What is an anesthesiologist?

Anesthesiologists are physycians (M.D. or D.O.) who specialize in the field of Anesthesiology.
Many people are apprehensive about surgery or anesthesia. If you are well-informed and know what to expect, you will be better prepared and more relaxed. Talk with your anesthesiologist. Ask questions. Discuss any concerns you might have about your planned anesthetic care. Your anesthesiologist is not only your advocate but also the physician uniquely qualified and experienced to make your surgery and recovery as safe and comfortable as possible.

There are four main types of anesthesia: Local, MAC, Regional, and General.

Local Anesthesia
The anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery by the surgeon. No anesthesiologist is present for true local anesthesia.

Monitored Anesthesia Care (MAC)
Monitored anesthesia care refers to instances in which an anesthesiologist has been called upon to provide services to a patient undergoing (typically) minor, superficial surgery.  The patient may also receive local anesthesia provided by the surgeon. In such a case, the anesthesiologist is in control of the patient’s non-surgical or non-obstetrical medical care, including the responsibility of monitoring the patient’s vital signs. The anesthesiologist usually administers sedation as appropriate. If a patient is unconscious during any part of a procedure it is considered general anesthesia.

General Anesthesia
General anesthesia makes you both unconscious and unable to feel pain during medical procedures. An anesthetized state is produced by the administration of intravenous medications and/or inhaled gasses (anesthetics).  The “sleep” you experience under general anesthesia is different from regular sleep. The anesthetized brain doesn’t respond to pain signals or surgical manipulations. The patient may require an advanced airway in some instances.  This is determined by the requirements of the surgery and the patient.

Regional Anesthesia Regional anesthesia is the “numbing” of a large or small part of the body. Regional anesthesia techniques can be divided into central and peripheral techniques. The central techniques include so-called neuraxial blockade (epidural anesthesia, spinal anesthesia). The peripheral techniques can be further divided into plexus blocks such as brachial plexus block, and single nerve blocks. Regional anesthesia may be performed as a single shot or with a continuous techniques. It is usually combined with monitored anesthesia care or general anesthesia.

The Anesthesia Care Team

Some patients having surgery at Sibley will be under the care of an individual anesthesiologist. Others may be cared for by an anesthesia care team. The Anesthesia Care Team consists of anesthesiologists supervising qualified, trained non-physician providers such as nurse anesthetists. Anesthesiologists may delegate patient monitoring and appropriate tasks to the non-physician anesthesia providers in a medical direction model.

Recovery from Anesthesia

Following surgery, patients gradually awaken in the “post-anesthesia care unit” (PACU). With our experienced and dedicated PACU nurses in attendance, and under the direction of the anesthesiologist, any needs will be addressed with respect to pain, anxiety, nausea and specific medical problems. Once stable and comfortable, patients are transferred either to the medical floor (if spending the night) or to a secondary recovery area where they are prepared for discharge.

Prior to discharge, patients are given instructions and a point of contact if questions arise regarding their post-anesthetic recovery.

Preparing for Surgery

What to expect

When you and your surgeon decide to proceed with a surgery, his or her office will call the hospital and add it the surgery to the operating room schedule.

The timing of the surgery is based on a combination of patient, surgeon and facility availability.

Once the surgery is scheduled you will be contacted by the admitting department at the hospital. The admitting department will create an update record in the hospital computer system. Demographic and insurance information will be clarified.

The information will also be forwarded to the Pre-Surgical Testing Center. The Pre-Surgical Testing Center will contact you by phone to gather relevant medical information.

More lead time between the date of posting and the date of surgery will make the process seem less rushed.

What will I need to prepare for surgery? Everyone

All patients presenting for surgery will require a history and physical (H&P).

The H&P can be performed by your surgeon or your primary care physician. It can also be performed by a Sibley provider in the Pre-Surgical Testing Center or on the day-of-surgery. Day-of-surgery history and physicals are usually reserved for patients with few coexisting medical problems or uncomplicated past medical histories. Please ask your surgeon who will be responsible for the H&P.

What will I need to prepare for surgery? Some patients

Some patients may require additional medical tests or expert consultations. What is required is typically determined by the type of surgery and any pre-existing medical conditions that may exist.

Patients with a history of significant heart, lung or bleeding disorders may be required to receive clearance from their respective cardiologist, pulmonologist or hematologist. Patients with unexplained shortness-of-breath or inability to perform daily activities without becoming short-of-breath require close preoperative evaluation.

Others who may require additional consultations include those patients who are taking opioid medications for chronic pain conditions, those patients taking blood thinners, those patients with electronic implantable medical devices or those patients with poorly controlled diabetes.

Please call the Pre-Surgical Testing Center or check with your surgeon or primary care solution for more information.

Copies of the results of any outside testing and copies of notes of office visits in preparation to surgery should be sent by fax to the Pre-Surgical Testing Center.

 

Avoiding Cancellations

Elective surgical procedures may be cancelled if the patient has any acute/unstable conditions or conditions that are not medically optimized. This does not occur frequently, but usually a cancellation can be avoided by obtaining the recommended history and physical and/or testing at least a week before surgery.

Please notify your surgeon or call the Pre-Admission testing center if there have been any recent changes in your health or medications in the period between your history and physical and the date of your surgery.

Surgery Locations

The Department of Anesthesia provides services throughout the hospital. Most procedures will take place in the main operating room or in the Sibley Ambulatory Surgery Center.

Can I See an Anesthesiologist Pre-Operatively?

Yes. Any patient can be seen by an anesthesiologist in the Pre-Admission testing center. These visits are usually arranged through the surgeon’s office. The appointment must occur no later than 48 hours prior to your elective surgery.

The Day Before and the Day of Surgery

Appropriate preoperative fasting is very important. Fasting helps reduce the chance of vomiting and aspirating items into your lungs during your surgery, and it is mandated for your safety. Vomiting anything while under anesthesia can lead to critical illness and even death. Patients who have not properly fasted will have their surgeries cancelled or delayed.

You may receive specific fasting instructions from your surgeon. If so, please follow those instructions.

Otherwise, please adhere to the following guidelines:

  • No solid foods, non-clear liquids (including milk or coffee/tea with milk) gum or candy after midnight. No alcohol.
  • Clear liquids may be ingested up until two hours prior to your scheduled arrival time at the hospital (this is typically two hours prior to your scheduled surgery start time). Clear liquids include: water, sports drinks, juices without pulp, coffee without cream, black tea. Avoid milk, smoothies, juices with pulp (citrus, pineapple, tomato, etc.).
  • Please limit the amount of clear liquids to a maximum of eight ounces at a time on the day of surgery (unless you are provided with specific instructions by your surgeon).

Swallow pills you are required to take the morning of surgery with only sips of water.  Please clarify with your surgeon when to stop blood thinners and aspirin. Hypertensive patients should not take diuretics, ACE inhibitors or angiotensin receptor blockers on the morning of surgery. They should take their other blood pressure medications. Vitamins and supplements should not be taken on the day of surgery. Weight loss medications must also be held for ten days. Patients taking medications for diabetes or chronic pain should follow specific instructions regarding what medications to take. Please call the Pre-Surgical Testing Center for further guidance and answers about specific medications.

If you are going home on the same day as your surgery, you must arrange for a responsible adult to take you home. It cannot be a taxi or Uber driver. You also need to arrange for an adult to stay with you for at least 24 hours after surgery.

Please wear clothes that are loose and comfortable. This makes it easier for you both before and after surgery, when you may be required to change and/or health-care team members may need to help you change.

Please bring a list of your medicines. Please do not bring jewelry or other valuables with you.

ERAS

Some patients may be given specific instructions regarding preoperative medication and fasting as part of the ERAS (Enhanced Recovery after Surgery) program. Some Sibley Hospital surgeons are participating in this evidence-based program which aims to shorten the hospital course and expedite the recovery of patients having specific surgeries.

Obstructive Sleep Apnea

What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is an increasingly common condition where people quit breathing during sleep. A blockage of the airway causes OSA, causing the body to sense a lack of air and wake up to resume breathing.  OSA causes poor sleep quality and is often associated with daytime sleepiness, obesity and hypertension. It is formally diagnosed by a sleep study.

Can I have sleep apnea and not know it?
Yes. Many people have sleep apnea and have never been formally diagnosed. Some of the most common symptoms are snoring and/or unexplained daytime somnolence.

How is obstructive sleep apnea treated?
A continuous positive airway pressure (CPAP) machine is one form of treatment for obstructive sleep apnea (OSA). Patients who use CPAP wear a plastic mask over their nose and/or mouth during sleep. The machine then gently blows pressurized room air through the airway at a pressure high enough to keep the throat open.

Can I have anesthesia if I have obstructive sleep apnea?
It is important to let your anesthesiologist know if you have, or suspect you have obstructive sleep apnea. People with OSA may not be suitable for outpatient surgery, and may require observation of their breathing in a hospital setting after surgery. Also, OSA may be worsened after surgery. When possible, your own CPAP machine may be used in the recovery room or on the inpatient floor to help you wake up safely.

Cardiac Rhythm Devices

Patients with pacemakers and/or implantable defibrillators should be evaluated to make sure their devices are functioning properly and have been recently evaluated by their cardiologist.  A special pre-op form (available from the Pre-Admission Testing Center) will need to be completed.

What if I Smoke Cigarettes?

Besides the obvious long-term health benefits of stopping smoking, having surgery may be a good motivation to stop smoking. Cigarette smokers typically have a less pleasant experience with anesthesia.

The American Society of Anesthesiologists has resources available for patients who smoke and want information for stopping.

http://www.asahq.org/lifeline/anesthesia%20topics/qa%20stop%20smoking

What are the risks of anesthesia?

Very common (1 in 10 chance) to common (1 in 100 chance):

  • Feeling sick to your stomach and vomiting
  • Sore throat, hoarse voice
  • Dizziness, blurred vision
  • Headache
  • Itching
  • Pain during drug injection
  • Temporary confusion, memory loss

Uncommon (1 in 1000 to 1 in 10,000 chance):

  • Chest infection
  • Difficulty with bladder control
  • Muscular pain
  • Slow breathing
  • Jaw joint pain
  • Damage to teeth, lips, gums. (Damage to teeth during intubation may be considered a risk associated with intubation).
  • Awareness (becoming conscious during anesthesia)

Rare (1 in 10,000 chance) to very rare (1 in 100,000 chance):

  • Damage to eyes
  • Serious allergy to drugs
  • Nerve damage
  • Stroke/heart attack/death

Will I receive a separate bill from the anesthesiologist?

Your anesthesiologist is a physician specialist like your surgeon or internist, and you will receive a bill for your anesthesiologist’s professional service as you would from your other physicians. If you have any financial concerns, your anesthesiologist or an office staff member will answer your questions. You will note that your hospital charges separately for the medications and equipment used for your anesthetic.