What is anesthesia?
Anesthesia is provided by a team of anesthesiologists (physicians specially trained in anesthesia) and CRNAs (nurses with specialty training in anesthesia). There are many types of anesthesia that are administered based on your health and the type of surgery you are having. Monitored anesthesia care (MAC) is a type of deep sedation provided in conjunction with local anesthesia that is injected by your surgeon. This is often appropriate for simple procedures on the skin and soft tissue.
Regional anesthesia (often referred to as a "nerve block") is provided by the injection of local anesthesia next to nerves. This type of anesthesia may be used alone or in conjunction with general anesthesia for surgery on the arms or legs. Epidural anesthesia, a type of regional anesthesia, is often used along with general anesthesia to provide pain relief after surgery in the chest or upper abdomen. Many surgeries require general anesthesia. In this case the patient is unconscious and feels nothing. Your anesthesiologist will determine the specific type of anesthesia that is best for you.
Is anesthesia safe?
Anesthesia can generally be administered safely and without major complications, even to patients with serious health problems. However, even when done carefully and competently, sometimes serious and even life-threatening complications do occur. Thanks to innovations in anesthetic drugs, monitoring techniques, equipment, and a better understanding of how the body reacts to anesthesia over the past several decades, it has become considerably safer. Today the risk of death from anesthesia is less than 1 in 200,000. The most common complications from anesthesia are nausea and sore throat.
Your risk of having a complication from anesthesia is determined by individual health status, the nature of your surgery, and whether or not your surgery is elective or emergent. On the day of your surgery your anesthesiologist can go over specific risks and their likelihood of occurrence based on the type of anesthesia that is being planned. You can reduce your risk by providing your anesthesiologist with complete information about your health, informing your primary care physician that you are planning to have surgery and by following appropriate fasting or "NPO" guidelines.
What information should I give to the anesthesiologist?
It is important for your anesthesiologist to have complete information about your health history. You should be sure to bring a list of medications and their dosages with you on the day of surgery. It is also important to ensure that information from your primary care doctor's office has been forwarded. Results from a stress test, cardiac ultrasound (echo) or a cardiac catheterization can give important information to your anesthesiologist that will help him or her plan a safe and comfortable anesthetic for you. It is helpful if you call and make sure your primary care physician knows that you are having surgery. Your primary care physician's office can fax any information to the pre-admission testing center at 444-4478. Please include your name, surgeon and the date of surgery on the fax.
Can I eat before surgery?
An appropriate fasting period is essential to patient safety. The objective is to empty the stomach so that the risk of inhaling stomach contents into the lungs is reduced. This is a serious potential complication called pulmonary aspiration and in severe cases, it can be fatal. You should not eat or drink for at least eight hours prior to surgery. This includes coffee, chewing gum and hard candy. It's okay to drink a small amount of water to take the medications you are allowed.
Which medications should I take prior to surgery?
Taking certain medications on the day of surgery improves your safety. On the morning of surgery you should take medications prescribed to you for the following conditions:
Taking other medications on the day of surgery can make your care more difficult. You should discuss with your surgeon whether or not to take medications that thin the blood including NSAIDs (ibuprophen, aspirin), plavix and coumadin.
If you are a diabetic you should not take any oral medications (pills) for your diabetes the day of surgery. Insulin guidelines are listed below.
If you have any questions, please call your surgeon's office.
I am diabetic. What if my blood sugar is low before surgery?
Check your blood sugar the morning of surgery. If your blood sugar is low, you may have ginger ale, Sprite or apple juice only. Do not have orange juice.
My surgeon told me I would have a "nerve block." How does that work?
Patients having certain surgical procedures may benefit from a nerve block, instead of, or in addition to, a general anesthetic. Nerve blocks often allow patients better pain control than narcotic pain relievers. They can facilitate a speedier discharge from the hospital for certain procedures. Regional blocks may also reduce the incidence of post-operative nausea.
The most common procedures that utilize nerve blocks at Rhode Island Hospital are knee and shoulder surgeries. Most often an anesthesiologist will perform the nerve block prior to surgery. The nerve block is done while the patient is awake, but sedated. Most nerve blocks utilize a nerve stimulator. This is a device that allows a small current to pass down the needle producing a muscle contraction when the needle comes near a nerve. Based on which muscles move, the anesthesiologist will know when the needle is in close proximity to the nerve he or she wishes to block. Other times, an ultrasound device is used to see the nerve and needle using sound waves. Generally, patients do not find this procedure uncomfortable and in fact, many do not remember having the nerve block.
Nerve blocks are done with the patient awake because this is the safest way for them to be performed. There is always a chance that severe and permanent nerve damage can occur during a nerve block, but this is very unlikely with an awake and cooperative patient. If you are offered a nerve block it is because your surgeon and anesthesiologist believe the potential benefit that you will receive from the nerve block outweighs the minimal risk.