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Your surgeon determines the time you should arrive at the appropriate center for surgery. Should you need help with directions to a facility please refer to Locations on our website.There you will find a link to the website of each center.
Once you arrive, you will be escorted to a holding area and greeted by a"preop" nurse. He or she will ask several questions early in the interview including your name and birth date, your surgeon's name, and the planned procedure. Some patients are alarmed by these questions ("don't they know what they are about to do to me?") but don't be. These questions are for your safety and ensure that the patient and the surgical team have the same plan, and that the procedure on the schedule matches the stated procedure for the patient.
The nurse will then take your vital signs including your heart rate, blood pressure, respirations and oral temperature. He or she will also ask some basic medical history questions including a list of your current medications, drug allergies, and the time of your last oral intake of food or liquid. We usually ask that patients not eat or drink after midnight on the date of surgery to decrease the risk of aspiration while under anesthesia or sedation.
You will then have an intravenous (IV) line placed by the nurse and blood will be taken at that time if needed for any indicated lab tests.
Next you will meet your anesthesiologist, and he or she will verify many of the pre-op nurse's questions, ask more about your medical history, and examine you as indicated. You will be given options and recommendations for the anesthesia (detailed here: Types of Anesthesia) and a plan for the anesthesia will be explained to you. This also usually involves at least a few questions from the patient so do not hesitate to ask.
You will then be taken to the operating room by a "circulating" nurse. This is one of the people who will stay in the operating room during the surgery to assist the surgical team and anesthesiologist. Typically a mild sedative is given through the IV prior to transfer to the operating room.
After surgery you will go to an area called the PACU (Post Anesthesia Care Unit) or recovery room. Here you will be monitored and treated as you emerge from anesthesia. You will stay here until you are comfortable and awake. Then you will either be transferred home or to a hospital room depending on the surgical procedure.
The events above are a general guide to the day and are basically the same regardless of the facility for your surgery. As you can tell, many things need to happen prior to surgery so please be patient.
An anesthesiologist is a physician who, after graduating from college and medical school, completes a four-year residency in the care of patients in the perioperative period. A residency in a medical specialty is an organized training program that includes both academic and clinical training. Programs are reviewed by the Accreditation Council for Graduate Medical Education (www.acgme.org) to ensure that they meet the standards required to produce well trained physicians in a particular specialty. After a residency is completed, the physician may begin practice and is considered board eligible. He or she then usually seeks certification from the American Board of Anesthesiology. This requires the physician to pass a written test and an oral test several months later.
Below is a link from the ASA describing various duties of the anesthesiologist:
For more information on types of anesthesia and anesthesia options for surgery please see the link below to the Mass General Hospital in Boston
General anesthesia involves complete loss of consciousness. This includes loss of sensation, pain and awareness. We will use either medications through the intravenous (IV) line or inhaled medications to keep you "asleep" during the procedure. Depending on the procedure and your medical history, a breathing tube may be inserted into your windpipe for surgery. During the procedure, we monitor all of your body's systems and vital signs. At the end of the procedure, we allow our medicines to wear off or we can administer additional medicines to reverse the effects of the anesthetic.
Below is a list of commonly used drugs for this category of anesthesia and when they are used:
- Propofol, Thiopental - Induces anesthesia (puts you to sleep)
- Desflurane, Sevoflurane or Isoflurane - Maintenance of anesthesia (keeps you asleep)
- Succinylcholine, Atracurium, cisatracurium, rocuronium or vecuronium - Paralytic agents (keeps you still)
- Fentanyl, Morphine, Hydromorphone or Meperidine - Analgesia (treats the pain)
If you are reviewing our site in preparation for ACL reconstruction-knee surgery, foot/ankle surgery or shoulder surgery, please read this section prior to your day of surgery.
Regional anesthesia is a type of anesthesia that produces temporary loss of sensation and movement to certain areas of the body. This can be used as a primary anesthetic or as an adjunct to general anesthesia and is a very common technique in our practice. The types of regional anesthesia are: EPIDURAL/SPINAL, PERIPHERAL NERVE BLOCKS, and IV REGIONAL.
Peripheral Nerve Blocks
A nerve block (or simply "block") is the process of making a nerve or bundle of nerves leading to the surgical site "numb". Usually we perform these blocks at the request of the surgeon just before surgery with the patient under sedation. The goal of the nerve block is to make you more comfortable after surgery by decreasing post surgical pain. By having a nerve block, the amount of pain medicine needed through your IV or by mouth decreases. You are alert faster and usually have less nausea and vomiting. The duration of the block depends on the type of local anesthetic administered and ranges from 10-15 hours, with some blocks lasting as long as 24 hours. As the nerve block gradually wears off, you are transitioned to oral medicines for pain control.
While we usually recommend nerve blocks, the decision is ultimately left to the patient. Should you decide against a block, we will use other means to control your pain.
Common nerve blocks in our practice are: femoral, sciatic, popliteal, interscalene and axillary blocks. The links that follow have detailed and very informative descriptions of these blocks. While complications are rare, be aware that nerve blocks are not without risk. Please ask questions and review these links. Here are some of the risks we usually mention: bruising at the injection site, bleeding, infection, nerve damage, reaction to the local anesthetic including seizures, and failure of the block to relieve pain.
Epidural and spinal anesthetics are regularly used for women in labor or for a c section. We also use these as a supplement for abdominal and thoracic surgeries to help with post operative pain control. An epidural involves placement of a tiny catheter into an area called the epidural space in the spinal area of the back. The catheter will not be felt once in the epidural space and will be secured in place to use for up to 3 or even 4 days after surgery. Your anesthesiologist will titrate local anesthetics and narcotics throught the catheter as needed and will have primary responsibility over pain control while the catheter is in place.
A spinal anesthetic is similar to an epidural but usually involves a "single shot" technique. This means that medicine is put into the spinal space and into the fluid that surrounds the spinal cord. No catheter is left in place. Our main use of spinal anesthesia in the general operating rooms usually includes Duramorph, a long lasting morphine. We do this to give a baseline amount of pain control for up to 24 hours after surgery at a fraction of the usual IV dose. This is commonly requested by our surgeons for lower abdominal surgery and some orthopedic procedures such as hip replacement.
Epidurals and spinals are probably the most common regional anesthesia techniques used in the world. As always, your anesthesiologist will discuss the risks and benefits of this type of anesthesia and will help decide what is best for you.
IV Regional Anesthesia
Regional anesthesia is also sometimes called a Bier block. We sometimes use this type of block for hand or wrist surgeries. With this block, a tourniquet (similar to a blood pressure cuff) is placed on the arm or forearm and is inflated to a pressure that restricts blood flow in and out of the arm. A local anesthetic is then injected through an IV in the operative arm. The local anesthetic diffuses throughout the arm making it numb up to the point of the tourniquet. Patients are also usually given a light sedative in addition to the block. At the conclusion of the surgery, the tourniquet is released and the local anesthetic "washes out" of the arm and the patient slowly regains function of the extremity.
In this category of anesthesia, an anesthetic drug, called a local anesthetic, is injected into the tissue to numb a specific location of your body. The surgeon frequently makes the injection, and anesthesiologists are sometimes asked to assist by sedating, monitoring the patient, and increasing the anesthesia if necessary. This is called monitored anesthesia care and is not a very common technique in our practice. We sometimes use this procedure to help with cataract or other eye surgery, endoscopy, or some small cosmetic surgeries.
Contrary to what many people think, there are a variety of ways we may take care of you during surgery. As a general rule, we will choose one of the aforementioned anesthetic techniques for your surgery or procedure. However, safety and comfort are our goals for you regardless of the type of anesthesia used.
Fortunately the risk of a major complication from anesthesia and surgery is quite low. Please refer to the link below for a more detailed description of anesthesia risk.
Our selection of monitors depends on the surgical procedure, type of anesthesia used, and medical history of the patient. The goal of monitoring a patient during surgery is to follow various physiologic variables and intervene, if necessary, to keep these variables within predetermined acceptable ranges.
There are several variables that we monitor during every procedure. Blood pressure is tracked using an automated cuff usually placed on the arm. The electrocardiogram, or ECG, is continuously monitored to help evaluate the status of the heart. A pulse oximeter continuously monitors the oxygen saturation of the blood and helps ensure that the patient receives the appropriate amount of oxygen. Respiratory gas monitors are used if a patient is placed under general anesthesia. The end-tidal carbon dioxide monitor helps the anesthesiologist know that the breathing tube is appropriately placed and that ventilation is adequate. Temperature is also usually followed and a warming device is used if needed to maintain a normal temperature.
More extensive monitoring may be required at times. If other monitors are needed, the anesthesiologist will explain the type of monitor and why it is needed.
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