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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:
http://www.lifelinetomodernmedicine.com/ The American society of
Anesthesiologists )
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