Patient FAQs

Anesthesiology is a discipline within the practice of medicine specializing in:

• The medical management (preoperative, intraoperative and postoperative evaluation and treatment) of patients who are rendered unconscious and/or insensible to pain and emotional stress during surgical, obstetrical and certain other medical procedures.
• The protection of life functions and vital organs under the stress of anesthetic, surgical and other medical procedures, including the management of cardiopulmonary resuscitation.
• The management of problems in pain relief, including acute and chronic pain medicine and obstetric analgesia.
• The management of critically ill patients in special care units.

Scope of Services:

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:

• General - The patient is completely unconscious and usually intubated (a breathing tube that goes into the lungs), breathing with the assistance of a mechanical ventilator.
• MAC - an abbreviation for "Monitored anesthesia care", this usually means an anesthesiologist is providing some amount of sedation and comfort but you are not rendered unconscious, you will breath on your own through the surgery, and usually some kind of local anesthetic will be provided by the surgeon.
• Regional - a category that includes spinals, epidurals, and nerve blocks. Depending on the exact surgery the anesthesiologist will place a nerve block or continuous catheter to completely numb the site of surgery. After this, some medication is typically provided to help you relax and possibly sleep through the surgery.

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.

Risks include:

• Death or serious injury from anesthesia--Extremely rare, less than 1:100,000
• Injury to nerves - may occur two ways. In some cases your position while you are asleep may put pressure on a nerve that leaves it injured after the surgery. We go to great lengths to pad pressure points and ensure this does not occur, but on rare occasions nerve injuries have occurred without obvious cause. In the case of a nerve block, there is a remote risk that the needle used to do the block may injure the nerve.
• Reactions to medications - True drug allergies are very rare, and in most cases the safest place to have an allergic reaction is under the care of an anesthesiologist, so complications are very uncommon. More common problems are nausea, itching, and low blood pressure, though these are usually manageable.
• Aspiration - this refers to the inhalation of stomach contents into the lungs. Again, this is rare, but this is why we insist on patients fasting before coming to the operating room.

General Anesthesia

• In addition to the risks above, teeth may be chipped or dislodged when the breathing tube is inserted. This is not common, but patients with small mouths and/or poor dental condition are at higher risk. Also, minor injuries to lips and the tongue may occur, and sore throat after surgery is possible due to the presence of the breathing tube. Some patients experience sore muscles, and nausea and vomiting is a post-operative risk.

Spinal or Epidural Anesthesia

• A specific risk of spinals and epidurals is headache, specifically a post-dural-puncture headache, and occurs around 1% of the time (less with epidurals). Some patients experience itching. Both of these complications can be treated. An extremely rare but serious complication is epidural hematoma, though this is primarily a concern in patients with clotting problems or on blood thinners

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.

Your anesthesia care will be provided by an attending anesthesiologist, either alone or in combination with a resident and/or nurse anesthetist. At all times a member of the team will be present in the operating room with you, monitoring your safety and comfort. We are proud of our clinical services here at UC Irvine Medical Center and if you have any questions about your providers you can discuss them with the perioperative care clinic or with your team on the day of surgery.

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.