Madison Anesthesiology Consultants : Patient Education, The Different Kinds of Anesthesia

There are different types of anesthetics that may be used for your surgery. The decision as to which type of anesthesia that will be used will be dependent upon your personal medical history, the type of surgery you are scheduled for, your surgeon's preference and your anesthesiologist. With all types of anesthesia, you will be monitored very closely. The anesthesiologist will monitor your breathing and blood oxygen level, heart rate, blood pressure, EKG and temperature. In our practice, an Anesthesiologist will always be present.

These different kinds of Anesthesia include the following. Please click the links or scroll down the page to learn more. For further information about anesthesia, please see the links in the Resources section.

The risks and benefits of the various types of anesthetic will be discussed with you by your anesthesiologist prior to your surgery. Please take the time to ask any questions that you might have. Remember, the decision as to the type of anesthesia to be administered is ultimately up to your anesthesiologist, to provide you with the safest anesthetic and surgery possible.

General Anesthesia involves the administration of a combination of inhalational and intravenous agents to provide loss of consciousness ("to put you to sleep"). A second goal is to provide pain control, so that you will not feel pain. General anesthesia is the most common type of anesthetic administered. With general anesthesia, you will have an IV started. In most cases, a breathing tube will be placed once you are asleep to control your breathing and to deliver the inhalation (gas) anesthetics, as well as oxygen. With this type of anesthetic, a combination of sedative, narcotic, anesthetic and inhalation agents will be used. For some procedures, the administration of a muscle relaxant will also be required.

Regional Anesthesiology blocks nerve impulses that transmit pain by applying a local anesthetic to the site of pain. This can be done through placement of an epidural catheter, through a spinal anesthetic or through the use of a nerve block. When this type of anesthetic is used, you will commonly be given a sedative through your IV to help you relax during the procedure.

Epidural Anesthesia involves the injection of a local anesthetic, usually with a narcotic, into the epidural space, through either a needle or catheter. The epidural space is outside of the spinal cord. This type of anesthesia is commonly used in labor and delivery and for procedures of the lower extremities.

Spinal Anesthesia also involves the injection of a local anesthetic, with or without a narcotic, into the fluid that surrounds the spinal cord. This type of anesthesia is commonly used for genitourinary procedures and procedures of the lower extremities.

Nerve Blocks are used to block pain at a specific site. By injecting a local anesthetic into or around a specific nerve or group of nerves, pain relief can be localized to the site of pain. This type of anesthesia provides for pain control during and after a procedure, and is associated with minimal side effects. Examples include a femoral nerve block in knee surgery and interscalene block for shoulder surgery.

This is a combination technique that puts you to sleep and provides pain control, not only during the procedure, but afterwards as well. The placement of the epidural catheter allows for you to have continued pain relief after surgery, which will help you sleep and to move more comfortably after surgery. This type of anesthesia is commonly used for major abdominal and thoracic (chest) procedures. The epidural catheter may be left in place for up to 5 days after your surgery.

This involves the injection of medications through an IV catheter to help you relax, as well as to block pain. A combination of sedative and narcotic medications are used to help you tolerate a procedure that otherwise would be uncomfortable. In addition, the surgeon will inject a local anesthetic at the site of the procedure for pain control. With this type of anesthesia, you are able to respond to questions, but will be drowsy throughout the procedure. Please keep in mind that if for any reason you are unable to tolerate this type of anesthetic, there may be a need for a general anesthetic to be administered to complete the procedure safely.

Madison Anesthesiology Consultants has a long history of providing Cardiac Anesthesia Care at Meriter Hospital. This area of our site is devoted to providing answers to questions our patients and loved ones may have regarding their cardiac procedure.

There are several types of heart procedures which involve the services of an anesthesiologist. They include:

1. Cardioversions, the conversion of an abnormal heart rhythm to a normal one.
2. Electrophysiologic studies, which involve identifying areas inside the heart where extra beats are formed, and possibly removing them.
3. Pacemaker placements, particularly the new dual chamber sequential types used in heart failure.
4. Open heart surgery, including coronary artery bypass, surgery on the aorta or pericardium, and valve replacement.

Many of the procedures done in the catheterization laboratory are performed using varying levels of sedation, from light sleep to general anesthesia. All open heart surgery is done in the cardiac operating rooms under general anesthesia.

Planning for your open heart surgery begins when your cardiologist discovers a potentially correctable problem, and receives your approval to contact a cardiac surgeon for a consultation. If you and your surgeon agree on a plan, your case is scheduled and the department of anesthesiology is notified. We will come visit you, either in your hospital room if you are an inpatient, or in a consultation room if you are an outpatient. Outpatients are asked to come to the hospital the day before their surgery for a preoperative anesthesia assessment, lab screening if indicated, and to receive special medications and instructions for the night before surgery. You may meet an anesthesiologist who will not actually be providing care for you; we are all partners, and discuss the cases together before your surgery. You will always meet with your anesthesiologist before the procedure, who can answer any questions which may have come up after your initial preoperative visit.

There are some specific instructions for you the night before your surgery. If you are an inpatient, the floor nurses will have all the preoperative orders from your doctors. If you are an outpatient, you will be given a list of instructions before you leave your visit. Instructions include:

• You should eat a light meal the evening before surgery.
• Take all your usual medications, unless instructed otherwise.
• Patients on blood thinning medications will have special instructions on how to manage them in the days before surgery.
• Diabetics will be given instructions on insulin management.
• Unless your surgery is scheduled late in the day, you should not have anything to eat or drink after midnight. The only exception is enough water to swallow your medications on the morning of surgery. It is ok to brush your teeth.
• Please do not chew gum, eat candy, or smoke the morning of surgery.

On the morning of surgery, you may be given a medication to help relax you before arriving in the operating room. Your family can be with you up until you enter the operating room area. Your anesthesiologist will greet you, and will need to start an IV while you are in the pre-procedure area. Once in the operating room, you will move to a special bed. Your anesthesiologist will place a monitor in an artery to watch your blood pressure during the operation. The anesthetic is given to you intravenously, and you will fall asleep quickly. Once asleep, your anesthesiologist has special procedures to do to ensure your safety during the operation. We are with you during the entire operation. When the surgery is done, you are still asleep. Your anesthesiologist will take you to the intensive care unit (ICU), where you will awaken later in the day. After you are awake and stable, a breathing tube we placed will be removed. You will spend at least one night in the ICU.

While the risks of anesthesia have been steadily declining over the past twenty years, your procedure is not without risk. Your risks may include:

• A heart attack or stroke
• Bleeding requiring a transfusion
• Hoarseness from many possible sources
• Numbness in hands or feet
• Infection or swelling at IV sites

Your risk of dying from the procedure is directly related to the severity of your heart condition, combined with the overall state of your health. Your surgeon and anesthesiologist will discuss this with you during your preoperative visit. It is imperative that you ask any questions you have about your surgery. Do not be embarrassed about asking us about our experience, successes, complications and training. This is an extremely important decision you are making, and you have the right to be well informed.

In the event that your child needs anesthesia, an anesthesiologist will meet with you and your child to gather and provide information necessary to provide safe care, and to give you an understanding of the options and risks of anesthesia. Anesthesiologists are doctors who specialize in the selection and administration of anesthesia, the monitoring of patients under anesthesia and the management of complications that might occur during or after a procedure or test done under anesthesia.

Beforehand, the anesthesiologist will ask questions about your child's medical history, including details about allergies, current medications, recent or long-term illnesses and past reactions to anesthesia in your child or in a relative. It is important to know when your child last had anything to eat or drink and whether or not he or she has any loose teeth. You should feel free to ask any questions that arise during your discussion with the anesthesiologist.

It is possible that more than one anesthesiologist will be involved in the care of your child. Sometimes one anesthesiologist will evaluate your child and give you information about anesthesia, and a colleague will provide the intra-operative care.

There are different types of anesthetic techniques, but certain techniques may apply only to certain procedures. Some anesthetic techniques are more suitable for older children while others may work best with younger children. In some cases, if the anesthesiologist considers it beneficial, medicine may be ordered for your child before a procedure. Some pre-operative medications may cause sleepiness or help relieve anxiety. Others are given to decrease pain. Many medications have combinations of effects.

Anesthesia is administered to children for surgery and sometimes for diagnostic tests (for example MRI scans), especially when a reliable test result depends on your child holding still for long periods of time. During the surgery or test, an anesthesiologist stays with your child at all times. He or she monitors your child's responses to anesthesia medications and many other parameters, like heart rate and rhythm, breathing, blood pressure and oxygen levels. The anesthesiologist makes any needed adjustments in anesthetic levels and watches for any unexpected problems to occur. Anesthesiologists have had extensive training in the diagnosis and treatment of complications that might occur during or after anesthesia.

After your child's anesthetic you may be allowed to be with your child in the recovery room, once your child is awake enough to be aware of your presence. It is not uncommon for children, especially younger children, to cry or appear distraught after anesthesia. Pain medication will be available if your child is in pain. Your child will be taken to his or her hospital room once it is determined that it is safe to do so.

PATIENT EDUCATION

PATIENT EDUCATION

THE DIFFERENT KINDS OF ANESTHESIA