Q. Are there different kinds of anesthesia?
A. There are three main categories of anesthesia: general, regional and monitored anesthesia care.
- General anesthesia is the most commonly used type of anesthesia and involves the use of medications to render you completely unconscious and pain free. This can be done with either intravenous (IV) medications, anesthesia gases or a combination of both.
- Regional anesthesia involves the placement of medications near specific clusters of nerves to numb a region of the body. It is commonly used in orthopaedic and joint surgery as well as obstetric anesthesia (childbirth). Regional anesthesia can be used alone for surgery, or can be combined with either general anesthesia or monitored anesthesia care.
- Monitored Anesthesia Care (MAC) can be thought of as a “lighter” version of general anesthesia. The goal of MAC is to provide sedation and pain relief during a surgical procedure, not to make a patient unconscious. MAC is commonly combined with either a regional anesthetic or local anesthesia injected by your surgeon. MAC is also commonly used for cataract surgery.
Q. Who will provide my anesthesia?
A. At Geisinger, we predominantly provide anesthesia using what is referred to as the “anesthesia care team” model. This involves both an anesthesiologist and a certified registered nurse anesthetist (CRNA).
- An anesthesiologist is a highly skilled medical doctor who has specialized in the field of Anesthesiology, and will serve as the director of the “anesthesia care team.” In addition to making decisions regarding your intra-operative care, anesthesiologists also perform pre-operative assessments and manage your medical conditions in the recovery room. Anesthesiologists are also specialists in pain management for surgical patients as well as women in child birth.
- A CRNA is a specially certified registered nurse anesthetist who provides anesthetic care and participates in the administration of anesthesia in a variety of surgical cases.
Q. Will someone be with me at all times?
A. Yes, at least one member of the anesthesia care team will be with you at all times. During the critical portions of your surgery, both the anesthesiologist and CRNA will be present.
Q. What are the common side effects of anesthesia?
A. All surgical procedures have some risks associated with them. These risks largely depend on the type of surgery and your medical condition. Fortunately, the serious risks of anesthesia are very rare. More common side effects associated with anesthesia are nausea, vomiting and a sore throat. You should talk to your anesthesiologist regarding any specific risks associated with your surgery and medical conditions.
Q. Why can’t I eat before surgery?
A. You should not eat or drink after midnight the night prior to your surgery. A small amount of liquid is acceptable to take medications. It is important to follow these guidelines to avoid the risk of having stomach contents enter your lungs while under anesthesia. This is called aspiration and is a very serious condition that can sometimes be life threatening. Special precautions can be made to prevent aspiration in emergencies, but elective surgery will be cancelled if fasting guidelines are not followed. These guidelines apply to all surgical procedures, even colonoscopies.
Q. Should I stop smoking before surgery?
A. Yes! Smoking has been shown to increase the risk of lung problems both during and after surgery. You will experience the greatest benefit if you quit smoking at least 6 weeks prior to your surgery. However, you can still experience improvement in your lung function even if you quit just a few days before surgery.
Q. Should I take any of my regular medications the morning of my surgery?
A. It depends on which medications you are taking. Most medications, such as those for blood pressure, can be safely continued on the morning of your surgery. Some medications require special attention. You should discuss any blood thinners you take (including aspirin, coumadin and plavix) with your surgeon. You should also discuss any diabetic medications, especially insulin, with either your surgeon or your endocrinologist. It is important to have a plan on which medications you will take the morning of your surgery to avoid any confusion or possible complications.
Q. How will my pain be treated?
A. There is great variation in the amount of pain you may have after a surgical procedure. This can depend on the type of surgical procedure, whether or you have used pain medications for a period of time before your surgery, as well as your tolerance to pain. Your anesthesiologist will discuss these options with you and determine which method is most appropriate for you.
Many options are available to treat post-operative pain, including intravenous (IV) medications, oral medications and regional anesthesia.
- IV medications are frequently used during a surgical procedure and immediately post-operatively. The most common type of medications used are opioids, like morphine. These medications will most frequently be given on an “as needed” basis by a nurse, but can be delivered directly by the patient using a concept called “PCA” (patient-controlled analgesia).
- Oral medications, like acetaminophen, ibuprofen, vicodin and percocet, are appropriate for mild to moderate pain. These require the patient to be able to tolerate drinking liquids and are more commonly used for outpatient surgical procedures.
- Regional anesthesia is becoming a more popular way to treat post-operative pain for a variety of surgical procedures. “Nerve blocks” are numbing procedures frequently used for knee, hip and shoulder surgeries and can provide very effective pain relief for 12 to 18 hours after surgery. An epidural can be utilized for surgeries on the chest and abdomen to provide pain relief for up to four days after surgery. The advantages to these techniques are that they significantly reduce, or completely eliminate, the need for medications like morphine.