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What you should know about anesthesia ?

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Anesthesia is used in surgery to minimize pain, discomfort, and shock for surgical patients. There are several types that can be used depending on the needs of the surgery. When anesthesia works as expected, the patient feels no pain during a procedure, and often does not remember the proceedings either. It increases patient comfort, which can in turn reduce recovery times. With the knowledge that they are not inflicting pain, it also makes it easier for a medical staff to work.

Are there different kinds of anesthesia?

There are three main types of anesthesia: local, regional and general.

Local anesthesia: The anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery, for example, on the hand or foot.

Regional anesthesia: Your anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You might be awake, or you may be given something to help you relax, sometimes called a sedative. There are several kinds of regional anesthesia. Two of the most frequently used are spinal and epidural anesthesia, which are produced by injections made with great exactness in the appropriate areas of the back. They are frequently preferred for childbirth and prostate surgery.

General anesthesia: You are unconscious and have no awareness or other sensations. There are a number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein. During anesthesia, you are carefully monitored, controlled and treated by your anesthesiologist. A breathing tube may be inserted through your mouth and frequently into the windpipe to maintain proper breathing during this period. The length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesiologist will reverse the process and you will regain awareness in the recovery room.

Is anesthesia safe?
Due to advances in patient safety, the risks of anesthesia are very low. Over the past 25 years, anesthesia-related deaths have decreased from two deaths per 10,000 anesthetics administered to one death per 200,000 to 300,000 anesthetics administered.
Certain types of illnesses, such as heart disease, high blood pressure and obesity, can increase your anesthesia risks. Even so, anesthesiologists routinely bring even very sick patients through major operations safely.

What are the risks of anesthesia?
All operations and all anesthesia have some risks, and they are dependent upon many factors including the type of surgery and the medical condition of the patient. Fortunately, adverse events are very rare. Your anesthesiologist takes precautions to prevent an accident from occurring.

The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your anesthesia.

What type of education and training does an anesthesiologist have? 
Anesthesiologists have four years of medical school and an additional four of advanced training as in anesthesiology. In addition, some anesthesiologists elect to complete a fellowship and spend an additional year of specialty training in a specific area like pain management, cardiac anesthesia, pediatric anesthesia, neuroanesthesia, obstetric anesthesia or critical care medicine.

What is the difference between an anesthesiologist and nurse anesthetist?
An anesthesiologist is a physician who specializes in anesthesia care and a nurse anesthetist is a nurse with extra training in administering anesthetics. Both work together on anesthesia care teams, led by anesthesiologists who make critical, medical decisions for patient care.
As physicians, anesthesiologists go through years and years of rigorous training. Anesthesiologists have at least eight years of post-graduate education and training, while nurse anesthetists have two-three years.

Nurse anesthetists are able to perform the technical aspects of the administration of anesthesia, but anesthesiologists have the education, skills and training to fully manage patients and respond to medical complications.

Should I continue to take my medications prior to surgery?
It is important to tell the doctors providing your care what medications you are taking prior to surgery so that they can be involved in making the decision about stopping or continuing these medications. 

Some examples of common medications are:

  • Aspirin and Plavix are drugs that are used to prevent blood from clotting. They are used to treat patients with certain disorders of the heart and blood vessels. Because of the way aspirin and Plavix work, they can cause increased bleeding when you get a cut or undergo surgery. If you are taking either of these drugs, you should talk to your primary care physician about stopping them before surgery. The decision to stop aspirin or Plavix is based on the reason why you need to be on the drugs (your medical condition) and on the risk of bleeding from the surgery. 
  • Diuretics (“water pills”) are commonly prescribed for treating high blood pressure. This class of drugs can cause changes to electrolyte levels, such as potassium. If you take diuretics, your anesthesiologist may perform certain laboratory testing before surgery. 
  • Diabetic patients are commonly treated with insulin or oral agents. Your anesthesiologist may decrease your usual morning insulin dose or discontinue your oral agents before surgery. Always speak with an anesthesiologist or your regular doctor to discuss your particular medications, before any surgical procedure.

Could herbal medicines, vitamins and other dietary supplements affect my anesthesia if I need surgery?
Anesthesiologists are conducting research to determine exactly how certain herbs and dietary supplements interact with certain anesthetics. They are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists anticipating a possible reaction is better than reacting to an unexpected condition. So it is very important to tell your doctor about everything you take before surgery.

What happens during a preanesthesia visit with my anesthesiologist?
The preanesthesia visit is an important visit when you will have a chance to learn about your options for anesthesia and to ask questions. It is also a time when the anesthesia care team can review your medical records, do a focused physical exam and make decisions about ordering additional tests and consultations.

The interview with the anesthesiologist is a key part of this review. During this interview, the anesthesiologist may ask questions that cover the following:

  • your general health, including any recent changes
  • allergies to medications or other items
  • chronic (long-term) medical problems, such as high blood pressure, heart disease, diabetes, asthma, acid reflux and sleep apnea
  • recent hospital admissions, including surgery or procedures
  • previous experiences with anesthesia, especially any problems

Some people keep their own health records on paper or in an electronic format. To help you answer these questions it is a good idea to bring any documents that describe your health history, as well as a list of all your medications.
When there are different anesthesia alternatives, such as general or regional (nerve block) anesthesia, your anesthesiologist may give you information about these options and then ask about your preferences.
At the conclusion of your visit, you should

  • have clear instructions on when to stop eating and drinking before surgery
  • know what medications you should or should not take on the day of surgery (and sometimes even a few days leading up to surgery)
  • know what type of anesthesia will be given to you (keep in mind that things may change between the day of your pre-operative visit and your procedure that result in modifying the anesthesia plan)

How will my anesthesiologist know how much anesthesia to give me?
There is no single or right amount of anesthesia for all patients. Every anesthetic must be tailored to the individual, and to the operation or procedure that the person is having. Individuals have different responses to anesthesia. Some of these differences are genetic, or inborn, and some differences are due to changes in health or illness. The amount of anesthesia needed can differ according to such things as: age, weight, gender, medications being taken or specific illnesses (such as heart or brain conditions). 

Among the things the anesthesiologist measures or observes, and uses to guide the type and amount of anesthetic given are: heart rate and rhythm, blood pressure, breathing rate or pattern, oxygen and carbon dioxide levels and exhaled anesthetic concentration. Because every patient is unique, the anesthesiologist must carefully adjust anesthetic levels for each individual patient.

Why do I need to have an empty stomach prior to surgery?
It is very important that patients have an empty stomach before any surgery or procedure that needs anesthesia. When anesthesia is given, it is common for all the normal reflexes to relax. This condition makes it easy for stomach contents to go backwards into the esophagus (food tube) and mouth or even the windpipe and lungs. Because the stomach contains acid, if any stomach contents do get into the lungs, they can cause a serious pneumonia, called aspiration pneumonitis. 

Can I smoke cigarettes before I have surgery?
You should stay off cigarettes for as long as you can before and after surgery. This will help you have the best possible results from your surgery. For example, quitting will reduce the chances you will have problems like a wound infection after the operation. It is especially important that you not smoke the morning of surgery – just like you don’t eat the morning of surgery, don’t smoke.

Many people find that surgery is also an excellent opportunity to quit smoking for good because most people do not have cravings for cigarettes while in the hospital, and your chances of successfully quitting are almost doubled if you try it around the time of surgery.

What are the different types of sedation?
Sedation allows patients to be comfortable during certain surgical or medical procedures. Sedation can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests.

During light or moderate sedation, patients are awake and able to respond appropriately to instructions. However, during deep sedation, patients are likely to sleep through a procedure with little or no memory. Breathing can slow and supplemental oxygen is often given during deep sedation.

What is a blood transfusion?
Blood transfusion is an important medical treatment that can save lives. When blood is lost during surgery or from other kinds of trauma, fluids are given to replace the blood. These fluids are essential for the heart and circulation. However, they do not contain essential platelets  and proteins that are needed to carry oxygen to tissues, clot when tissues are injured and fight infection. Only a blood transfusion provides these things.

Who might need a blood transfusion?
Individuals who lose blood during surgery or from other kinds of trauma may need a blood transfusion. In particular, individuals who start off with lower blood counts and those with heart disease, circulation problems or other major illnesses are more likely to receive a blood transfusion.

Do anesthesiologists administer blood transfusions?
Anesthesiologists administer approximately half the blood transfusions in the United States and are experts in making the risk and benefit assessments needed during a transfusion. Anesthesiologists are committed to the responsible use of the blood supply and to make the best decisions for patients.

How can I help prevent wrong site surgery?
While wrong site surgery is very uncommon, anesthesiologists feel that even one case is too many. The most important things you can do as a patient to prevent wrong site surgery is to make sure your consent form is accurate and to be involved in the process of clearly marking the intended site.
Also, before surgery, there will be a “time out” precaution. While you may be sedated or under anesthesia at this time, all health care providers in the room will stop, pause and listen while the entire team confirms the correct site.

Should my IV site continue to be sore and swollen weeks after surgery?
Phlebitis is a term that means inflammation of a blood vessel. Phlebitis occurs quite commonly after the insertion of an IV. There is a wide variation because it depends on how phlebitis is defined, such as the place the IV is inserted, the duration that the IV has been in place, the type of material that the IV is made of, the length of the IV catheter, and on the existence of other disorders such as diabetes. If you continue to feel pain and have swelling for more than three weeks you should connect with your physician.

( Courtesy: The American society of Anesthesiologists )

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