Anesthesiologist
Pre-Assessment Clinic
Pre-Operative Interview
Types of Anesthetics
Post Operative Care
Anesthesia for Children

Members of Anesthesia Associates provide all anesthetic services in the operating rooms of Deaconess Hospital and Medical Center (DHMC) and Valley Hospital and Medical Center (VHMC). A board-certified or board-eligible anesthesiologist will either provide your anesthetic him/herself or will supervise a certified registered nurse anesthetist (CRNA).

For the surgeons, anesthesiologists, and nurses at DHMC and VHMC, your safety is their number one priority. Their training and experience, the use of modern medical monitoring devices and medications, and your cooperation in adhering to all pre-operative instructions help ensure that your surgery is safe and convenient.

It is normal for patients and their families to experience stress and anxiety prior to surgery. We hope that the following information will help put you at ease.

ANESTHESIOLOGIST

The anesthetic for your surgery at DHMC or VHMC will be the responsibility of an anesthesiologist. Anesthesiologists are physicians who, after medical school, have received at least 4 additional years of specialized training in the medical specialty of anesthesiology.

PRE-ASSESSMENT CLINIC

Most patients having surgery at DHMC or VHMC will have the opportunity several days before their surgery to either be interviewed in person or via telephone by registered nurses in the pre-assessment clinic. The nurses will ask you to complete a confidential detailed health history questionnaire about prior surgeries, current and past medical problems, and medications you take. The information obtained from this important health history is used to guide the anesthesiologist in the choice of your specific anesthetic.

Also, during your pre-assessment interview you will have the opportunity to ask questions, and you will receive important instructions, such as what medications to continue, and when and what you can eat and drink before surgery. The risks patients expose themselves to when they fail to comply with the eating and drinking guidelines are prolonged hospitalization and life-threatening lung injury. Please remember that the pre-operative instructions apply to all types of anesthesia.

PRE-OPERATIVE INTERVIEW

An anesthesiologist will visit with you on the day of your surgery, utilizing both the health history questionnaire you completed for the nursing staff and information you provide him/her directly.

Your anesthesiologist needs to know as much about you as possible because anesthesia and surgery affect your entire system. During your pre-operative interview, an anesthesiologist will ask you about your medical history, prior surgical and anesthetic experiences, and your allergies and current medications. Frequently, people requiring surgery have other medical conditions, such as diabetes, asthma, high blood pressure, arthritis, or heart disease. The preoperative evaluation will allow the anesthesiologist to be aware of these conditions and to be well prepared to treat them during your surgery and immediately afterward in the Post-Anesthesia Care Unit (PACU), also known as the “Recovery Room”. From information obtained from the pre-operative evaluation, your anesthesiologist may order laboratory tests or determine that you would benefit from a consultation with another medical specialist. Based on all this information, plus the type of surgery you are having, the anesthesiologist will outline to you the anesthetic alternatives. The choice of anesthetic technique is best left to your anesthesiologist and surgeon.

Your type of surgery and your physical condition will determine if you will need to stay overnight following your surgery.

Before your anesthetic starts, you will have an intravenous (IV) catheter placed into a vein. For most patients, since local anesthesia is used at the insertion site, there is little discomfort associated with the catheter. The IV is used to administer anesthetics, other medications, and fluids during your surgery. Once you are actually in the operating room, important monitoring devices will be attached to you: blood pressure cuff around your arm, ECG electrodes on the skin of your chest, and an oxygen monitoring device on a finger tip.

Once the monitors are in place, your anesthetic will begin.

TYPES OF ANESTHETICS

There are three major categories of anesthetics: general anesthesia, regional anesthesia, and local anesthesia with sedation (also called “conscious sedation”). The choice of anesthetic is based on many factors, including your physical condition, your specific surgery, and your current medications. The number one consideration is always your safety.

Anesthetics are designed so that you awaken shortly after the completion of the surgery. Short-acting anesthetic medications and specialized anesthetic techniques are used to make your surgical experience as safe and pleasant as possible.

GENERAL ANESTHESIA - patients having general anesthetics are unconscious and do not awaken until the anesthetic is discontinued. General anesthetics are injected into veins or are inhaled. Frequently, a combination of intravenous and inhaled anesthetic medications is used. In most cases of general anesthesia the anesthesiologist will place a breathing device down your mouth after you are unconscious, assuring the movement of anesthetic gases and oxygen to and from the lungs. Modern anesthetic medications have less nausea and vomiting and faster wake up times. Patients who have had general anesthetics awaken in the Phase 1 of the Post-Anesthesia Care Unit (PACU).

REGIONAL ANESTHESIA – examples of regional anesthesia include: spinal anesthesia and epidural anesthesia. Certain patients will benefit from these techniques in which local anesthetics are placed by the anesthesiologists near specific sites that block sensation to the areas of the body on which the surgery will take place. Spinal anesthesia is accomplished by injecting local anesthesia in the lower back into the spinal space resulting in temporary numbness from the waist down; it is frequently used for operations of the prostate gland, ankle, and knee. Epidural anesthesia also involves placement of local anesthesia into the back near the spinal space; the exact placement of the local anesthetic is slightly different than that for spinal anesthesia, and the epidural allows for placement of a small catheter into the epidural space that can be used for several days as a method for supplementing post-operative pain control.

The duration of the regional anesthetic can vary from an hour to many hours, and is dependent upon the specific local anesthetic solution selected by the anesthesiologist and is based on the projected duration of the surgery itself.

The anesthesiologist will usually combine some intravenous or inhalational anesthesia with the regional anesthetic techniques allowing for patients to rest comfortably throughout their surgery.

LOCAL ANESTHESIA AND SEDATION- for some patients having certain specific surgeries, a combination of local anesthetics injected at the operative site by the surgeon combined with sedatives and narcotics administered intravenously by the anesthesiologist allow for patients to be comfortable during the procedure without requiring unconsciousness or regional anesthesia. This technique is called “conscious sedation”. This anesthetic technique often allows for a more rapid recovery and discharge. However, conscious sedation is suitable for only certain patients and surgeries. Your anesthesiologist will select the anesthetic that is safest for you.

The anesthesiologist will closely monitor your vital signs throughout your operation whether you are having a general anesthetic, regional anesthetic, or conscious sedation anesthetic.

POST-OPERATIVE CARE

Modern anesthetics allow for patients to awaken quickly following surgery. There are two phases to the recovery of patients who receive general anesthesia and regional anesthesia, and one phase for those patients who received conscious sedation. Immediately following completion of a surgery involving general and regional anesthesia, the anesthesiologist and operating room nurse transfer all patients by gurney from the operating room to Phase 1 of the Recovery Room. Nurses with advanced training in post-operative care monitor patient’s vital signs, assist in the wake up, and treat any discomfort. It is in Phase 1 that patients awaken and may receive additional pain or anti-nausea medications.

Patients who were administered conscious sedation usually do not go to Phase 1, but are transferred directly from the operating room by gurney to Phase 2. Patients who are staying overnight in the hospital do not go to Phase 2 of the PACU, but rather are transferred to their rooms in the hospital.

Only patients who are expected to be discharged home on the day of surgery are taken to Phase 2 of the PACU. These patients are more fully awake, and they are allowed to sit up in special chairs, to sip fluids and to eat small amounts of food. Patients and families are given post-operative instructions, in verbal and written form, and then patients are discharged home once they have met specific recovery room criteria. All patients having general anesthesia, regional anesthesia, or conscious sedation must, without exception, have an escort to drive them home. This rule is strictly enforced for the safety of the patient and the public.

ANESTHESIA FOR CHILDREN

The preparation for surgery for children begins with efforts by the parents to explain honestly and calmly to their child what the anesthetic and surgery will be like. Words and phrases with positive connotations should be used. The condition of unconsciousness is best described as “a special nap”. The word “medications” sounds better than “drugs”.

Anesthesiologists and nurses are specialists in treating pain. Children need to know that yes, there will be some discomfort after the surgery, but that the doctors and nurses will work very hard to make them feel better. Also, children should be informed that parents will not be with them at all times, but that the parents will be in the building waiting for them.

We encourage the children to bring with them into the operating room their favorite stuffed toy or blanket, but not their parents. It is the opinion of the anesthesiologists at DHMC and VHMC (and confirmed by national studies) that there is no value in terms of patient safety or comfort to have parents in the operating room at any time. It is natural for young children to cry when they are separated from their parents in the pre-operative area. But the crying does not last long, and the warm hugs of the operating room staff combined with the rapid and gentle onset of the anesthetic gases makes the beginning of the anesthetic almost always a pleasant experience for children.

For children, the anesthesiologist may begin the anesthetic in the operating room by having the child breath an anesthetic gas through a mask, then placing an intravenous catheter (adults have their IV placed before the anesthetic begins). This depends on the pre-operative evaluation, the physical exam and the type of surgery. Oftentimes this is a desirable induction method as it eliminates the discomfort associated with the placement of an IV in patients who are awake. However, in some situations it is safer to have an IV placed prior to beginning the anesthetic. When this is the case, local anesthetics are placed into the skin to reduce the pain when placing the IV.

It is normal for children to be uncomfortable in a hospital. It is difficult being a patient when you are a child (or adult), and it is difficult being the parent of a child having a surgery. Your operating room staff understands this, and their experience allows them to safely care for children and parents of all temperaments.

After surgery, children will be taken to the Phase 1 of the Post-Anesthesia Care Unit (PACU) and cared for by nurses with specialized training. It is there that patients awaken and may receive additional pain or anti-nausea medications. Parents are allowed in the Phase 1 area, and can accompany their child to Phase 2 if their child is to be discharged or can accompany their child to its hospital room, if the child is an inpatient.

In Phase 2 PACU, patients are offered small amounts of food and drink, and their IV is removed, which is usually painless. Also, parents of out-patients receive detailed post-operative instructions (written and verbal) prior to discharge to home.

Should questions or concerns arise regarding the anesthetic, parents should first telephone their child’s surgeon, who will then contact the anesthesiologist.