Patient FAQ

In general anesthesia, you are unconscious and have no awareness or sensations. There are a number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein.

In regional anesthesia, your anesthetist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake or be given a sedative. Either way, you do not feel the surgery taking place. There are several kinds of regional anesthesia; the two most common are spinal anesthesia and epidural anesthesia.

In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the location of your body requiring minor surgery or a procedure.

Sedation allows patients to be comfortable during certain surgical or medical procedures. Sedation can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests.

During light or moderate sedation, patients are awake and able to respond appropriately to instructions. However, during deep sedation, patients are likely to sleep through a procedure with little or no memory. Breathing can slow and supplemental oxygen is often given during deep sedation.

It is very important that patients have an empty stomach before any surgery or procedure that needs anesthesia. When anesthesia is given, it is common for all the normal reflexes to relax. This condition makes it easy for stomach contents to go backwards into the esophagus (food tube) and mouth or even the windpipe and lungs. Because the stomach contains acid, if any stomach contents do get into the lungs, they can cause a serious pneumonia, called aspiration pneumonitis.

When preparing for surgery, many patients think of the anesthetist as just the person behind the mask who puts them to sleep and wakes them when it’s over. They may not realize the comprehensive medical care the anesthetist provides between those two points and beyond.

anesthetists play a vital role in a patient’s medical care, making decisions to protect and regulate critical life functions. They serve as the patient’s advocate and typically are the first to diagnose and treat medical problems or complications that may arise before, during and after surgery. They have a wide range of knowledge about medications and how the human body works and responds to the stress of surgery at all stages of a procedure. Think of anesthetists as your seat belt during surgery: When there is an emergency or complication, they can save your life.

• Before surgery: anesthetists evaluate the patient to develop an anesthesia plan, taking into consideration the patient’s medical history and physical condition.
• During surgery: anesthetists use advanced technology to monitor the body’s functions and determine how best to regulate and treat the body’s vital organ systems while administering a personalized, delicate balance of anesthetic medications. In some hospitals, nurse anesthetists may assist the anesthetists with the monitoring. However, anesthetists are responsible for interpreting the monitoring and making medical judgments about the patient’s responses and necessary treatment.
• After surgery: anesthetists reverse the effects of the anesthetic medications and return the patient to consciousness. They keep the patient in a comfortable state during recovery and are involved in providing critical care medicine in the intensive care unit.

There is no single or right amount of anesthesia for all patients. Every anesthetic must be tailored to the individual and to the operation or procedure that the person is having. Individuals have different responses to anesthesia. Some of these differences are genetic and some differences are due to changes in health or illness. The amount of anesthesia needed can differ according to such things as age, weight, gender, medications being taken or specific illnesses (such as heart or brain conditions).

Among the things the anesthetist measures or observes, and uses to guide the type and amount of anesthetic given are: heart rate and rhythm, blood pressure, breathing rate or pattern, oxygen and carbon dioxide levels and exhaled anesthetic concentration. Because every patient is unique, the anesthetist must carefully adjust anesthetic levels for each individual patient.

You shouldn’t really.

If you smoke and you’re scheduled for surgery, anesthetists recommend you take immediate steps to quit and remain smoke-free until at least one week following your procedure—or indefinitely. Quitting smoking is one of the best things you can do to recover from surgery without complications. People who smoke have an increased chance of complications during and after surgery, including wound infections, pneumonia and heart attacks. The earlier you quit smoking before surgery, the lower your chances of complications.

It is recommended that you have someone stay with you for the first 24 hours. Make arrangements for a ride or for someone to transport you safely home. Every case is different, please consult with your anesthetist.

After a general anesthetic (an anesthetic which you fall asleep and lose consciousness), for most cases, you will be awake within minutes after surgery and spend approximately an hour in the recovery room. During that first hour, we will be intensely monitoring your vital signs and making sure you are safe and comfortable.

If you had a nerve block placed for post-op pain control (this is done during surgery), that portion of your anesthetic will typically last 24-36 hours (which is usually the most painful period in recovery). Be sure to take a dose of pain medicine as directed by your physician before your nerve block completely wears off. You will know that your nerve block is starting to wear off when you have the sensation of your operative body part tingling (like when you have slept on your arm or leg in an awkward position and it awakens you with that same tingling sensation). If you have not taken any pain medicine before going to bed that first night after your surgery, please take a dose at bedtime in case the nerve block wears off during your sleep.

Continue regular exercise and eat healthy diet. The key is to maintain a healthy lifestyle. Don’t smoke. Don’t make any sudden changes to your lifestyle where your physiology/body may be in recovery.

Side effects of anesthesia can occur during a surgery or procedure, or afterward when you are recovering and the anesthesia is wearing off. The possible side effects vary, depending on what kind of anesthesia you have: general (sedation provided through inhaled or intravenous – IV – medications), regional (numbing only part of your body, usually below the waist) or local (numbing a small area). While some side effects that occur after surgery may be uncomfortable or frustrating, most don’t last long.

General Anesthesia

The side effects of general anesthesia can include:

• Nausea and vomiting – This very common side effect can occur within the first few days of having surgery and can be triggered by a number of factors such as the medication, motion and type of surgery.
• Sore throat – The tube that is put in your throat to help you breathe can leave you with a sore throat after it’s removed.
• Confusion – Confusion when waking up from surgery is common, but for some people – particularly those who are older – confusion can be more pronounced.
• Muscle aches – The medications used to relax the muscles so a breathing tube can be inserted can cause soreness.
• Itching – This is a common side effect of narcotics, one type of pain medication sometimes used during general anesthesia.
• Chills and shivering – This is common when patients regain consciousness after surgery. It can occur in up to half of patients. Researchers aren’t sure, but think it might be related to the body’s altered sense of it’s own temperature. The shivering can be resolved with medication.

Rarely, general anesthesia may cause more serious complications, including:

• Malignant hyperthermia – Some people inherit this serious, potentially deadly reaction to anesthesia that can occur during surgery, causing a quick fever and muscle contractions. If you or your family member has ever had heat stroke, or suffered from the condition in a previous surgery, be sure to tell the anesthetist.

Regional Anesthesia

The potential side effects of regional anesthesia (such as an epidural or spinal block, in which an anesthetic is injected in the lower back), include:

• Headache – This can occur a few days after the procedure if some of the spinal fluid leaks out.
• Minor back pain – Soreness can happen at the site where the needle was inserted into the back.
• Difficulty urinating – Because the area below the waist is numbed, it may be difficult to urinate.
• Hematoma – Bleeding beneath the skin can occur where the anesthesia was injected.

Serious but rare complications include:

• Pneumothorax – When anesthesia is injected near the lungs, the needle may accidentally enter the lung. This could cause the lung to collapse and require a chest tube to be inserted.
• Nerve damage – Although very rare, nerve damage can occur, causing temporary or permanent pain, weakness, numbness, or paralysis.

Local Anesthesia Injection

Injection of local anesthesia numbs just the part of your body requiring minor surgery or a procedure. Side effects are minimal and usually are related to how much anesthesia is injected.

If you’ve had any of these or other side effects or complications with past surgeries or procedures, tell your anesthetist, who may be able to give you medicine before or after the procedure, or make other adjustments to prevent it from happening again.

Very rarely – in only one or two out of every 10,000 medical procedures involving anesthesia – a patient may become aware or conscious. The condition – called anesthesia awareness – means the patient can recall the surroundings or an event related to the surgery while under general anesthesia. Although it can be upsetting, patients usually do not feel pain.

Certain surgeries or circumstances increase the risk of awareness during surgery because the usual dose of required anesthesia cannot be used safely. These include emergency surgeries – such as C-sections, heart surgery and trauma surgery – as well as when patients have multiple medical conditions. anesthetists closely monitor surgeries using sophisticated equipment to ensure that, even in the rare case when awareness occurs, a patient is safe and does not feel pain.

If you think you experienced anesthesia awareness during a procedure, tell your anesthetist or health care team as soon as possible.

It’s not uncommon for patients to believe they were aware during surgery, when this was not the case. A patient typically remembers the time when the anesthesia has just begun to work but has not completely taken affect, or shortly after surgery, when the anesthesia has not yet worn off, but this is not considered awareness which would take place during the procedure.

Patients also are more likely to have awareness with procedures that do not involve general anesthesia. For example, you may recall all or part of your procedure if you have:

• Intravenous, or “twilight” sedation, often given during minor procedures such as a colonoscopy, a biopsy or a dental procedure
• Local or regional anesthesia, such as an epidural or spinal block, or a nerve block

To reduce your risk of experiencing awareness during procedures with general anesthesia, it is important to tell your anesthetist important health information, including:

• Previous problems with anesthesia, including a history of being aware during surgery
• All medications you are taking, both prescription, over-the-counter and herbal supplements
• Concerns you may have about surgery, including fear of being aware during surgery

Patients who have experienced anesthesia awareness during a procedure can get counseling to help ease any feelings of confusion, stress or trauma.

Many women choose an epidural to relieve labor pain. Women sometimes ask if an epidural can slow labor or lead to a cesarean delivery. There is no evidence that it increases your risk of a cesarean delivery. To decrease the possibility of side effects, ask for an anesthetist to be involved in your pain management plan.

Epidurals are safe, but you should be aware of some potential epidural side effects:

• Decrease in blood pressure: The medication may lower your blood pressure, which may slow your baby’s heart rate. To counter this decrease in blood pressure and to maintain the baby’s heart rate, you will be given extra fluids through a tube in your arm (IV line) and may need to lie on your side to maintain a good blood pressure. Sometimes, your anesthetist will treat your lower blood pressure with a medication to increase it to its original value.
• Sore back: Your lower back may be temporarily sore where the needle was inserted to deliver the medication. This soreness should last no more than a few days.
• Headache: Rarely, the covering of the spinal cord may be pierced when the needle is placed, which can cause a headache that may last for a few days if left untreated.

Before you give birth, talk to your physician to find out who will administer your anesthesia if you decide to have pain medication during labor. Your childbirth anesthesia care should be led by a anesthetist — a medical doctor specializing in anesthesia, pain and critical care medicine — who works with your other physicians to develop and administer your anesthesia care plan. With 12 to 14 years of education and 12,000 to 16,000 hours of clinical training, these highly trained medical specialists ensure safe, high-quality care.

The hospital or surgical facility usually bills your surgical anesthesia services directly to the insurance. If your surgery is covered by your insurance, generally a portion of your anesthesia bill will be covered. But please make sure to contact your insurance provider for approval if you have concerns.