FAQ’s

When will I get to speak to my Anesthesiologist?
Why can’t I eat before surgery?
When should I stop eating and drinking?
What about my medications?
Why do I have to remove my jewelry for surgery?
What are my anesthesia choices?
Do I have to be asleep for my operation?
Will an anesthesia provider be with me the entire time I am asleep?
How am I monitored during anesthesia?
Will I wake up during my surgery?
Will I need to receive blood during my surgery?
What will happen when I wake up after surgery?
Does anesthesia have risks and effects?
What are the other risks?
What if I have significant health problems like heart or lung disease?
A relative of mine had a bad reaction to anesthesia, could it happen to me?
Does smoking have anesthetic implications?
What are your privacy policies with regard to my medical information?
If I am awake afterwards may I drive myself home?

When will I get to speak to my Anesthesiologist?

Patients are rarely admitted the night before surgery and generally arrive only several hours before their scheduled operation. The evening prior to your operation, your anesthesiologist may attempt to reach you by telephone. However, sometimes that is not possible. After your arrival at the hospital, you will have the opportunity to meet your anesthesiologist and discuss the anesthetic procedure in detail as well as ask .

Your medical history, surgical experiences, and allergies will be reviewed with your anesthesiologist. A list of your current medications (including herbals) will be important to provide for your anesthesiologist. After carefully considering the nature of your surgery, your overall health, medical history, lab tests, and your own concerns and preferences, you, your anesthesiologist, and your surgeon will make the final decision about the type of anesthesia that is both safe and best for you.

Why can’t I eat before surgery?

While under anesthesia, you lose your protective reflexes such as coughing. It is possible to throw up and aspirate your gastric contents (in other words, whatever was in your stomach can end up in your lungs). If you have eaten or had fluids recently, there will be more acid and particles in your stomach. Aspiration of this could cause extensive damage to your lungs. This "aspiration pneumonia" was one reason many people died under anesthesia many years ago before fasting guidelines were instituted. During emergency surgery, many precautions are taken to limit the risk of aspiration pneumonia in patients with a full stomach. However, it is best to follow the fasting guidelines set by your anesthesiologist for elective surgery. You may be asked to take some or all of your usual medications with a few sips of water before surgery which typically dissolve and pass out of your stomach by the time anesthesia starts. Your anesthesiologist may also recommend that you take certain antacids prior to your anesthetic if you are at risk for aspiration.

When should I stop eating and drinking?

In order to reduce the risk of severe complications, we ask that all patients follow specific guidelines for eating and drinking.

Adults and Children over 12yo: STOP solids at midnight or at least 8 hours prior to surgery. You may have clear liquids up to 4 hours before surgery.

Children over 2yo and less than 12yo: STOP solids at midnight or at least 8 hours prior to surgery. You may have clear liquids up to 4 hours before surgery.

Children 2 Years and Younger: STOP solids (including formula) 6 hours before surgery, breast milk 4 hours before surgery, and clear liquids 2 hours before surgery.

Solids are all food including liquids such as milk, milkshakes, smoothies, and anything turbid. Clear liquids are anything you can see through including water, Sprite or 7-Up, apple, cranberry juice, coffee or tea without cream or milk, and Pedialyte.

What about my medications?

Do Not Take:

• Oral hypoglycemic agents (oral diabetic medicines): Do NOT take on the day of surgery.
• Glucophage: You may take Glucophage the evening before but do not take the morning of surgery.
• Diuretics (water pills) should not be taken the morning of surgery except when given for high blood pressure.
• Anticoagulants (such as Coumadin, aspirin, Plavix, Lovenox), and other Nonsteroidal Anti-Inflammatory agents (such as Motrin, Advil, Ibuprofen) should be stopped as directed by your surgeon. Call your surgeon's office if you usually take any of these medicines and have received no specific instruction.
• Large bulk medications such a Metamucil.
• Some medicines say "take with food or milk". Do NOT take those medications.

You May Take:

• On the day of surgery, you may continue to take oral medication pills with a small sip of water (except as noted above).
• Chronic pain medications should continue to be taken.
• Insulin: Your dose for the day of surgery may be determined by your anesthesiologist, primary physician, or surgeon. If you have not received specific instructions regarding your insulin by the morning of your surgery, then take one half your usual dose and
  monitor your blood sugars closely.
• Inhalers for asthma and emphysema: use as scheduled and bring your inhalers with you to the hospital for continued use during your hospitalization.
• Take only those herbal medications approved by your anesthesiologist.

Why do I have to remove my jewelry for surgery?

This is not an anesthetic concern but your surgeon may need to use a special instrument to stop bleeding during your surgery. If you are wearing metal jewelry that is in contact with your skin, it could cause an electrical burn in the area.

What are my anesthesia chioces?

There are 3 basic types of anesthesia which can be used alone or in combination:

1. General Anesthesia – With general anesthesia you are unconscious for the entire procedure. You will be unaware and will feel no pain during the surgery. The medication is given into a vein or inhaled. A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery.
   
   
2. Local Anesthesia – Numbing medication is injected directly into the surgical site to block pain sensations from a particular area. A sedative medication may also be administered for relaxation.
   
   
3. Regional Anesthesia – This involves injecting local anesthetic around major nerves or adjacent to the spinal cord in order to block pain signals. You may also be given a sedative medication for relaxation. There are 2 basic types of regional anesthesia:
   
   
   1. Spinal or Epidural anesthesia – The numbing medication is injected around the spinal cord and blocks pain signals from the entire region of the body below the level of the block. This is often used for lower extremity, lower abdominal, obstetrical, gynecological and rectal procedures.
      
      
   2. Peripheral Nerve Blocks – The numbing medication is injected near major nerve groups to speci?c areas, i.e., the shoulder, arm, hand or leg. This blocks the pain signals from that area.

Some surgical procedures can be accomplished readily with regional or local anesthesia. Regional anesthesia involves numbing a limited area of a patient's body to prevent pain during surgery. This can be accomplished with or without sedation. Other procedures may require general anesthesia. For certain procedures, we offer elective nerve blocks to help with post operative pain and reduce the amount of general anesthesia required. Your anesthesiologist will discuss these options with you as well as the risks or complications involved with general anesthesia, regional anesthesia or nerve blocks

Do I have to be asleep for my operation?

Some surgical procedures can be accomplished readily with local anesthesia, regional anesthesia, or light sedation alone and frequently in combination thereby allowing our patients to maintain consciousness. Other procedures may require general anesthesia for patient safety or to achieve a satisfactory surgical result. Please be sure to discuss these options with your anesthesiologist.

Regional anesthesia, like general anesthesia, is safe. While complications and side effects with regional anesthesia are rare, they can include the following:

• Infections at the site of injection can range from inconsequential to life-threatening (meningitis).
• Rarely is permanent nerve damage a result of these techniques.
• Epidural, spinal, and caudal anesthetics are associated with a small but real risk of headaches. These may last several days after the procedure and may require special treatment.
• One can also experience temporary difficulty emptying the bladder, which may require catheterization of the bladder. This problem resolves as the anesthetics wear off.
• Heart, breathing, and blood pressure problems can occur.

Will an anesthesia provider be with me the entire time I am asleep?

Yes, the standard of care in anesthesiology is that a competent anesthetist be in the patient's presence continuously during the entire anesthetic.

How am I monitored during anesthesia?

Your response to your anesthetic is continually monitored by the vigilance of your anesthesiologist. An increasing number of sophisticated monitoring devices are used to assure your well being and safety throughout the entire surgery.

Will I wake up during my surgery?

Awareness under anesthesia is an extremely rare event, but not an impossible one. In most instances, your anesthesiologist is able to give you sufficient medications to eliminate this possibility.

Will I need to receive blood during my surgery?

The answer to this question depends upon the type of surgery you are having and your medical condition. Often the need for a blood transfusion is known before the surgery. Sometimes unexpected events occur during surgery and the need for an emergency transfusion may arise. If you have personal beliefs against, or concerns about, this possibility, you should be sure to discuss this with your anesthesiologist during the pre-operative interview. Your anesthesiologist recognizes the seriousness of blood transfusion. Patients only receive blood when it becomes the treatment option necessary for the well being of the patient.

What will happen when I wake up after surgery?

You will be monitored in the recovery room for one to two hours where our expert nursing staff will continue to give medications to assist with pain, nausea, vomiting, hypertension, hypotension or other possible side effects related to the surgery and anesthetic. Some people, however, are more prone to these symptoms and will therefore have to be monitored for a longer period of time. You will then be discharged or transferred to your room.

Does anesthesia have risks and effects?

Yes. Anesthesia administration is safer than it has ever been in the history of medicine. Serious debilitating complications are very rare. The likelihood of any side effects or complications depends upon a variety of factors. These include, but are not limited to, your preoperative medical condition, the nature of the operation, and the anesthesia technique used.

The most common (unwanted) side effect is postoperative nausea and vomiting (PONV). Fortunately, the medications and techniques used in anesthesia today have reduced the incidence of PONV. Another possible side effect more related to Surgery than Anesthesia but nonetheless important is pain. Pain is specific to surgery and we consider all aspects of your medical and surgical conditions to incorporate a detailed pain management plan implemented with your physician and nursing provider care team. Sore throat is a potential and common but mild side effect related to the dry sterile medical gases and the placement of breathing tubes necessary for safe anesthesia. Sore throats typically do not require treatment and will resolve in 24 to 48 hours. Cepacol throat lozenges and ice chips can be soothing remedies. Dental injuries are also a possibility, especially if you have been less diligent about preventive dental care and/or have artificial dental devices such as caps or bridges. This is not necessarily related to anything that the anesthesiologist did. In some instances, it may be impossible to insert a breathing tube quickly, especially in someone with a small mouth, without touching any teeth. Just as frequently, dental injuries may occur during the wake-up phase, when you may roll over or bite down on a tooth that is fragile, causing it to crack or break. Again, these situations are rare, but certainly not impossible.

What are the other risks?

As with any other medical procedure, results cannot be guaranteed. Unexpected reactions or complications may occur. Patients with apparently similar medical conditions may have varying responses to certain anesthetics or procedures. Possible risks include, but are not limited to allergic reactions; infection; pneumonia; inflammation of the veins; nerve injury or paralysis; damage to or failure of the heart, liver, kidneys and/or brain; and death. These more severe complications are highly unlikely but can occur in some cases, regardless of the experience, care and skill of the anesthesia provider.

What if I have significant health problems like heart or lung disease?

Anesthesiologists frequently (on a daily basis) care for patients with heart disease, lung disease, kidneys problems, cancer, blood disorders, and many other pathologic conditions. They know how to deal with these problems from an anesthetic standpoint because they have had years of advanced training and experience caring for patients with complex medical problems. Your anesthesia provider will ask you a number of questions about your medical conditions to allow them to formulate a plan to minimize the risk associated with your specific medical history. He or she may even arrange for further tests or consultations with additional medical experts to learn more about your condition.

A relative of mine had a bad reaction to anesthesia, could it happen to me?

Most "bad reactions" to anesthesia are not life-threatening. There are two rare but preventable inherited conditions that we will mention here:

"Malignant Hyperthermia" (MH) is a very rare but serious hereditary (inherited) problem that is triggered by inhaled anesthetic agents such as Sevoflurane or the IV muscle relaxant Succinylcholine. MH causes severe metabolic disturbances and dangerously high temperatures during or after anesthesia. The exact incidence of MH is unknown. The rate of occurrence has been estimated to be as frequent as one in 5,000 or as rare as one in 65,000 administrations of general anesthesia with triggering agents. The incidence varies depending on the concentration of MH families in a given geographic area. High incidence areas in the United States include Wisconsin, Nebraska, West Virginia and Michigan. If you have a family history of relatives that might have experienced severe fever or other serious metabolic complications during surgery or during recovery from anesthesia you must inform your anesthesia provider.

"Pseudocholinesterase deficiency" is a condition in some individuals whereby they are unable to metabolize (break down) the drug Succinylcholine which is often used to relax the muscles during the surgery. As a result of their inability to metabolize this agent, the drug may last much longer than it would ordinarily. This is a rare problem occurring in approximately 1 in 3,000 people.

By providing your anesthesia provider with an accurate anesthesia history and details of what happened to you or your relatives they will be able to decide whether or not specific precautions in your case are necessary.

Does smoking have anesthetic implications?

If you are a smoker, our advice is to quit smoking as soon as you can! Smokers are more likely to experience breathing complications during and after anesthesia. Fortunately, these problems are usually managed without great difficulty. Smokers must also be especially careful to carry out deep breathing exercises after their surgery to prevent chest infection, pneumonia or other lung problems. The use of an incentive spirometer, a device which gauges your lung function, can be very helpful during recovery from surgery.

What are your privacy policies with regard to my medical information?

Since all medical information is retained by the facilities where we practice, we follow the privacy policies of those facilities.

If I am awake afterwards may I drive myself home?

You may not drive a vehicle for 24 hours after receiving anesthesia. Whether you receive a general anesthetic or sedation for local anesthesia, you will be given medications to allow you to tolerate surgery or unpleasant procedures by relieving anxiety, discomfort, and pain. While current medications allow you to wake up quicker, the total elimination of these medications takes upwards of 24 hours. Thus, your ability to concentrate, make decisions, have normal reflexes, and safely drive will be hindered for up to 24 hours.