Patients are rarely admitted the night before surgery and generally arrive only several hours before their scheduled operation. After your arrival at the hospital, you will have the opportunity to meet an anesthesia provider in person, discuss the anesthetic procedure in detail, and ask questions. Your medical history will be reviewed with you by your anesthesia provider. Other surgical experiences you have had are an important part of your medical history. If you have high blood pressure, heart disease, asthma, diabetes, lung, liver, kidney, or other serious conditions, be sure the doctor is aware of it! After carefully considering the nature of your surgery, your overall health, medical history, lab tests, and your own concerns and preferences, you and your anesthesia provider will make the final decision about the type of anesthesia that is safest and best for you.
Through vigilance by the anesthesia provider and your monitored response to the medications given, your anesthetic is adjusted during the procedure for your safety and comfort. A number of sophisticated monitoring devices are used to assure your well being.
Yes. Anesthesia administration is safer than it has ever been in the history of medicine. Yet these powerful medications, designed to protect you during surgery, are not benign. 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. Problems can arise in the operating room,in the recovery room, while recuperating in the hospital,or at home. The most common (unwanted) side effect is postoperative nausea and vomiting (PONV). Fortunately, the medications used in anesthesia today have reduced the incidence of PONV. However, it remains a significant problem, particularly in those patients prone to PONV and for those surgeries where the incidence is high. We can be helpful in preventing or treating this problem. Additionally, sore throat, headache, hoarseness, drowsiness, muscle aches and fatigue may occur for the first several days following surgery. Do not hesitate to discuss these concerns with your anesthesia provider. Aspiration pneumonia (inhaling stomach contents into the lungs) is a serious complication of anesthesia. Several precautions can minimize your risk. First, we ask that you not eat or drink anything for a certain time period before your surgery. Please follow these suggestions carefully. Secondly, medication may be administered prior to your surgery to reduce the amount and type of acid in the stomach. Finally, we may use an endotracheal tube (breathing tube) during surgery to protect your lungs. Other complications that can occur during your anesthetic include nerve damage, low blood pressure (hypotension), high blood pressure (hypertension), irregular heartbeat, heart attack, allergic reactions, airway blockage, physical injury, chipped teeth, muscle cramps and even death. Fortunately, serious debilitating complications are very rare.
Some surgical procedures can be accomplished readily with regional or local anesthesia. Regional anesthesia involves numbing a limited area of a person’s body to prevent pain during surgery. Other procedures may require general anesthesia. Be sure to discuss these options with your anesthesia provider. 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.
Adults and Children over 2: 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) 8 hours before surgery, breast milk 4 hours before surgery, and clear liquids 3 hours before surgery.
ANESTHESIA PREOPERATIVE RECOMMENDATIONS FOR PATIENTS ON MEDICATIONS On the day of surgery you may continue to take oral medication pills as usual, except those listed below, with a small sip of water.
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. Do NOT take Glucophage after surgery until kidney function is determined by your physician to be acceptable.
Insulin: Your dose for the day of surgery must be determined by your anesthesia provider, 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.
Phentermine/Fenfluramine should be stopped for at least one week prior to surgery. Both of these when used in combination, or Fenfluramine alone are not FDA approved.
Diuretics (water pills) should be held the morning of surgery except when given for hypertension.
Anticoagulants (such as Coumadin, aspirin, Triclid), and other Non-Steroidal 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 instructions.
Inhalers for asthma and emphysema: Use as scheduled and bring your inhaler with you to the hospital for continued use during your hospitalization.
If you have questions or concerns about your care, contact our office at: (314) 485-1101.
As a private group, our services are billed separate from the hospital. You will however be billed by the hospital for your anesthesia drugs and supplies. We do participate with most of the same insurance plans as your hospital and surgeon. Depending on your insurance, you may have some out-of-pocket expense for our professional services. If you have questions about your bill or need assistance in filing an insurance claim, contact our billing office by phone at (314) 775-2811 or by email at the firstname.lastname@example.org.
Labor Epidural FAQ
An epidural is a regional anesthetic block that helps diminish the pain associated with labor and delivery. You will be sitting or lying on your side. An anesthesia provider will numb a small area of skin between two backbones of the lower back. The block is administered below the level of the spinal cord. A needle will be placed until the epidural space is identified. The epidural space is the area located around the envelope, which surrounds the spinal cord, called the “dura”. A small flexible tube called an epidural catheter is inserted through the needle into this epidural space, then the needle is removed and the catheter is taped in place. Local anesthetic is given through the catheter continuously by a computerized pump. Fetal monitoring is routine before, during, and after the procedure. After the epidural is in place, you will notice a brief increase in the frequency of your blood pressure measurements.
The onset is gradual. Pain will begin to diminish within 15 to 20 minutes after dosing. The pain relief can be extended as long as necessary by continuing the medication given through the epidural catheter.
You will likely be aware that a contraction is occurring, but ideally, the epidural will significantly decrease the pain sensations of labor. You can usually move your legs very well, although they may feel weak or slightly numb. Depending on your circumstances and the baby’s condition, the anesthesia provider can adjust the epidural for your comfort
and to assist labor and delivery.
The most common complications of an epidural are minor and easily treated.
- These are:
· A drop in blood pressure, which may also cause nausea and vomiting, is usually treated by intravenous fluids (fluid given into a vein).
· A headache can occur about a day after the epidural is placed. This is a rare occurrence which happens in only 0.5% to 2% of cases. It is treated by lying flat, taking oral fluids, and very rarely will require extra treatment by an anesthesia provider.
· Rarely, some of the local anesthetic can enter the spinal space or a vein. This can lead to temporary side effects such as headache, ringing in the ears, tingling around the mouth and very rarely seizures. Infection and spinal cord compression
are even more rare complications. These have never occurred at our institutions, however, be aware that we are extremely qualified to treat any of these untoward effects.
· Back pain can occur where the epidural was placed.
· Shivering may occur, and in fact, is very common.
· Although extremely rare, transient or permanent nerve damage can occur.
Considerable research has shown that epidural analgesia and anesthesia can be safe for both mother and baby. However, each patient is unique and medical judgment, special skills and precautions are required. That is why a qualified anesthesia provider should perform this procedure.
Again, each patient is unique and will respond differently to the various epidural medications. Occasionally there will be a short period of decreased uterine contractions. However, often times the epidural relaxes the patient and their labor may actually progress faster.
No, we avoid placing epidurals in patients with bleeding abnormalities or severe blood pressure problems. Patients with back or nerve problems can talk to the anesthesia provider and an epidural may be considered. Some patients have anatomical considerations that may make placing the epidural very challenging.
If an epidural was already placed earlier for labor, it can be used as the anesthetic for the delivery by adding stronger local anesthetic. Time permitting, one can also be placed in the C-section room for the patient who does not already have an epidural. A spinal block can also be used for a Cesarean delivery. This is placed very similarly to an epidural but a smaller amount of anesthetic is injected into the dura (the envelope surrounding the spinal cord) instead of outside the dura. The onset of numbness is more rapid. General anesthesia is also a possibility for C-section. It is used when an epidural or spinal is not possible or safe.
Interscalene Block FAQ
An interscalene block is an approach to the brachial plexus (collection of nerves that control the shoulder and arm providing movement and sensory innervation). Nerve roots (C5-T1) lay between the anterior scalene and middle scalene muscles and form three trunks. Local anesthetics applied to these trunks can relieve compression of these nerves or numb the shoulder, are or hand.
• Surgery to the shoulder or upper arm
• Reduction of a dislocated shoulder, or arm fractures
The block takes a few minutes and is precisely guided by a nerve stimulator. The nerve stimulator allows the doctor to stimulate the nerves and thereby put local anesthetic next to the nerves providing the optimal blockade of these nerves.
You are laying on your back with your arms at your sides and your head turned away from the side to be blocked. The area of the neck is palpated by the doctor to feel the scalene muscles and other landmarks. The neck is prepped with a sterile antiseptic solution. The skin is anesthetized with local anesthetic and a stimulating needle is passed into the sleeve of connective tissue surrounding the trunks of nerves. The arm and shoulder is stimulated by the nerve stimulator and you will feel the muscles of your shoulder, arm, hand and sometimes chest, contract. When the exact stimulation is achieved the stimulator is turned off and the local anesthetic is applied to the nerves. You will be asked if you hear a ringing in your ears, taste a metallic taste in your mouth, or feel dizzy. If you experience any of these sensations you should tell the doctor because this could mean the local anesthetic is leaking into structures other than the nerve sleeve. Once the block is completed your arm and shoulder will begin to get numb and you will be given a sling to protect your arm.
The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). There is some discomfort involved. We use a very thin needle for injecting local anesthetic.
No. This procedure is done under local anesthesia.
After the block your arm will be numb for many hours. You should take care not be come in contact with
extremely hot or cold items because you will not be able to protect yourself from injuries of extremes of temperature. You should wear a sling while your arm is numb to protect over extension of your shoulder or elbow. A nerve called the phrenic nerve controls the expansion of the diaphragm and is blocked by the local anesthetic, since there are two phrenic nerves blocking one will not cause a problem but you may notice a slight difference in your ability to take a deep breath following the block. You will be asked to fill out a pain log to see what your short-term and long-term effects of the block are. If you get some relief from the block it will probably be repeated 2-3 times to see if you can get long-term relief from your pain.
Unless there are complications you should be able to return to work the next day.
This procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The most common side effect is pain at the site of injection, which is temporary.
• 100% incidence of ipsilateral hemidiaphragm paralysis leading to a 30% reduction in vital capacity.
• Intravascular injection
Other risks involve bleeding, infections, spinal block and injection into blood vessels and surrounding nerves. Fortunately, the serious side effects and complications are uncommon.
Very rare complications are epidural or subarachnoid injection, vertebral artery injections resulting in convulsions(seizures), and rarely pneumothorax (collapse of lung) these complications are lessened by placement of block under x-ray guidance and use of a stimulating needle.
• Cervical epidural block
• Local anesthetic toxicity
• Horner’s syndrome
• Hoarseness of the voice (recurrent laryngeal nerve block)
Patients who are having surgery to the shoulder or upper arm. Patients who are suffering from functional thoracic outlet syndrome (a condition where the nerves of the neck are squeezed by the muscles of the neck and shoulder from splinting or holding muscles in a constant tight position). If you are allergic to any of the medications to be injected, if you are on a blood thinner (e.g. Coumadin, Plavix, Heparin), if you have an active infection going on, or if you are or could be pregnant, you should not have the injection.