioning of the heart and lungs.

Finally there are other monitors that allow your anesthesia care providers to fine tune your care.  These include awareness monitors and anesthesia gas monitors.

It is important to make a note about awareness and anesthesia.  This is a very rare but important issue to deal with head on.  Fortunately we have many tools to prevent it.  Please read about it in the awareness section.

Post-Surgery

After surgery or a procedure patients generally recover in a Post Anesthesia Care Unit (PACU).  Here patients wake up and the anesthesia wears off.  While in the PACU, patients are monitored by a team of recovery room nurses who specialize in this field.  Additional pain and anti nausea medication are commonly given in this location.  After spending some time recovering from anesthesia in the PACU you will be ready to be discharged to home or to a hospital floor.  It may be a good idea to talk to your doctor about pain control after surgery as there are many options that will influence how you recover from surgery.