Anesthesiology FAQ

Frequently Asked Questions

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Anesthesiologists are physicians who have specialized training in providing pain control and caring for the general well-being of the patient in the operating room. They monitor your vital signs (heart rate, blood pressure, respiratory rate, etc.), administer medications to ease pain and avoid recall, monitor your fluids and act as your advocate while you are unable to do so for yourself. S/he will monitor and record all of these things and make adjustments as necessary (and in accordance with your pre-identified preferences) to provide you with the safest and most comfortable outcome possible. At a minimum, anesthesiologists have completed four years of college, four years of medical school and four years of internship/residency before starting to practice in our group. Many of our anesthesiologists have completed additional training and fellowships in such areas as chronic pain management, pediatrics, cardiothoracic and obstetric anesthesia.

Informed consent means that you have been presented with your treatment options and that the most common risks and possible side effects have been explained. You will have an opportunity to ask questions and, if you wish to proceed with anesthesia, to sign an informed consent indicating that this process has occurred. Clearly, in extreme emergencies it may be necessary to waive this step.

In some cases, multiple options may be medically appropriate. In these instances, your anesthesiologist will be happy to consider your preferences if you make them known during the pre-operative discussion.

New research shows that patients enjoy stronger recoveries (wake up feeling better and have lower risk of infection) from their surgeries if they are not malnourished and dehydrated prior to surgery.  As such, the old instruction of "nothing to eat or drink after midnight" is no longer encouraged.  In fact, we now encourage patients undergoing elective surgeries to take a light, fat free meal about 6 hours prior to the scheduled surgery time and to drink clear liquids up until about 3 hours beforehand.  Your surgeon may have different instructions so please make sure you follow the most restrictive instructions you are given.

A light meal consists of plain, dry toast or crackers and clear liquids.  Other foods like milk, fatty or fried foods should not be eaten at any time on the day of surgery.  No food of any type should be eaten within 6 hours before your scheduled surgery time.

Clear liquids are something you can see through.  Options include apple juice, sports drinks, black coffee or tea without any milk or cream.  Nothing containing milk, fat, pulp, protein or insoluble fiber should be taken on the day of surgery.  Clear liquids (see examples above) should be consumed in normal quantities up until 3 hours before the scheduled surgery time.  NOTHING (including gum, mints, clear liquids and water) should be put in your mouth within 3 hours before your scheduled surgery time.  The only exception to this is that prescribed medications should be taken as directed by your physician with a small sip of water.

Breast milk should be given up until 4 hours before surgery.  Infant formula and non-human milk should be discontinued 6 hours prior to scheduled surgery time.  No liquids of any type should be given to babies within 4 hours before scheduled surgery time.

These patients can follow the guidelines above for adults but may need additional supplementation as directed by their treating physician in consultation with the anesthesiologist.

These guidelines are intended for healthy patients undergoing elective surgeries.  They are not intended for women in labor, who may have to undergo surgery unexpectedly.  Women in labor should refrain from eating or drinking anything unless otherwise instructed by their obstetrician or anesthesiologist.

There is a risk of aspiration if there is anything in the stomach when anesthesia is given. Aspiration means that the contents of the stomach end up in the lungs and this can be life-threatening. This is why it is most important to follow the instructions given specifically, to adhere strictly to timelines given and to tell your anesthesiologist if you have had anything to eat or drink (including a sip of water or coffee) during the time period for which they ask.

The answer to this question depends upon the type of surgery you are having and your medical condition. Often the need for a blood transfusion is known before the surgery. Sometimes unexpected events occur during surgery and the need for an emergency transfusion may arise. If you have personal beliefs against, or concerns about, this possibility, you should be sure to discuss this with your anesthesiologist during the pre-operative interview.

This is not an anesthetic concern but your surgeon may need to use a special instrument to stop bleeding during your surgery. If you are wearing metal jewelry that is in contact with your skin, it could cause an electrical burn in the area.

This is an extremely rare but not impossible risk of anesthesia. In most instances, your anesthesiologist is able to give you sufficient medications to eliminate this possibility. In some severe emergencies, or in certain types of high-risk surgeries and sets of patient circumstances, it may not be possible to administer sufficient medication to both maintain life and eliminate this possibility in its entirety.

You will be monitored for a period of time in the recovery room, where they will continue to give medication to assist with your pain. Side effects such as nausea and vomiting continue to be a possibility within the first 24-48 hours following surgery, although a number of newer drugs have significantly reduced the incidence of these side effects. Some people, however, are more prone to these symptoms and will therefore have to be monitored for a longer period of time.

It is not uncommon to have a sore throat for a few days, especially if you had a breathing tube placed. Dental injuries are also a possibility, especially if you have been less diligent about preventive dental care and/or have artificial dental devices such as caps or bridges. This is not necessarily related to anything that the anesthesiologist did. In some instances, it may be impossible to insert a breathing tube quickly, especially in someone with a small mouth, without touching any teeth. Just as frequently, dental injuries may occur during the “wake-up” phase, when you may roll over or bite down on a tooth that is fragile, causing it to crack or break. Again, these situations are rare, but certainly not impossible.

As with any other medical procedure, results cannot be guaranteed. Unexpected reactions or complications may occur. Patients with apparently similar medical conditions may have varying responses to certain anesthetics or procedures. Possible risks include, but are not limited to allergic reactions; infection; pneumonia; inflammation of the veins; nerve injury or paralysis; damage to or failure of the heart, liver, kidneys and/or brain; and death. These more severe complications are highly unlikely but can occur in some cases, regardless of the experience, care and skill of the anesthesia provider.

Obstetrical Anesthesia

 

Your obstetrician may provide intravenous medications to help relax you and provide pain relief. If you wish for a more complete method, anesthesiologists may be called in to provide regional anesthetics in the form of an epidural, a spinal or both.

It is a local anesthetic delivered through a small catheter placed in the small of the back near the spinal canal. It is generally considered one of the most effective methods for patients wishing for significant pain relief but wanting to be awake and able to participate in the birth.

It is similar to an epidural but, because anesthetic is injected directly into the spinal canal, the effects are felt faster. It is more difficult to move and push via this method, however, due to greater numbness. For this reason, the epidural is the more popular method.

People on blood thinners or with a history of bleeding disorders, those with nervous system disorders, with an infection in the back or those with a history of back surgery and/or spinal abnormality may not be good candidates for these methods of pain relief. If you have specific questions about whether you are a candidate, it is possible for you to discuss this with an anesthesiologist at one of our monthly seminars (see below).

The epidural will not be placed until you are in active labor (usually at least 4-5cm dilated). You will have already been administered several liters of intravenous fluid, such that at least 1-2 liters have been given. You will be asked to position yourself on your left side or in a sitting, fetal-like position. The skin of your back will be wiped with an antiseptic solution to reduce the chance of infection. Following injection of a local anesthetic, a needle will be placed through the numbed area and into the epidural space of your spine. A catheter is then inserted through the needle and left in place after the needle is removed in order that an anesthetic may be administered continuously. The catheter is removed after the baby is born. Pain relief generally last 1-2 hours after the catheter has been removed.

Risks include severe headaches, inadequate pain relief, and/or allergic reaction to the medication. Epidurals may inhibit the ability to push in some patients, which may increase the chances of a forceps delivery (a procedure which carries its own set of risks). Additionally a sudden, and possibly dangerous, drop in the blood pressure of the mother and/or baby can occur. This can usually be easily treated but, for this reason, periodic blood pressure monitoring is required.  Finally, although rare, additional unexpected but severe complications may also occur. Accidental injection into blood vessels resulting in seizures, inadvertent injection into spinal canal causing temporary but total paralysis, a broken needle or catheter which may require surgical removal, post delivery back pain, weakness or paralysis of the lower part of the body, bleeding and/or infection are all unusual but distinct possibilities.

 

We ask all patients considering obstetric anesthesia to attend our “Night Out With the Anesthesiologist” classes given the second Tuesday of each month at the Women and Childrens’ Center of Holmes Regional Medical Center. Registration to attend one of the classes must be made on line at www.health-first.org and then selecting “More Events and Classes” or by calling 434-7344. At this session, you will view an informative video and one of our anesthesiologists will be on hand to answer your questions.

Anesthesiology Locations

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BPA is a physician owned and operated community based group of more than 150 physicians and advanced level practitioners formed in October, 2013.

 

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