 |
|||||||||
|
|
|
|
|
 |
|
|
|
1. Is Anesthesia Safe? Is Anesthesia Safe? Serious complication rates have dramatically improved over the past 20 years. In the 1980's the rate was 1:10,000 anesthetics. The current rate ranges from to 1:250,000 to 1:1,000,000 for otherwise healthy adults. This decrease is a result of better drugs, equipment and personnel. Your anesthesiologists will discuss your risks and alternatives with you. Is Awareness Under Anesthesia Common? Awareness under general anesthesia is a rare occurrence. Nevertheless, the media gives it a great deal of attention. In the United States, the incidence under general anesthesia per year is thought to be less than 0.2%. The risk is higher during certain procedures, such as trauma, cardiac surgery and obstetrical cases, or when a patient has an unusually high anesthetic. It is very unlikely to happen to most patients. Is Postoperative Nausea And Vomiting Common (PONV)? Nausea and vomiting represent one of the most common side effects of anesthesia with an incidence as high as 1 in 3 patients undergoing general anesthesia. If you have a previous history of PONV, are female, young, obese, and are having certain types of surgical procedures, you are more inclined to have post operative nausea. If you have had a serious problem with nausea and vomiting in the past or get carsick easily, please stress this at the preoperative interview as certain prophylaxis can reduce the incidence by more than 50%. We are very aggressive in our treatment of nausea. Why Can’t I Eat Before Surgery? Anesthesiologists go to great lengths to protect their patients. Having an empty stomach lowers your risk because it reduces your chance of having stomach acids and pieces of food go from your esophagus (food pipe) into your trachea (wind pipe). This causes a very serious pneumonia that can kill you. A simple fast helps to virtually eliminate this complication. Why Do We Ask If Family Members Had Problems With Anesthesia? There are two disease processes, Malignant Hyperthermia and Pseudocholinesterase Deficiency, that can be triggered by anesthesia. They both run in families, but are very rare. Malignant Hyperthermia (MH for short) is a rare genetic disorder characterized by extreme body temperature elevation under general anesthesia. The incidence in adults is about 1 in 30,000 general anesthetics. Untreated, it can kill patients. All of our anesthesia locations carry the medication necessary to treat this disease. Pseudocholinesterase Deficiency is the absence of an enzyme that breaks down a few of our medications. If a patient receives a medication that requires the enzyme, and they are deficient, they will take a few extra hours to return to normal after the anesthetic. How Am I Monitored? The monitors we use under anesthesia depend on both the type of operation and the patient's medical condition. The minimal monitors under anesthesia include: blood pressure, EKG, heart rate, temperature, and two monitors of breathing: the pulse oximeter (placed on the fingertips) which measures the oxygen saturation of your blood and the capnograph monitor which measures the carbon dioxide in your exhaled breath. These monitors have markedly improved the safety of anesthesia. For more complex procedures, such as open heart surgery, additional monitors may be used. Your anesthesiologist will discuss any anticipated need for placement of any additional monitors with you prior to surgery. What Are Some Risks Of Anesthesia? The most severe complication, death, is very rare. The most common side effects of general anesthesia include nausea, sore throat from the breathing tube, dental damage, muscle aches and shivering postoperatively. Side affects of regional anesthetics such as spinal and epidural anesthesia include spinal headache, nerve irritation, rare infection or bleeding and back pain. In general, for most patients, the most dangerous part of the day is the drive to the hospital. How Will I Be Billed? The anesthesia services bill is separate from the surgical and hospital fee. Your insurance company will be directly billed for our services (if procedure is covered by insurance). The patient will be billed for the portion not covered by insurance. Will The Anesthesia Staff Be With Me At All Times? An anesthesiologist will be with you at all times in the operating room. Postoperatively, in the recovery room a registered nurse, under the direction of an anesthesiologist, will provide your care. How Is My Pain Controlled After Surgery? Pain control is a team effort. There are multiple techniques to minimize pain. The surgeon can inject local anesthetics at the surgical site. Intravenous pain medicines such as narcotics and anti-inflammatory drugs are carefully dosed in the operating room and recovery room. For some procedures, an epidural catheter can be placed by an anesthesiologist either prior to surgery or in the recovery room. Epidural analgesia provides a continuous infusion of local anesthesia and narcotics that gives pain relief at the site of incision. Epidural catheters typically remain in place for 24-72 hours, depending on the type of surgery. Narcotics can be injected with local anesthesia as part of a spinal anesthetic. For most surgeries, your surgeon decides the best combination of pain medicines for you. These medications may be delivered by mouth, as a shot in a muscle, or through an IV. He may set up a patient controlled analgesia pump (PCA for short) allows for self-medication. This device delivers small doses of narcotic when the patient pushes a button. The dosage amounts are adjusted in the device to prevent overdose. Most often pain is controlled by several of the above approaches at once. What Follow Up Care Do I Receive? As an inpatient you will be seen postoperatively by one of our recovery room nurses. All complications are reported immediately to the anesthesiologist for follow-up. Outpatients are contacted by our same day surgery staff. Again any complications are immediately reported to the anesthesiologist. Patients with emergent postoperative anesthetic concerns may call the hospital operator and ask for the anesthesiologist on call. Which Is Better General Or Regional Anesthesia? General Anesthesia induces a loss of consciousness throughout surgery. It uses a combination of medications, vapors and gases to render a patient insensible to pain, and allows the surgeon to perform procedures without the patient experiencing pain or awareness. Regional Anesthesia involves numbing the part of the body where the surgery will occur. This can be done with an epidural, a spinal, a nerve block or infiltration of an area with local anesthesia (numbing medicine.) Although one could remain awake during a regional anesthetic, we commonly give light sedation to allow relaxation or light sleep. Many studies have been done on this topic, and to date, no one has shown that overall one technique is better than another. Some operations cannot be done under regional anesthesia. Others have a significant benefit when done under regional, such as Caesarean Section and Hip Replacement. For this reason, we advise patients to ask questions, and allow your anesthesiologist to guide you to the anesthetic that makes the procedure easiest for the surgeon, and that the anesthesiologist thinks he can do best for you. If there is no advantage to one choice or another, we are happy to let you have your pick! When Can I Eat And Drink After Surgery? This will vary with the procedure. Patients who have had minor outpatient procedures can eat and drink as tolerated after discharge. You should start with fluids and progress to a full meal, avoiding greasy foods. In cases such as major abdominal surgery, you cannot eat or drug until your bowel function returns to normal. This can take longer than 24 hours. Your surgeon will guide you for the optimal time to resume your diet. What Drugs Do You Use? Anesthetic drugs are unique in that they are seldom used outside of the operating room setting. For this reason, most patients have never heard of (Sevoflurane, Desflurane, Sufentanil, Succinylcholine, Atracurium, Cisatracurium, Rocuronium and Vecuronium) as well as those that many recognize (Propofol, Fentanyl, Morphine, and Dilaudid). Your anesthetic will be constituted of a mixture of medications, vapors and gases that keep you asleep, control your pain, block your memory, and make the procedure easier for the surgeon to perform. How Do You Know How Much Anesthesia To Give Me? Under general anesthesia we constantly are adjusting the amount of medications you need so that you stay asleep, yet wake up quickly at the end of the operation. Everyone is unique, so constant adjustment is necessary. For regional anesthesia techniques, dosage of local anesthetics is guided by the duration of surgery and by the height and weight of the patient. When Do I Wake Up After A General? Most patients wake up within 10 minutes of the end of the operation. Pain medicines tend to make patients drowsy for the rest of the day. We tell people to expect to feel hung over and tired for the rest of the day. We advise them not to start a family, drive, use sharp objects, or make decisions bigger than the choice of the TV station for the first 24 hours after general anesthesia. What Precautions Are Taken For Latex Allergy? It is important to inform us of your allergy. Although almost all of our supplies are latex free, we have a special cart with latex free supplies and equipment so that we can eliminate all latex from the procedure. Latex allergy would be suggested by allergic symptoms (runny nose, itchy eyes, wheezing) during blowing up balloons, dental exams, contact with underwear elastic, condoms or diaphragms or exposure to rubber gloves. Please let your anesthesiologist know if you have such symptoms. Will I Need A Blood Transfusion? Usually no. We go to great lengths to minimize the chance of needing transfusion. The decision to give blood is determined by many things, including the patient’s medical condition and the type of surgery. We wait until there are no other alternatives before we transfuse. The possibility of transfusion is higher in procedures that might involve significant blood loss such as spine fusion and open heart surgery. Techniques such as recycling your blood (cell saver) and pre-donation of your blood before surgery reduce the possibility of blood transfusion. If you are a Jehovah’s Witness, we will have a frank discussion of your wishes, and will honor the beliefs and requests of competent adults regarding blood products. Do I Have To Have An IV? An intravenous line (IV) is placed prior to surgery in all patients who receive any kind of anesthesia or sedation. This is used during surgery to administer medications and fluids. The skin is typically numbed before the IV is placed. Will I Get Medication To Decrease Anxiety Before Surgery? This is the decision of the anesthesiologist that evaluates you prior to surgery. We always sedation patients before heart and major vascular surgery, and we sometimes sedate patients for most other procedures. Up To What Time May I Drink And Eat Prior To Surgery? The answer to this question will depend on you, and the diseases that you have. (Depending on the urgency of the procedure, and the presence of other factors, the anesthesiologist may extend or shorten the fasting time period.) In general, we require a minimum of an 8-hour fast for solid foods. For this reason, we instruct patients not to eat after midnight. This includes fluids that contain particulates such as orange juice and milk. Many patients are allowed clear fluids until 2 hours before surgery. This includes up to 16 ounces of water or clear juices. If you are called by the operating room for an earlier than scheduled arrival, please stop drinking immediately. Patients that cannot have clear fluids until 3 hours before the operation are those that are pregnant, have bowel disease such as an obstruction, are morbidly obese and are diabetic. This is because their stomach empties abnormally. What You Should Know About Herbal Use and Anesthesia What are herbal medicines? Herbal medicines and other dietary supplements are over the counter preparations that are used to treat many conditions. They are frequently not prescribed by a physician, and are not regulated by the same laws as other medicines. Are herbal medicines safe? In general, when taken in isolation, these medications are safe. However, there is a great deal of variation in the purity and potency of these products (because they are not regulated) and there is always the possibility that they will have a bad drug interaction with other herbal and non-herbal medications. Natural doesn't necessarily mean safe. Herbs have chemical properties just as manufactured drugs do. We don’t know how much of each active ingredient is really safe, particularly over long-term use. There are even case reports of contaminated herbs causing death. Does the federal government make sure that herbs are safe? Herbal medicines are not studied the way prescription drugs are because whole plants cannot be. If the FDA suspects that an herb is unsafe, it can be removed from the market. The FDA cannot require testing of all herbal products before they are put on the shelf. In what types of preparations are herbal medicines available? Herbal medicines come in all forms. Just because it isn’t a pill, doesn’t make it safer. Do I need to tell my doctor about all of the herbal products and other supplements that I take? Yes It is absolutely essential that you tell your doctor about any treatments that you are using. These include the use of herbal medicines, vitamins, nutritional supplements or any other prescribed or over-the-counter drugs. Herbs can prolong anesthesia, cause bleeding or unstable blood pressure, among other side effects. Many require that they are stopped for a period of 1 to 2 weeks for your safety. The Stockton Anesthesia web site has a list of Green (don’t need to stop), Yellow (stop for 1 week) and Red (stop for 2 weeks) Herbal Medications. Check with your surgeon if you have any questions about the prescription or nonprescription medications that you are taking. |
|
|