Today, a great majority of our patients arrive at the hospital on the same day of surgery instead of being admitted the night before as was once customary. Patients usually do not meet their anesthesia provider until just prior to surgery. As a result we find that patients are often more anxious about their anesthetic course than the actual surgery itself. Hopefully the following information will help to decrease your concerns. Please feel free to ask your anesthesia provider any question regarding anesthesia prior to proceeding to the operation room. Our goal is to make you as comfortable as possible before, during and after surgery. We strive to provide complete, individualized and flexible anesthesia services, using the most up-to-date concepts of anesthesia care.
Important to the safe conduct of any anesthetic is an accurate medical history. This will be reviewed with you by your anesthesia provider. Medications (including herbals) which you are taking as well as allergies are important. Other surgical experiences and your general medical background play a part in planning your pending anesthesia.
When you arrive at your facility to have surgery, you will check in to registration. Next, you will be taken back by a nurse to the preoperative area who will take your vital signs and ask you questions to verify your contact information and medical history. This will include specific questions regarding screening for the symptoms of COVID-19. For adults, an intravenous (IV) line must be placed before surgery. An anesthesiologist will then meet with you to go over your medical history, examine you, and discuss your anesthetic plan for your surgery. A certified registered nurse anesthetist (CRNA) may meet with you as well and take you back to the operating room.
If you are having a regional block performed as part of your anesthetic, then this procedure may be performed before you enter the operating room, in this preoperative area. If you are having a regional block, you may expect the following actions to be performed. A time out will be performed with the preoperative nurse and the anesthesiologist to verify several things regarding your procedure. A medication to decrease your anxiety and pain may be administered at this point. Supplemental oxygen may or may not be given to help with your breathing. The anesthesiologist will guide a needle to the appropriate location using an ultrasound machine or a nerve stimulator machine. Numbing medication will then be injected around a certain area. When an area is numb, it is generally less painful. So, this is done to decrease pain during and after the surgery, so that you require less pain medications. The area will be very numb for about 2 hours after the injection. It will be somewhat numb for 12-24 hours after that point.
Similarly, if you are having an epidural placed beforehand as a part of your anesthetic plan, you may expect the following actions to be performed. A time out will be performed with the preoperative nurse and the anesthesiologist to verify several things regarding your procedure. A medication to decrease your anxiety and pain may be administered at this point. Supplemental oxygen may or may not be given to help with your breathing. The anesthesiologist will clean off your back with cleaning solution. Numbing medication will be placed on to your back. A needle will help to find a certain spot in your back called the epidural space. A small flexible catheter will be placed to administer numbing medication and pain medication during and after your surgery.
On your way to the operating room, your anesthesia provider may administer a medication to reduce your level of anxiety if he or she feels it is appropriate to do so. Once in the operating room, you will be introduced to the additional personnel in there: nursing staff and surgical assistants. You will move on to the operating room table. We will then place a number on monitors on you to monitor your vital signs, such as your heart rate, blood pressure, and oxygenation level.
At this point, the next steps taken will depend on the anesthetic plan that was chosen.
For general anesthesia, a mask delivering oxygen will be placed. Medications will be given through your IV to make you fall asleep. A device or tube will be placed into the mouth and throat to help you breathe. During the surgery, we make sure that you are asleep and comfortable by closely monitoring your hemodynamics. We ensure that your vital signs are stable and we give you anything that you need so that your vital signs are stable. At the end of the surgery, we make sure that you are breathing well on your own, and we take out the breathing device or tube.
For spinal anesthesia, you may be asked to sit on the operating room table. Your back will be cleaned off with a cleaning solution. Numbing medication will be placed. A needle will be placed in the back. Once a specific area is located, numbing medication and possibly pain medication will be injected into your back to make the area that the surgeon is working on numb and pain free. Your lower body will be very numb for about 2 hours and somewhat numb for 12-24 hours after the procedure. You will then be laid down on the operating room table. Medication may be placed into your IV to make you relaxed and sleepy.
For IV sedation (monitored anesthesia care) or a regional block, you will be given supplemental oxygen either through your nose or in a mask. Additional medications will be given through your IV to make you more relaxed and sleepy. Your surgeon may inject more numbing medication where he or she will be working.
After waking up in the operating room, you will be taken to a recovery area where you will be monitored after your surgery and anesthetic. In the recovery area, the nurses will check your vital signs. The nurses will also make sure your pain is controlled and will administer pain medications if needed. They will also make sure that your nausea is under control. They will also make sure that there is no bleeding from the surgical site.
If you are being admitted to the hospital, then you will go from the recovery room to your hospital room.
If you are going home, then you may go to another area to be discharged or to you may be discharged from the recovery area. Before you go home, your nurse will go over your discharge instructions with you. He or she will ensure that you are able to get the proper prescription medications to recover from your surgery. We must make sure that someone is able to safely take you home and keep an eye on you. You must be able to safely go into their vehicle.
While at home, please follow any and all discharge instructions that were given to you by your surgeon. If you need to get prescription pain medications or antibiotics to recover from your procedure, then make sure that you get those on the same day that you go home from the surgery.
If you feel anything out of the ordinary, while recovering at home do not hesitate to contact your surgeon’s office who will direct you on any further actions that need to be taken. If you experience anything that may be a life threatening emergency, such as chest pain, difficulty breathing, sudden onset of weakness, or loss of consciousness, amongst other symptoms, then please do not hesitate to call 911 or go to the nearest emergency room.
Common issues after anesthesia would include:
Sore throat or hoarse voice
This usually goes away on its own but can last up to 7 days after surgery. Cough drops or lozenges may help. If your hoarse voice persists for 2 weeks after the surgery, then you may contact us.
Injury to the mouth or teeth
Dental injuries may happen during anesthesia and may also be related to the surgical procedure. Please contact us if necessary. Please note that we do not cover any pre-existing dental problems.
We make sure that your nausea is under control before you leave the hospital. Sometimes, you take pain medications at home to control pain as prescribed by your surgeon, and these can also cause nausea. If your nausea cannot be controlled at home, then you may need to go to the emergency room.
Pain medications may cause itching.
This is always a possibility. Luckily, it is somewhat rare to be allergic to our anesthetic medications, but it does happen sometimes.
Sometimes, people can scratch their eyes around the time of surgery. It can be painful. We generally recommend eye lubricating drops and sometimes an antibiotic solution. Numbing medication is not recommended in this situation, and eye doctors strongly recommend against this.
You will most likely feel tired after your surgery. Anesthetic medications generally stay in your body for about 24 hours. Please do not drive on the day of your surgery. Also, avoid making legal decisions on that day as well. It is best to have someone helping you that day since you will be tired for the rest of the day.
Anesthetic complications are not limited to these, but these are the more common ones. There are more rare, more severe complications, which include injury to the organs, including the kidneys, the liver, the heart, or even something like a stroke. We do everything that we can to decrease this risk and prevent these events from happening, but unfortunately it is still a possibility. Clearly, risk will be different based on your surgical procedure, age, and medical history.