Information About Your Anesthetic

 

Anesthesia services at Oklahoma Surgical Hospital are provided by Associated Anesthesiologists, Inc., a group of physicians, certified registered nurse anesthetists and physicians assistants that specialize in anesthetic medicine and pain therapy services.

What is anesthesia?

Anesthesia is a means of blocking pain. Your anesthesiologist can give anesthesia in one of two ways: general (you will “go to sleep”) or regional (your pain is blocked in a certain area).

Unconsciousness is produced under general anesthesia by injected drugs and inhaled gases. Regional anesthesia blocks nerves in the area of your surgery and is given with a needle and/or catheter (small tube). Some types of regional anesthesia include caudal, spinal, epidural, intravenous (IV), and peripheral nerve blocks. You may request medicines to relax you during your regional anesthetic.

A member of the anesthesia team will meet with you before surgery to discuss your physical condition and your specific anesthesia. If you have any special problems or questions, you should discuss them with the anesthesiologist or PA at that time.

Who will give me the anesthesia? 

The anesthesiologist chooses your anesthesia according to your physical condition, age, current medications, and type of surgery. An anesthesiologist or certified registered nurse anesthetist (CRNA) will administer your anesthesia. An anesthesiologist is a doctor with special training in anesthesia. A CRNA is a registered nurse (RN) who is formally trained to give anesthesia under a doctor’s supervision. When you arrive in the pre-op area, an intravenous infusion (IV) will be started. After you are moved to the operating room, several monitoring devices will be applied to observe heart rate, blood pressure, and other vital signs.

What are the types of anesthesia?
How are they given?


General Anesthesia
General anesthesia for adults is usually given with drugs through an IV followed by further IV medicines and anesthetic gases given through a mask or breathing tube. This breathing tube may be inserted into your windpipe, or other devices may be placed in your nose or mouth to help your breathing during surgery. Be assured that your anesthetist is in constant attendance with you throughout the operation. Your anesthetist will maintain the anesthesia and watch your vital signs. Your breathing tube will not be removed until you can satisfactorily breathe unassisted, so you may wake up in recovery to find it still in place. Do not be alarmed if that happens; you will be closely monitored, and the tube will be removed when you can breathe normally without help.

Following surgery, you will be taken to the recovery room where specialized nurses provide care. An anesthesiologist is immediately available for you in recovery until you are stable.

Most small children are given general anesthesia with gases through a mask. An IV is started after the child is asleep if needed.

Regional Anesthesia
Regional anesthesia is quite different from general anesthesia. You are not asleep as with general anesthesia, but you may be sedated to a “twilight” sleep (semi-consciousness).

For some surgical procedures, a small catheter is placed between the vertebrae (bones of the spine) and the sack containing the spinal cord. Anesthetic drugs and narcotics are given through this epidural catheter during the surgery. Frequently, this epidural catheter is left in place after the operation so that narcotics and weak anesthetic drugs can be given to control pain. A patient controlled pump connected to the catheter allows you to give yourself extra pain medication if you need it by simply pressing a button.

Monitored Anesthesia Care (MAC)
Monitored Anesthesia Care (MAC) combines intravenous sedation with local anesthetic or nerve blocks, enabling patients to undergo lengthy and complex procedures as an outpatient and then promptly and safely be discharged home.

Nerve Block Information

Your surgeon and anesthesiologist may recommend an additional procedure to improve your post operative pain relief. There are a number of procedures that the anesthesiologist can perform to make you more comfortable post operatively. These procedures are the following:

Femoral Nerve Block/Adductor Canal Nerve Block
Femoral nerve blocks are performed on patients having a variety of knee surgeries including total knee replacement and ligament reconstruction. This block helps to make the patient more comfortable post operatively while using fewer narcotics. It is generally
performed pre-operatively under light sedation. The anesthesiologist injects a local anesthetic in the skin above the nerve which is located just outside the groin area or the upper thigh. The femoral nerve is found using ultrasound visualization and then local anesthetic is injected around the nerve. The single injection block lasts 10-20 hours but may last longer. For some surgeries, the anesthesiologist will pass a small tube next to the nerve to allow for a continuous infusion of local anesthetic for 1-3 days after surgery. Obesity may make performing a femoral nerve block or advancing the catheter difficult or
impossible.

Nerve damage is possible but rare with the use of ultrasound guidance or the nerve stimulator for accurate needle placement.

Interscalene / Superclavicular Block
The interscalene block is performed on patients having surgery on their shoulder and humerus.  The block significantly reduces the amount of  pain you will have after surgery.  Very obese patients and those with severe lung disease may not be good candidates for the block.  The block is performed pre-operatively under light sedation.  A small needle will be placed near the nerve under ultrasound guidance and local anesthetic will be injected around the nerve.  The shoulder, arm, and hand will feel “numb” and the arm muscles will be weak.  This “numbness” usually lasts 10-20 hours but may last longer.

Often other nerves are also blocked as the anesthetic is absorbed by the surrounding tissue. The Phrenic nerve, which coordinates your breathing muscle, may also be blocked. When this happens you may have the desire to cough and feel as though you can’t get your breath. Occasionally obese patients and those with lung problems may be admitted overnight to receive oxygen. Sometimes the nerve to the vocal cord muscle is blocked causing hoarseness for several hours. This will pass, but it is a good idea to sip clear liquids after surgery before trying to eat solid foods. Sometimes the nerves regulating blood flow to the face are blocked. If this happens the side of your face will feel warm and you will get a stuffy nose on the same side. Your eyelid on the side of the block may also droop. This will pass in several hours. Rarely, the nerves can be damaged and occasionally the block does not work. This is unusual when using ultrasound guidance for accurate needle placement. If the block is unsuccessful you will be given painkillers through your IV and/or the block may be repeated in the recovery room. Interscalene blocks are generally well tolerated and provide superior post operative pain relief.

Popliteal Fossa / Sciatic Block
The nerves in the popliteal fossa area are blocked to provide improved pain relief for patients having surgery on the ankle, foot or knee.  The block is performed under light sedation.  The nerve is located using ultrasound.  Then, local anesthetic is injected around the nerve.  This numbness usually lasts 10-20 hours but may last longer. 

Nerve damage is possible but rare when using ultrasound guidance to help with accurate needle placement.  Obesity may make performing the block difficult or impossible.

Spinal Block
The spinal block is used in patients undergoing lower abdominal or leg surgery.  If you are on blood thinners it is very important that you tell the anesthesiologist.  The use of blood thinners can lead to serious complications with the spinal block.  The spinal block is performed under sedation with you placed on your side or sitting in the bed.  The skin is cleansed with an antiseptic solution and the skin and deep tissue are injected with a local anesthetic.  A small spinal needle is placed between the bones in the lower back.  A small amount of local anesthetic and/or narcotic is injected.  The needle is removed and over minutes you will become numb below your chest area.  You may have more sedation during your surgery.  The numbness wears off after 2-4 hours but the spinal narcotics provide pain relief for 10-18 hours.  Obesity may make performing the block difficult or impossible. 

Side effects are generally minor and may include nausea and itching.  Occasionally patients may develop a headache after a spinal block.  This headache can be treated by notifying your nurse who will contact the anesthesiologist on call.

How do I prepare for anesthesia?

Prior to your arrival for surgery, please remove purple, dark blue, red, black or sparkle nail polish as this can interfere with your monitoring. Do not wear mascara or eye shadow as these can damage your eye during your anesthetic. Also, please remove all jewelry and body piercings including tongue and lip jewelry as they can damage your airway and get in the way of devices used in anesthesia.

For your safety, if you wear dentures, you will be asked to remove them prior to your procedure. Dislodgement or damage can occur during your airway management and interfere with your breathing. Arrangements can be made to remove and replace dentures prior and after your surgery.

You should not drink any alcohol for at least 24 hours before surgery. You should stop all use of illegal drugs as soon as your surgery is scheduled. Undergoing an anesthetic with alcohol or illegal drugs in your system will place you at increased risk for serious complications. Please discuss this with your anesthesiologist. Stop all non-prescription medicines 4 days prior to surgery and be sure to list them during your pre-operative evaluation.

You may be instructed to take certain medications on the day of surgery. When you arrive for surgery, the nurse may give you some medication to relax you and/or lessen the chance of nausea and vomiting. Children may be given an oral syrup to lessen their anxiety.

What is invasive monitoring?

Invasive monitoring is the use of special methods to manage your particular form of anesthesia. Depending upon your health and the nature of your surgery, your anesthesiologist may continuously monitor your blood pressure, heart performance, fluids, or blood gases. This is done by placing catheters in your arms, wrists, and neck or sometimes even through a vein leading to the heart itself. During some surgeries, a probe may be placed in your esophagus to allow the anesthesiologist and other physicians to view your heart function.

The anesthesiologist gains critical information about your condition from these techniques, but the risks are weighed against the benefits when these monitors are placed. Although it is very rare, you should know that invasive monitoring could cause complications including loss of limb, rupture of blood vessels, collapsed lungs, perforated esophagus and loss of life.

Will my memory be affected by anesthesia?

Sometimes after surgery, you may experience some loss of memory. This can be produced by the anesthetic drugs or the medication used to relax you and relieve discomfort following surgery. Your memory may return as early as leaving the operating room or several hours later.

On rare occasions, a patient remembers events that occured during surgery. This “recall” usually involves only hearing. It does not mean that the patient was incompletely anesthetized or felt pain during the operation. If you have any questions concerning memory after your operation, you should contact Associated Anesthesiologists, Inc and talk to an anesthesiologist.

What are the risks of anesthesia?

The risks of anesthesia are much less today than in years past because of improved anesthetics, better monitoring and better training. However, there are still serious possible risks that you should be aware of, even for minor operations. Complications may include slight bruising where the needle is inserted, sore throat, headache, damage to teeth, paralysis, loss of limb, and loss of life.

Damage to teeth may occur when patients bite hard on the breathing tube during various levels of anesthesia. This may happen even though the greatest caution is used to protect teeth. You should be aware that artificial, diseased, or previously damaged teeth are especially vulnerable. During your pre-operative visit, make sure to identify caps and poor or damaged teeth. This may help prevent tooth loss.

People with untreated sleep apnea may be at increased risk postoperatively. If you have been diagnosed with sleep apnea and/or find yourself very sleepy throughout the day, snore loudly at night, had a spouse see you stop breathing or experience frequent early morning headaches, be sure to make this known during your pre-operative visit.

Rarely, when regional anesthesia is used, nerve function may not return to normal for an extended period of time, sometimes even months. Nerve damage can also occur from events unrelated to anesthesia. Pressure or stretch to nerves sometimes happen due to the position of a limb during or after surgery.

How much does anesthesia cost?

The charge is based on the type of surgical procedure performed, the general health of the patient, and the length of the procedure. A charge will also be added if special monitoring techniques are required. You will receive a separate bill from Associated Anesthesiologists, Inc. for these services. The amount covered by health insurance policies varies.

Attention Medicare Patients
Your Medicare charge represents deeply discounted fees which are set by the federal government. We accept Medicare assignment. If you have special needs, please contact our office at:
    Associated Anesthesiologists, Inc.
    6839 S. Canton
    Tulsa, OK  74136
    (918) 494-0612

This information to patients regarding anesthesia does not cover all precautions or side effects of anesthesia.

 

Oklahoma Surgical Hospital