This page has answers to questions many patients ask about anesthesia. If you do not find the answers to your questions here or elsewhere on this Web site, send us your question at firstname.lastname@example.org.
Anesthesiology is a discipline within the practice of medicine specializing in:
The Department of Anesthesiology provides complete anesthesia services, including consultation for patients and other physicians, general anesthesia, spinal and regional analgesia, obstetric analgesia/anesthesia, deep sedation, management of intensive care patients, and acute and chronic pain management. Anesthesia service is available at any time of the day.
Every surgery and every patient is different. The kind of anesthesia you receive for your surgery will depend on your health and special conditions you may have, the location and type of surgical procedure you are scheduled for, and in many cases your own preference once the options are explained to you. In some situations a particular anesthetic type will not be feasible and if this is the case your anesthesiologist will explain why.
In many situations, however, several types of anesthesia may be equally safe and offer different advantages and disadvantages. In these cases your anesthesiologist will discuss the options with you and together you can decide on how to proceed.
The primary types of anesthesia available are:
While your exact risks will depend on your anesthetic and your personal health history, anesthesia is very safe overall. Recent estimates place the risk of death from anesthesia (not related to the surgery) at 1 in 200,000 to 1 in 400,000 patients or less. Advancements over the last twenty years in monitoring and equipment have made our profession among the safest in the medical specialties.
Nevertheless, any procedure assumes some amount of risk. The most frequent complications with anesthesia include reactions to medications, high or low blood pressure, and breathing or airway problems. More common complications include scratched cornea of the eye, sore throat, chipped teeth, sore muscles, or nerve injury.
Whenever we perform a regional block, we will usually provide sedation during the surgery itself, and the majority of patients don't remember the operation at all.
Still, it is possible that you will remember being in the operating room. For cases like these it is important to remember that you will be completely numb, that you will not be able to see the surgery because of the sterile drapes, and that at all times your anesthesiologist will be sitting right next to you.
If you are uncomfortable, nervous, or just want some reassurance, he or she is at your side to take care of you. Our only concern is your comfort and well-being.
The incidence of intraoperative awareness during general anesthesia is extremely low, despite what we see in the movies, and estimated at 0.1-0.2%.
We have a number of methods to monitor a patient's sedation and comfort during surgery, but rarely - extremely rarely for general anesthetics - patients may have some recall of the operation. If you are concerned, talk with your anesthesiologist before the surgery.
He or she is at the head of the bed, monitoring your vital signs, breathing, ensuring you are receiving adequate anesthesia and pain medication, and giving you whatever fluids (or blood transfusions) are necessary. There is always an anesthesiologist or nurse anesthetist present during the surgery.
The short answer is that it depends on you and your surgical procedures.
Some surgeries, namely large surgeries in the chest, abdomen, or head, virtually always require a breathing tube to protect your airway and ensure you are breathing. Many other surgeries do not require a breathing tube per se but it may be advisable given the length of surgery or your medical conditions.
Your anesthesiologist will be able to discuss this with you. Bear in mind that if a breathing tube is required you will be asleep when it is placed. The vast majority of patients have no memory of the breathing tube.
Everyone is different with regard to their sensitivity to anesthesia and nausea. Many patients have no problems at all. Some patients experience minor nausea that is readily treated with medications.
A small percentage of people consistently have severe nausea post-operatively. If you have had severe nausea in the past, be sure to alert your anesthesiologist as he or she may be able to modify your anesthetic to reduce the risk.
This is definitely a question you want to ask your surgeon and the preoperative clinic, as many medications should be taken and many others should not. Be sure you are given clear instructions on which of your medications to take and which to skip the morning of surgery.
If you do have medications you are instructed to take the morning of surgery, it is generally permissible to take them with a small sip of water (not a glass of water, a sip!).
Diabetes Medications: Do not take oral diabetes medications on the morning of surgery (this group includes drugs like metformin, glyburide, glipizide, etc.) If you take injectable insulin the clinic will provide you with specific instructions on your insulin dosing for the day of surgery.
Before your surgery, you will meet an important physician specialist, your anesthesiologist. A vital member of the surgical team, your anesthesiologist has the responsibility for your welfare when you undergo anesthesia. The anesthesiologist is your advocate in the operating room. It's more than just "putting you to sleep." Your anesthesiologist cares for your breathing, your brain, your heart, your blood circulation, your kidneys and other important bodily functions during an operation. He/she gives you anesthesia to ensure unconsciousness, prevent and treat pain, and relax your muscles during surgery so the operation can be done. He/she cares for you so that your surgeon can focus on the operation. An anesthesiologist is a physician specialist who looks after patients during surgery. Because of the anesthesiologist's involvement, surgery or diagnostic procedures can be performed safely, without pain and stress. The specialized anesthesiology training allows this physician to safely anesthetize patients and to recognize and treat medical problems that may arise during and after surgery. Your anesthesiologist is also responsible to wake you up comfortably and safely, and take care of you during the immediate postoperative period.
Anesthesiologists have been instrumental in reducing the incidence of deaths and medical complications during this period.
Anesthesiologists are physicians of medicine who, after graduating from college with a strong background in physics, chemistry, biology and mathematics obtain a medical doctorate degree after completing four years of medical school. Following medical school, they learn the medical specialty of anesthesiology during an additional four years of post medical school training - one year of internship and three years in an anesthesiology residency program.
During the first year, anesthesiologists must complete training in diagnosis and treatment in other areas of medicine - such as internal medicine, neurology, obstetrics, pediatrics or surgery - or complete a rotating internship where they spend an equal amount of time training in each of the other areas of medicine.
Today's anesthesiologists then spend three intensive years of training in anesthesiology learning the medical and technical aspects of the specialty. In addition, they may further specialize in a subspecialty, such as neurosurgery, pediatrics, pain or intensive care by completing one to two more years in a subspecialty-training program.
Today's anesthesiologists are innovators in their field, continuing a long tradition of advancing the practice of modern medicine. Even after residency training is completed, they continue studying new medical advances and anesthetic techniques, so that every patient experience can be safer than the next. They specialize in cardiology, critical care medicine, internal medicine, pharmacology and surgery to be able to fulfill their role in modern medicine.
The purpose of your interview by the center for perioperative care is to verify information about your health history to allow the anesthesia team to make the best plan for you to have the best experience possible. There are special features of a medical history important to anesthesiologists, and this will also allow you the time to ask questions you may have and receive teaching about your upcoming anesthetic.
The anesthesia resident is a medical physician undergoing training to become a board certified anesthesiologist. The training begins with a diverse one year internship followed by three years of comprehensive and specific anesthesia training. The resident physicians are always supervised and mentored by an attending physician during their four years of education. At the conclusion of their residency, these doctors are skilled in providing anesthesia for most surgical cases, medical conditions and age groups. They may choose to undergo additional training of 1-2 years in an area of specialty such as cardiac anesthesia, pediatric anesthesia or pain management. The process of education during this time includes annual practice testing for the written and oral board examinations. The anesthesiologist, at the end of their training programs, is eligible to take the certification examinations to become board certified in Anesthesiology.
A Nurse Anesthetist or CRNA is registered nurse who has satisfactorily completed an accredited nurse anesthesia training program. In 1980 the American Association of Nurse Anesthetists mandated that all applicants to nurse anesthetist programs must have a minimum of a Bachelor of Science (but not necessarily a bachelor's degree in nursing)-a requirement that took effect in July 1987. Nurse must gain at least two year of practice experience before entering an accredited nurse anesthesia training program. Following completion of a 2 to 3 year program they are required to pass a national certification examination.
Nurse anesthetists are non-physician anesthetists who specialize in the provision of anesthesia care and participate in the administration of anesthesia in a variety of surgical cases. They are frequently supervised by an anesthesiologist, but may also work under the supervision of other physicians.
Directed by an anesthesiologist, the Anesthesia Care Team consists of anesthesiologists supervising qualified non-physician anesthesia providers and/or resident physicians in training in the provision of anesthesia care.
In an Anesthesia Care Team, anesthesiologists may delegate patient monitoring and appropriate tasks to non-physician anesthesia providers while retaining overall responsibility for the patient.
Members of the Anesthesia Care Team work together to provide the optimal anesthesia experience for all patients. Core members of the anesthesia care team include both physicians (anesthesiologist, anesthesiology fellow, anesthesiology resident) and non-physicians (anesthesiologist assistant, nurse anesthetist, anesthesiologist assistant student, and student-nurse anesthetist). Other health care professionals also make important contributions to the peri-anesthetic care of the patient.
To provide optimum patient safety, the anesthesiologist directing the Anesthesia Care Team is responsible for management of team personnel, patient pre-anesthetic evaluation, prescribing the anesthetic plan, management of the anesthetic, post-anesthesia care and anesthesia consultation.