During Surgery

During Surgery

Many patients are concerned about what they will experience in the operating room and what the anesthesiologist will do for them during that time.  Here are some frequently asked questions about what happens when we take care of you during your procedure. 

 

FAQ's

Will I always have an anesthesiologist taking care of me during surgery?

Matrix Anesthesia employs physician anesthesiologists or a care provider under the direct supervision of a physician anesthesiologist.  For further information on physician anesthesiologists, refer to the link/brochure below

[insert specialist anesthesia .pdf here] 

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Does the anesthesiologist ever leave during the surgery?

No, an anesthesiologist or anesthesia care provider will be by your side for the length of the surgery. This is required because many physiological changes can occur under anesthesia and surgery, requiring constant monitoring and vigilance on the part of your anesthesiologist.  In some cases, another anesthesiologist may replace your anesthesiologist, but there is never a break in care as you are being monitored continuously for the entire duration of surgery.

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Do I need an "I.V." for surgery?

Almost all patients need an IV placed before surgery. Only on rare occasion can the IV be placed while you are “asleep”.  Some procedures in children are the exception, and an IV may not be needed (usually the case for ear tube placement). 

Within the preoperative holding area, a registered nurse or your anesthesia provider will place your IV. This can usually be done with minimal discomfort by the use of a small amount of local anesthetic at the site of IV insertion. An IV is needed for hydration purposes and is the primary route for administering medications during and after surgery.

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What is General Anesthesia?

A general anesthetic involves the loss of consciousness and loss of awareness and sensations during the surgical period.  The drugs used to provide anesthesia are very potent and their management can be very complex. The achievement of the desired effect while avoiding or minimizing side effects requires continued vigilance, monitoring and adjustments by the anesthesiologist. General anesthesia can be split into phases known as induction (beginning), maintenance (during), and emergence (end).

The “induction” of anesthesia most commonly involves the injection of IV medications that quickly puts the patient into the unconscious state. Another less commonly used option for the induction of sleep involves breathing anesthesia gases via a mask (although common in young children). 

The “maintenance” of anesthesia during the surgical period involves a combination of IV medications and certain anesthetic gases (inhalation agents) to keep the patient “asleep". During this time, the anesthesiologist is closely monitoring your anesthetic depth and vital signs.

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What are the risks of general anesthesia?

The risks of general anesthesia vary greatly depending upon your medical condition and the type of surgery. In addition, emergency surgery tends to have higher risks than planned elective surgery. Your anesthesiologist will have a thorough discussion with you about the particular risks specific to you during your surgical visit.

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Will I feel anything while I am anesthetized? Will I wake up during the surgery?

No, you will not feel pain while under general anesthesia. The use of general anesthetics hampers the portions of the central nervous system that controls awareness and pain.

No, arousal from general anesthesia will not occur in the vast majority of cases during the surgery. Other types of anesthesia (i.e. regional anesthesia) may just involve sedation and therefore, arousal can occur.

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Will I remember anything while I am under general anesthesia?

Although a concern for many patients, the occurrence for anesthetic awareness is very rare.  The incidence is thought to be 1-2 per 1000 patients.  Although very unsettling, most patients who have anesthetic awareness do not feel pain.  For further information regarding anesthetic awareness, refer to the link/brochure below.

Awareness and Anesthesia

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If I have general anesthesia will I have a tube put in my throat?

In most general anesthetic circumstances, an airway device will be put in a patient’s throat. General anesthetics inhibit our normal natural reflexes that control our breathing patterns.  A breathing device allows us to deliver oxygen to your lungs, administer inhaled anesthetics to keep you asleep, and may protect stomach contents from entering your lungs. There are many different types of airway devices, but they are usually placed after you are asleep and removed prior to waking up. Therefore, you will have no memory of the device or any pain involved with its placement.

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What are the side effects of general anesthesia?

Theoretically, many types of side effects are possible from general anesthesia. Their likelihood of occurrence however, depends on your medical condition, the type of surgery performed, the type of anesthetic agents used, and many other factors. Your anesthesiologist will discuss these issues with you prior to your surgery in full detail. In reality, however, the most common side effects include nausea, a sore throat, or an “anesthetic hangover”. Generally, these respond well to treatment and have a short duration.

 

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What is Regional Anesthesia?

Regional anesthesia involves making a particular region of your body insensitive to pain or “numb” by placing local anesthetic near a nerve or group of nerves.  This is often referred to as getting a “block”.  Most commonly heard of blocks include a spinal anesthetic or epidural anesthetic.  Other common options include adductor canal blocks for total knee surgery, axillary/supraclavicular blocks for hand surgery, or epidurals for abdominal surgery.  The field of regional anesthesia and use of ultrasound has advanced profusely in the last decade, which makes it a great safe alternative to opioid use for pain control after surgery. 

For further information on regional anesthesia, please refer to the link below.

American Society of Regional Anesthesia Patient Information

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What are some of the benefits of regional anesthesia?

Patients who receive a regional anesthetic block usually have less nausea or vomiting and generally awaken faster. In most circumstances, the pain control is superior when compared to intravenous or oral opioids (narcotics).  Since the pain control is superior, less opioids and its associated side effects are decreased.

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Why would my anesthesiologist or I want me to have regional anesthesia?

  • Some surgical procedures are well suited for regional blocks (i.e.- carpal tunnel release & total knee replacements).
  • Certain medical conditions make a regional anesthetic a better choice than general anesthesia (i.e.- emphysema).
  • Patient preference (i.e. desire to watch portions of some surgical procedures on a TV monitor)
  • Avoidance of general anesthesia (i.e.- concern of postoperative nausea & vomiting)
  • Avoidance of the exposure of general of anesthesia to certain body organs (i.e.- a patient with heart disease)
  • Prolonged pain relief after surgery can be achieved with longer-acting anesthetics.

 

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What is Epidural and Spinal Anesthesia?

These are two of the most common types of regional anesthesia. These two techniques are employed to “numb” the lower half of the body for many surgical and obstetric procedures.

Both techniques involve the placement of a needle and sometimes a small plastic tube (catheter) into the lower back region.  The procedure is done in a sterile manner with the patient either sitting or laying on their side.  A local anesthetic is used to numb the area prior to placement of an epidural or spinal anesthetic. This local anesthetic should make the remainder of the procedure pain free.  A separate dose of local anesthetics are then injected, achieving numbness of the desired areas. The numbness can last varying lengths of time based on the amount and type of local anesthetic used.

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What is involved in getting Spinal or Epidural Anesthesia? Does is hurt?

As when receiving any type of anesthesia, you will need the proper monitors placed prior to the procedure, such as an EKG and blood pressure cuff. An IV will also be placed. Depending on your health and the type of procedure, you may be able to have some sedative at this point. You will then be positioned appropriately, either sitting or lying on your side. Sterile disinfectants and drapes are placed around the lower back. A local anesthetic (numbing medicine) is then injected into the skin of your lower back, using a small needle. This is typically the most uncomfortable portion of the procedure for most people, but it lasts only a few seconds. A spinal or epidural needle is then advanced through the previously numbed tissues to the proper position while the patient remains still.  The remainder of the procedure should be pain free.  If at any time pain or discomfort is felt, let your anesthesiologist know and more anesthetic will be provided. 

After the spinal or epidural anesthetic medication is given, a warming sensation is felt initially and later a numbness in the lower half of your body. The extent of the numbness that results depend on the medication used and the type of surgery planned. Generally, there will also be a temporary decrease in muscle strength in the numbed area. Both strength and sensation fully return to normal after the anesthetic has worn off.

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I have been told that I have to stay flat after a spinal, is that true?

No. In the past this was felt to decrease the incidence of a particular side effect. That has found out not to be true.

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What are the risks of a Spinal and Epidural?

As with any procedure, there are risks and benefits associated with a spinal or epidural anesthetic. Thankfully, the benefits usually outweigh the risks. The most common risks associated with spinal or epidural anesthesia include headache, backache, bleeding and infection. These risks have a low incidence of occurrence, and your anesthesiologist will discuss all of these prior to your procedure.

Further information regarding the risks of a spinal or epidural anesthetic can be accessed at the link below:

Risks and benefits of regional anesthesia as advised by the American Society of Regional Anesthesia

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Do I always have the option of Spinal or Epidural anesthesia?

No. Some surgeries are not possible under these types of anesthesia. Other reasons that a patient may not be a candidate for these anesthetics include but not limited to patient refusal, bleeding disorders, certain infections, previous back surgery, morbid obesity or poor cooperation on part of the patient.

 

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Will I get to decide which type of anesthesia I will have?

With a thorough discussion with your anesthesiologist, you will have input on the type of anesthetic that is right for you.  After the anesthesiologist performs a thorough medical history and examination, he or she will give their opinion as to the best anesthetic for you keeping your wishes in mind. This opinion is based on your medical condition, the surgery planned, the expected length of surgery, and the considerations of the risks and benefits of the anesthetic options.  Matrix Anesthesia providers have a vast clinical experience and an extensive history of giving safe anesthesia care. Therefore, we will closely work with you on determining the right anesthetic care for your specific needs.

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