Frequently Asked Questions Regarding Anesthesia
1. What is anesthesia?
Anesthesia is relief from the sensation of pain. This can be achieved through various methods such as numbing the surgical area, medications that make you sleepy and forgetful, or medications that make you unconscious during surgery.
2. Are there different types of anesthesia?
YES. There are several forms of anesthesia. They are local anesthesia, regional anesthesia, MAC/sedation, and general anesthesia.
Local Anesthesia- This type of anesthesia consists of injecting medication into the area surrounding surgical site that will result in that area being numb throughout the surgery. This is used for small surgical areas.
Regional Anesthesia- This type of anesthesia consists of injecting medication into a specific site that numbs a larger area or region to be operated on. This type can be broken down into two subtypes called peripheral nerve blocks and spinal or epidural anesthesia. Peripheral nerve block means blocking or numbing a specific nerve in your extremities, face, or abdomen. Spinal or epidural anesthesia is blocking or numbing central nerves near the spine to cover an even larger area.
MAC- This stands for Monitored Anesthesia Care. It is most commonly known as “twilight” or a heavy sedation and is often combined with local anesthesia. This type of anesthesia consists of IV medications that often allow you to sleep through your surgery. In addition, these medications usually make you forget your surgical experience. Typically you breathe on your own and given supplemental oxygen either through a nasal cannula or a facemask.
General Anesthesia- During this type of anesthesia you are given medications that render you unconscious during the surgery. This type of anesthesia often requires that you receive a type of “breathing tube” after you are asleep. This “breathing tube” is removed at the end of surgery, either while you are asleep or as you are waking up. Most people never remember this.
3. Who administers anesthesia?
The two main anesthesia providers are Certified Registered Nurse Anesthetists (CRNAs) and Anesthesiologists. CRNAs are Advanced Practice Registered Nurses specializing in the practice of anesthesia. Typically, after obtaining a Bachelor’s degree in Nursing or basic science (biology, chemistry, etc.) and an average of 3-7 years of critical care nursing experience, these nurses attend a 27-36 month Master’s or Doctoral degree program of anesthesia education and clinical residency. All (100%) CRNAs must be board certified to practice.
Anesthesiologists are physicians specializing in anesthesia practice who have undergone a 1-year internship and 3 years of residency after medical school. Many times these two types of providers work in collaboration as an Anesthesia Care Team (ACT).
4. How is the type of anesthesia I received chosen?
Many factors go into choosing the right anesthetic for each patient. Your medical history, the type of surgery, and the requirements of your surgeon are major points that we use to determine the best type of anesthesia for you. We also discuss our plan with you and make sure that you are comfortable with it as well. Sometimes more than one type of anesthesia is appropriate and our conversation with you determines which is best.
5. What are the risks of anesthesia?
Modern anesthesia care is extremely safe. The risk of dying under anesthesia is less than 1 in 200,000. According to the National Safety Council, you are more likely to die from a lightning strike (1 in 126,158). Your risk of any adverse events during anesthesia depends on your medical conditions. If you are healthy with no medical problems, then your chance of anything happening during anesthesia is very low. If you have medical conditions including diabetes, heart disease, lung conditions, kidney disease, or you are a smoker, then your risk will be higher than if you were completely healthy. Until we see your health history, we cannot determine this risk. We will discuss any risks with you prior to your anesthetic. Even if you have some of these medical conditions, we will take every precaution to ensure we minimize your risks.
6. Will my nurse anesthetist stay with me throughout my surgery?
YES. You will meet your anesthesia provider in the pre-operative area to discuss your health history and your anesthesia plan. Once you go to the operating room, your anesthesia provider will remain with you until you are in the recovery room and we determine it is safe to turn your care over to the recovery room nurse. While in the recovery room, your recovery room nurse will remain with you until you are discharged home. Throughout your recovery period, your anesthesia provider and surgeon will be available if they are needed.
7. How long do the anesthesia medicines last?
The length of time that the medicines last can be from several hours to 24 hours depending on the type of anesthesia. For this reason, you are advised not to drive, drink alcohol, or make any legal decisions for 24 hours after surgery. Also, you will need someone to take you home and an adult to stay with you for the first 24 hours after surgery.
8. Is it ok for me to take my usual medicines?
Please see our ‘Pre-anesthesia Instructions’ section for more specific information. If you are required to obtain a clearance from another physician, including but not limited to your primary care, cardiologist, pulmonologist, or nephrologist, then you are to follow their recommendation regarding your medication routine. Typically, we have you take your heart medication, blood pressure medication with some exceptions, any lung treatments, and chronic pain and anxiety medications. Typically, we have you skip your morning diabetic medication unless your diabetic management is such that we feel you should consult your endocrinologist. It is important that you list all of your medications and dosages at your pre-op appointment, so that we can instruct you on what should and should not be taken.
9. I am under pain management. Will this affect my anesthesia?
This is important for you to point out at your pre-op visit. This will not prevent you from receiving anesthesia, however it could affect the choice and dosage of medication that we use to perform your anesthetic. You should consult your pain management physician regarding your dosages and timing of your normal pain medication routine following your surgery.
10. Could herbal medicines or other dietary supplements affect my anesthesia?
Research is currently being conducted on how various herbal medications and dietary supplements affect anesthesia. Some are believed to prolong anesthesia and others are believed to increase blood pressure or bleeding. For this reason, it is important to report anything that you take at your pre-op appointment.
11. Why can’t I eat or drink after midnight the night before my surgery?
You are asked not to eat or drink after midnight because it is possible to vomit while under anesthesia. Any food or liquid you have recently eaten can increase acid concentration in your stomach. Stomach contents can then be aspirated (end up in your lungs) if you vomit under anesthesia. If you aspirate, you could end up critically ill in the ICU, possibly including death. This is why it is important to follow the guidelines that we give you regarding eating and drinking before surgery.
12. Will my sleep apnea affect my receiving anesthesia?
Sleep apnea is a diagnosis of increasing frequency in America. If you have been diagnosed with sleep apnea, it is very important to make this known at your pre-op appointment. You will be asked to bring any medical equipment, such as a CPAP machine, with you on the day of your surgery. We will monitor you longer in the recovery room to make sure it is safe for you to go home. When you go home you will be asked to sit up in a chair, and if you lie down to wear your CPAP or use whatever medical device you have been prescribed for your sleep apnea.
13. Will I get sick after receiving anesthesia?
Nausea and vomiting after surgery, unfortunately, are not uncommon complications. There are many factors that can cause or increase your risk of nausea and/or vomiting after surgery/anesthesia. Your gender, the type of anesthesia, the type of surgery, and the type of post-op pain medications can increase this risk. We routinely administer medications to try and prevent this from occurring after surgery. If you have gotten sick after surgery in the past, please let us know at your pre-op appointment. We may determine that additional preventive treatment is necessary.
14. Will I have a sore throat after surgery?
The type of anesthesia you receive as well as the type of surgery will determine if this is a risk for you. If you receive general anesthesia, you will most likely have some type of “breathing tube” placed after you are asleep. If this is the case, you are at risk of having a sore throat after surgery. If your throat is sore, it typically only lasts 1-2 days.
15. Is it possible for me to wake up during surgery?
Your risk of waking up during surgery is dependent on the type of anesthesia you receive. Waking up or experiencing recall under general anesthesia is very rare. MAC/sedation anesthesia could include anything from receiving a light anti-anxiety drug, to heavy sedation allowing you to sleep through the entire procedure. It is expected that some people may remember portions of the procedure with this anesthetic, but will never be uncomfortable. This is not an adverse event. Your nurse anesthetist will monitor very closely to ensure that this does not happen.
16. What is my risk of forming blood clots? What should I do to prevent them?
Your risk of forming blood clots is determined by your medical history, the type of medications that you take, and the type of surgery & anesthesia that you are having. There are certain measures that are taken in the operating room to lessen the occurrence of blood clots. After surgery, exercising the muscles in your legs or frequently getting up and walking, as well as staying hydrated are all helpful in preventing blood clots from forming. Your surgeon will let you know what type and how much activity you can perform. If you are determined to be high risk, your surgeon may order blood thinners for you.
17. When will I see my family or friend after surgery?
Do to the critical nature of a recovery room; your family and friends will not be permitted to see you until after your recovery period. If you would like, your surgeon will speak to them after surgery and your recovery room nurse will keep them updated on your recovery status. When you are ready to go home, your family or friend will be asked to bring the car to the appropriate area for you to be transported to the car. This is the most common time that you will see them after surgery.
18. If I have any questions or I am experiencing a problem after surgery, whom should I call?
If you have any questions or concerns after surgery, call your surgeon at the number provided to you. If you think that you are experiencing a life-threatening emergency, please call 911.