What type of anesthesia will I have for my upcoming procedure? The answer to this question depends on several factors, including the type of procedure, anticipated length of your procedure, your underlying medical condition and the preference of both you and your surgeon. Certain types of procedures, such as laparoscopic surgery or neurosurgery, require general anesthesia, while others, such as knee arthroscopy, can be done via several different techniques. Your anesthesia provider will discuss the options available to you before your surgery, and a decision will be made as to which type of anesthesia is best suited to your situation.
How safe is anesthesia? While no anesthetic technique is 100% safe, the medications and monitoring techniques used in anesthesia today are safer than they have ever been. This improved safety can be attributed to the use of newer and more accurate monitoring techniques, safer and shorter-acting medications, and more rigorous training of anesthesia providers. The risk of a life-threatening complication from anesthesia is very rare, and the risk of death attributed to anesthetic complications is currently about 1 in 250,000, which makes it several times safer than it was in decades past. During your surgery, you will have a trained anesthesia provider with you at all times. They will be continuously monitoring your vital signs, administering appropriate medications to provide safe and comfortable care.
Is it possible for me to wake up during surgery? Depending on the type of anesthesia you receive, and the type of surgery you are having, it is possible to be aware or awake during your surgery. For example, many patients receive sedation for a procedure (such as colonoscopy), and many of these patients report remembering all or part of their procedure. However, true "anesthesia awareness," which is said to occur when a patient has some awareness of his or her experience while under general anesthesia, is exceedingly rare (less than 1%). Typically, anesthesia awareness occurs in situations where a patient's condition is too unstable to allow the use of the normal amount of anesthetic medications. Several medical centers (including Berkshire Medical Center and Fairview Hospital) employ the use of brain-wave monitoring during general anesthetics to assist in decreasing the likelihood of anesthetic awareness. If you feel that you have ever experienced anesthesia awareness, it is important to discuss this with your anesthesia provider so that an appropriate plan of action may be taken.
My child is scheduled for surgery. What should I expect? The type and delivery of anesthesia in the pediatric population depends upon the age and temperament of the child, their medical history, and the type of procedure they will undergo. In general, most children will receive general anesthesia for their procedure, either via inhalation of anesthetic gases through a breathing mask or via an intravenous (IV) catheter. If a child presents to the surgical suite with an IV already in place, we will typically initiate anesthesia with medication given through the IV.
For younger children who do not already have an IV, anesthesia will often times be initiated in the operating room via a breathing mask. The child will be escorted to the operating room by the anesthesia team and an escort (usually a parent) if conditions allow. Monitors will be placed on the child, and anesthesia will be given via a face mask. It is normal for the child to experience a phase of agitation as he/she is falling asleep, and this may be upsetting to the child's caregiver, however it must be noted that this is a normal reaction to this type of anesthesia and is seldom remembered by the child. Depending on the situation, an IV and/or breathing tube may be placed after the child is anesthetized. After the surgery, the child will be taken to the recovery room where their condition will be continuously monitored. As soon as it is deemed safe for the child to have a visitor, every effort will be made to re-connect the child with his/her caregivers.
How long will it take to recover from my anesthetic? The answer to this question depends on several factors, including the type of anesthesia you received, the length of your procedure, your underlying medical condition and your body's reaction to the medications you have received. Most of the medications in use today are very short-acting, and allow for rapid emergence from an anesthetic state, enabling many patients to go home on the same day of their surgery. Your anesthesia provider can give you a reasonable estimate for how long your recovery time will be, but each patient has a unique experience, and it is important to be flexible in your expectations. Also, patients often receive pain medication after their surgery and often can realize side effects from the medication which are believed to be from the actual anesthetics.
What side effects should I expect from my anesthetic? Certain side effects are more common than others, and also depend upon which type of anesthetic medications you received during your surgery. For a complete list of possible complications, please refer to the Types of Anesthesia link on the previous webpage.
Will I have a chance to meet my anesthesia provider before my surgery? Unless an emergency situation prevents you from being awake prior to your surgery, you will meet your anesthesia team immediately prior to your surgery, if not sooner. You will have a chance to meet with a physician anesthesiologist, and possibly a nurse anesthetist as well. They will evaluate you and your medical history and discuss the options available to you, and will discuss the risks and benefits of each option, at which point you (or a designated healthcare proxy) will be asked to sign a written consent form.
Will I be able to choose my anesthetist? Most of the time, the answer is yes. In order to request a specific anesthesia provider, express your request at your surgeon’s office when your surgery is scheduled, or at your Pre-Anesthesia Services (PAS) interview. While we make every attempt to honor these requests, please bear in mind that scheduling conflicts may occur, and it may be necessary to transfer your anesthetic care to another provider.
Why am I not allowed to eat or drink before my procedure? The reason we ask patients to fast prior to surgery is that while a patient is under anesthesia, their airway reflexes are diminished, making it possible for someone to vomit before, during, or after surgery. If there is food and/or liquid in the stomach, this material could potentially be transmitted to a patient's lungs and cause respiratory complications. Under certain circumstances, such as emergency surgery, precautions are taken to minimize the risk of this complication, as it is assumed that the patient will not have an empty stomach. For routine, elective surgery, fasting is required to minimize postoperative complications. You will receive specific instructions regarding your last food and liquid intake.
Should I take my medicine on the day of surgery? Depending on your medical condition and the type of surgery you are having, you may be required to take some or all of your medications on the day of surgery. You will be given specific instructions during your Pre-Anesthesia Services (PAS) interview. Certain medications, such as blood thinners and diabetic medications, may need to be stopped in the few days prior to surgery, but these will be discussed with you at the time of your PAS interview. If you have any questions or concerns, please do not hesitate to ask.
Will I be able to go home after my procedure? In general, this question is better answered by your surgeon. Whether or not you are able to go home on the same day of your surgery depends on the type of surgery you have had, your underlying health, and whether or not there were any unexpected occurrences during or after your surgery that require you to be monitored in the hospital overnight or longer.
I'm sensitive to many types of pain medicine. Are there alternatives available to control my pain after surgery? Absolutely. It is very important that you relay any information about drug sensitivities to both your surgeon and anesthesiologist prior to your surgery, so that an alternative pain regimen may be planned and followed. Some of the options available to control your pain after surgery are opioids, such as morphine; non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or ketorolac (Toradol); local anesthetic nerve blocks; and other modalities such as epidural anesthetics.
Can I become addicted to the pain medicine I receive? Many of the medicines used to control pain after surgery are in the family of opioids, also known as narcotics. Some examples include morphine, hydromorphone (Dilaudid), fentanyl, Vicodin, Percocet and Darvocet, among others. While it is possible for patients to become addicted to narcotic pain medicines, when used properly and as prescribed, the incidence of addiction is relatively uncommon. Some of the predisposing factors to opioid addiction are certain psychiatric illnesses or having a history or a family history of substance abuse. Many patients withhold taking their pain medicine after surgery, for fear that they will develop an addiction, but when used for the purpose of treating acute surgical pain, narcotic pain medicine is very useful and effective. If a patient does feel that they are having a problem with addiction to pain medicine, they should seek help from a physician immediately.
My surgeon mentioned a nerve block. What is it, and what should I expect? Please refer to the information about nerve blocks on the previous webpage for a full description. In general, nerve blocks are typically performed immediately prior to surgery, after a patient has received sedation. Depending on the type of block administered you may expect to experience some degree of numbness in the affected region for a period of time ranging from hours to days.
If I choose regional anesthesia, does that mean I will be awake during the surgery? You may remain awake, or you may be given a sedative. You do not see or feel the actual surgery take place. Your anesthesia provider, after reviewing your individual situation, will discuss the appropriate amount of sedation for you.
What anesthetic options will I have when I deliver my baby?
For an uncomplicated vaginal delivery, you have the option of either receiving an injection of pain medicine intramuscularly (IM) or intravenously (IV), or you may be offered neuraxial (spinal or epidural) pain relief, which is administered by an anesthesiologist. Neuraxial anesthesia involves the delivery of local anesthetic solution to the epidural or spinal space located in your lower back. This medicine blocks the transmission of pain signals from the abdomen and pelvis, thereby decreasing the pain of labor. Please refer to the section "Spinal/Epidural" under "Types of Anesthesia" for more information.
For a Caesarean section, the anesthetic most frequently administered is a spinal anesthetic. This differs from an epidural in that medication is injected directly into the spinal fluid in order to bathe the nerve fibers in a solution of local anesthetic. This results in a more dense sensory block, and is more suited to the purpose of surgical anesthesia than relief of labor pain.
If a patient has a pre-existing epidural catheter, and requires a Caesarean section, in most cases the epidural can be used to administer the type of medication necessary to perform surgery. On occasion, however, the epidural may not be adequate for use during surgery, in which case a spinal or a general anesthetic may be indicated.
I'm going to be having a Caesarean section. What should I expect? A Caesarean Section (or C-Section) is a surgical procedure which involves delivery of the baby through an incision in the abdominal wall. Like most other types of surgery, anesthesia is administered prior to the beginning of surgery (see above). However, because patients are encouraged to participate in the experience of childbirth, a C-section is usually performed with the patient awake, under a spinal or epidural anesthetic. Depending on the circumstances, it is usually possible to allow one other support person (such as the father) to join the mother in the operating room during the surgery. Following delivery of the baby, the support person may be allowed to accompany the newborn to the newborn nursery, or they may choose to remain with the mother for the remainder of the procedure. Following the operation, the mother will be transported to the recovery room to recover from anesthesia, where she will be re-united with her newborn, provided there are no complications or contraindications.