FREQUENTLY
ASKED QUESTIONS
NOTE:
Material on this page does not constitute medical advice. Consult
with your physician concerning specific medical conditions.
What is your patient or
outpatient surgery related question?
I had spinal anesthesia for a knee replacement
procedure. I experienced a loss of taste after surgery. After
4 months I have only partial recovery. Is this anesthesia related?
-
TOP
Answer: It is possible that your loss of taste and spinal anesthesia
are related. Cranial nerve disfunction has been reported after
spinal anesthesia. The nerve responsible for taste is a cranial
nerve. The most common cranial nerves affected are those going
to the eye muscles.These occurances are rare. Lingular nerve dysfunction
[loss of taste] is even rarer. It is thought that loss of spinal
fluid associated with dura puncture at the time of administration
of spinal anesthesia leads to loss of support and therefore tugging
on the cranial nerves. The condition you have is called ageusia.
Usually nerve function returns in a few weeks but some take longer
and a few do not recover completely.
My mother died from a "probable reaction"
to anesthesia. I am going to have a D&C which will require
anesthesia. I have a history of pvc's and negative reactions to
most drugs including pain killers, antibiotics and antihistamines.
What would be the safest type of anesthesia for someone with my
history and needing a D&C? -
TOP
Answer: The fact that your mother may have had significant problems
related to an anesthetic is important information which should
be communicated to your anesthesiologist when you visit with him
or her. As to your best choice of anesthesia, there are several
ways to go. Spinal anesthesia would be a good option since it
would involve one drug, a local anesthetic. However, if you would
prefer a general anesthetic , TIVA, total intravenous anesthesia,
would work well.Talk with your anesthesiologist and together work
out a safe anesthetic plan for you.
I am going to have knee surgery soon. I am taking
atenolol 25 mg. daily for a problem where my heart beats too fast.
Should I worry about interactions between my medication and anesthesia
drugs? -
TOP
Answer: Atenolol is one of the current popular beta blockers used
to slow the rate of heart contractions. In most cases, where the
patient is placed on a beta blocker ,such as atenolol, for heart
rate control, the anesthesiologist would want the drug continued
right up to the time of surgery.
Your anesthesiologists needs to know that you are taking atenolol
and why you have been prescribed the drug. There is little to
be concerned about as far as drug interactions between the drugs
used for general anesthesia or regional anesthesia and atenolol.
Is there another option for surgery besides general
anesthsia? I am a diabetic. What about propofol? -
TOP
Answer: There are options to general anesthesia. However,these
options vary with operative site, training of your anesthesia
provider and needs of your surgeon. The options , other than general
anesthesia, include spinal or epidural anesthesia. These are used
mainly for surgeries on the lower extremities and lower abdomen.Peripheral
nerve blocks with local anesthetics can be used for shoulder,
arm and leg surgery. Local infiltration with local anesthetics
can be used for superficial surgical procedures almost anywhere
on the body.
Diabetes does not preclude the use of general anesthetics. Diabetic
patients undergo general anesthesia daily and the vast majority
do extremely well.
Propofol is an intravenous drug which produces "sleep".
It is frequently used as an induction agent for general anesthesia.
After the airway is secured an inhalation agent is administered
to provide surgical anesthesia. Inhalation anesthetics are liquids
which are converted to a gas so they can enter the body through
the lungs. Propofol may also be used as a continuous infusion
via the IV to keep the patient "asleep".
As with any pending surgery, you should talk with your anesthesiologist
as well as your surgeon and learn what options are available to
you for your given procedures.
What are the concerns I should have with the taking
of herbal compounds and vitamins with inpending surgery and anesthesia?
-
TOP
Herbal supplements and vitamins are biologically active and can
interact with medications and have an effect on surgery. These
effects include increased bleeding, blood perssure changes, prolong
sedation after anesthesia, fluid and electrolyte changes and alterations
in blood sugar. The Americian Society of Anesthesiologists recommends
that patients stop taking herbal medications and vitamin supplements
at least two to three weeks prior to surgery. Always tell your
anesthesiologist that you are taking herbal and vitamin supplements.
I will be undergoing liposuction of the arms. I
am concerned because my mother has angina and has had a bad reaction
to anesthesia before. I beleive angina can be hereditary. I sometimes
have had chest pain, usually when I am stressed. Physicians have
never found anything. They say Angina can be hard to confirm.
Should I be concerned about general anesthesia? -
TOP
Patients with stable angina usually do quite well with general
anesthesia. If you have been evaluated for angina and cleared
by your physicians you can feel comfortable about undergoing a
general anesthetic, especially if this evaluation included a stress
test. You should discuss your concerns with your anesthesiologist
and go over your options with him or her.
I am exploring nerve block as well as local anesthesia
for shoulder surgery. Please advise me of the advantages and/or
negatives of this extra procedure. -
TOP
You have chosen a good path to explore the possibility of nerve
block for your rotator cuff and tendon repair of your shoulder.
The primary advantage of using a nerve block for shoulder surgery
is reduced postoperative pain. Shoulder surgery can be associated
with a fairly significant amount of discomfort. With a nerve block
this discomfort can be eliminated or greatly reduced for anywhere
from 15-30 hours. Of course, there are certain risks associated
with nerve blocks (bleeding, infection, drug reaction, nerve damage).
The likelihood of them occurring is small, but it exists.
Usually, anesthesia for shoulder surgery of this type is one of
the following:
- Nerve block- This often consists of an interscalene approach
to the brachial plexus (the nerves which supply your shoulder
and arm) and involves placement of local anesthesia above the
collarbone to numb the area around the shoulder on that side.
- Nerve block plus general anesthesia- Often patients having
the above nerve block require or request sedation or general
anesthesia in addition to the block for the surgical procedure.
The block can make the sedation or general anesthesia course
smoother, fewer side effects from general anesthesia, such as
nausea, and then after the operation, the block can provide
several hours of post operative pain relief.
- General anesthesia only- Patients who are not good candidates
for a block may best have general anesthesia only
- Local anesthesia alone placed at the surgical wound area
is usually not sufficient to provide pain relief for the surgical
procedure itself, but local anesthesia can be added at the end
of the procedure to help provide pain relief in the post operative
period.
After
receiving input from both your surgeon and anesthesiologist caring
for you, a block or local anesthesia can sometimes be of very good
benefit to patients having this type of surgery.
Each patient and surgical procedure must be individualized and so
one size does not fit all. Therefore, it is probably best to discuss
these options with your anesthesiologist who can involve your wishes
and specific health issues in helping choose the best course for
you.
I recently underwent general anesthesia during a
radical prostectomy. Almost immediately after the procedure I began
to suffer from acid reflux which I never had before. It has been
7 weeks since my surgery and I still experience acid reflux at various
times. I've read that this has to do with being intubated during
my surgery. What happened to cause this and how should I go about
treating this? Thank You -
TOP
When a patient is intubated for a surgical procedure,
the tube is placed in the trachea, so the anesthesiologist can supply
oxygen and anesthetic agents to the patient’s lungs. We are
not aware of any association between placement of an endotracheal
tube and reflux of gastric contents into the esophagus. Reflux since
the time of surgery may be related to surgical stress, increased
acid production, and possibly an ulcer. If your symptoms persist,
you should consult your personal physician.
I had surgery on 02/20/04 at about 10:00 PM and by
about 02/25 or 02/26 I started feeling dizzy or faint. Is this a
common side effect of anesthesia or not? My follow up visit to the
Surgeon is not till 03/04 and I was wondering if this is abnormal
or should I be concerned. They anesthetized me and they also brought
me out of it. In one hour I was awake. -
TOP
It is not uncommon for patients to feel tired and
dizzy or faint for some time after surgery. However these symptoms
can also be indicative of a more serious problem. It is in your
best interest to contact your surgeon to discuss your symptoms.
Your surgeon will ask you other questions to make sure that nothing
serious is wrong.
I would like to know what are the risks for someone
that is pregnant? Will the anesthesia hurt the baby? This person
is only 7 weeks pregnant. -
TOP
When a woman is pregnant, the first
12 weeks are the most critical in the baby's development, as all
organs and major structures are formed during this time. Therefore,
most elective surgery is delayed until after the 12th week of pregnancy.
If the surgery is not elective (ie, the mother’s health is
at risk without the surgery), the procedure may need to be done
urgently or emergently.
There is very little data on the
safety of most drugs used during pregnancy, including many of drugs
which may be part of an anesthetic. Some medications have known
risks to the fetus and are easily avoided. Other drugs have been
used safely during pregnancy for many years and are the preferred
anesthetic agents for early pregnancy. Of course the type of surgery
is important as well, with a higher risk to the fetus with abdominal
surgery versus repair of a broken wrist, for example.
The most important point is for the
woman having surgery to let both the surgeon and anesthesia team
KNOW that she is pregnant, then discuss her options about timing
of surgery and which anesthetic drugs will be used.
When may regional anesthesia be used for laparoscopic
lower abdominal surgery? I wish to avoid general anesthesia. My
upcoming surgery would be performed with me in the Trendelenburg
position and a CO2 pneumoperitoneum established. An anesthesiologist
from a well known clinic has told me that such procedures are regularly
performed this way. It can be a bit uncomfortable but most individuals
tolerate it well. The hospital at which I am having the surgery
has no experience at performing laparoscopic abdominal surgery without
general anesthesia. I encountered a similar situation several years
ago for a TEP hernia repair. I convinced the surgeon to allow me
to have regional anesthesia and all went well. Can you help me sort
this out? -
TOP
Laparoscopic procedures that are performed with an
inflated abdomen are most commonly performed with general anesthesia.
Performing such procedures using regional anesthesia requires that
both the surgeon and the anesthesiologist be comfortable with performing
the procedure in such a manner. If you wish to have the procedure
done under regional anesthesia then it would probably be best to
find a surgeon who normally does their laparoscopic procedures that
way. That surgeon will also have anesthesiologists who are willing
to perform regional anesthesia for your surgery. It is not in your
best interest to try to make your surgeon and anesthesiologist use
a technique that they are not comfortable using. Regional anesthesia
may be useful for patients having laparoscopic procedures to localize
pelvic pain, where an awake patient can help localize and characterize
the pain. This technique is done with an intravenous anesthetic
that allows the patient to be deeply sedated at times, then awake
enough to respond to questions. Most patients can tolerate this
quite well, although they are highly motivated and carefully selected,
with no contraindications such as pulmonary disease, acid reflux
or severe obesity.
However, any significant pneumoperitoneum (or any
inflation pressure greater than 15mmHg), coupled with the Trendelenberg
position makes it almost impossible for a patient to maintain adequate
air exchange. The elevation of the diaphragm and upward pressure
from the abdominal contents will make the patient very uncomfortable
to begin with, and overtime, as CO2 builds up from inadequate alveolar
ventilation, a significant feeling of air hunger will ensue. If
the procedure can be done without the pneumoperitoneum, the patient
may be able to tolerate it comfortably under regional anesthesia.
General anesthesia is considered very safe and in
most healthy patients relatively free of side-effects.
I
am terrified to get my wisdom teeth removed. I have never "been
under" and I am worried about the mortality rates of using
anesthesia. Would you be able to give me some info on the seriousness
of going under and the risks involved with my procedure? Thank
you -
TOP
The amount of surgery performed in outpatient clinics
for the past 26 years attests to the safety and effectiveness of
this setting for medical operations. In general, the risk of a experiencing
a major complication in an otherwise healthy patient is extremely
low, but not impossible. For example, there is always the remote
chance that a patient may have a reaction to a medicine that may
not have been predicted. Sometimes this may be life-threatening,
but this is the very reason that your physical status (vital signs)
will be so closely monitored throughout the surgery and perioperative
period. Concerning the risk of death, some figures may be illuminating.
If you are healthy and undergoing minor surgery, your risk of dying
from anesthesia is probably less than 1 in 200,000. By comparison
your lifetime risk of ever being struck by lightning is 1 in 10,000
(20 times greater) and your risk of actually dying from a lightning
strike is 1 in 30,00 (about 7 times greater). If you drive 1,000
miles, you have about 1 in 42,000 chance of dying or about 5 times
greater risk than dying from anesthesia. Concerning the risk of
death, in general, it's probably riskier to die crossing a street
in a big city than it is to die during or after general anesthesia.
Anxiety about surgery and anesthesia is normal, so
please share your concerns with your anesthesia care team and ask
any questions you have. We recommend that you contact your physician
first to discuss your concerns.
What can be done for the sore
throat. My husband had surgery yesterday and his throat is so sore
he is afraid that maybe some damage was done to this area. He is
on percocet and has gargled twice with salty water. What else can
we do to ease this discomfort? -
TOP
Sore throats
are a known side-effect after general anesthesia. The cause is irritation
of the back of the throat by the breathing tube that was used for
the case. In the majority of instances, comfort measures are all
that are indicated, such as an over-the-counter anesthetic spray,
e.g., Chloroceptic, or throat lozenges. Sore throats usually resolve
in a day or two following surgery. If it does not improve or gets
worse, a call to the surgeon or anesthesiologist is warranted as
well as a visit to your family doctor. Should you experience difficulty
breathing, immediate evaluation at the nearest emergency room is
suggested.
What
can I do or say to ensure I receive adequate anesthesia for op surgeries
or procedures? It's a nightmare for me to wake up during a surgery,
etc. when I've told them that I seem to need more anesthesia than
the average patient. I've just had a breast biopsy and actually
felt the dr cutting into the lump during the biopsy. I just had
to endure it. A patient should not have to experience this nightmare
with today's technology. The dr's listen to my concern, but don't
do anything about it initially. I've experienced excruciating pain
during my first c-section; numerous dental visits; recent colonoscopy;
and breast biopsy last week. What can I do or say about this? Please
help. -
TOP
Some patients who receive conscious/deep
sedation for a procedure may experience discomfort. With conscious
sedation or deep sedation, the surgeon needs to inject local anesthetic
into the surgical site to prevent the patient from feeling any discomfort.
Some patients may have some recollection from the local anesthetic
being injected. Unfortunately, there are circumstances when "enough"
local anesthetic cannot be given. If this is the case, the anesthetic
plan may be changed to a general anesthetic. General anesthesia
should provide complete loss of consciousness. While awareness during
general anesthesia is a problem that we know exists, it is very
rare. This may occur in spite of normal vital signs during the course
of the procedure. Some medications, when used on a regular basis,
may increase the requirement for anesthetic medications. Medication
use should be discussed with the anesthesiologist involved with
your case. For some procedures where conscious/deep sedation is
suggested, it is not unreasonable for the patient to ask for general
anesthesia to be performed.
The anesthesiologist who is used
by your surgeon should be consulted before the day of surgery so
that proper attention can be given to a patient’s particular
needs.
I suffer shock from IV sedation and lose most of my hair
within 3 weeks of surgery. The pain of that needle going in is just
incredible. Is it possible that I am also allergic to Versed? How
do I find a doctor or anesthesiologist who can sedate me painlessly,
as with demerol and valium? I'm having an awfully hard time with
this problem. Thank you.
Your question includes several statements that may
or may not be related. Your statement that you suffer from "shock"
with IV sedation is difficult to interpret without knowing your
medical history and reviewing the records from the anesthetics during
which you had "shock". If indeed you do experience a severe
life-threatening drop in your blood pressure simply due to sedative
drugs then you may have a more serious underlying medical condition.
Based on this statement it would be advisable for you to obtain
copies of your anesthetic records and have them reviewed by your
primary care physician to see if further medical work-up is warranted.
Loss of hair after sedation or general anesthesia
is probably much more common than is realized. The medical term
for this is telogen effluvium. Briefly, due to a specific event,
hair follicles prematurely terminate the anagen phase and enter
the resting or telogen phase. The hair follicle is not damaged or
diseased, but has simply had its biological clock reset. Resting
hairs remain on the scalp for about 100 days, so hair loss occurs
about 3 months after the event that caused the biological clock
to be reset. Hair loss is diffuse and up to 50% of the body's hair
can be affected. There are many types of events that can cause this
to occur. They include acute blood loss, childbirth, high fever
(commonly seen in children), and physical and/or psychological stress.
Hair dressers, when they see patients who have had surgery, commonly
blame this problem on the anesthesia. They are wrong-it's the surgery,
because of the associated physical and/or psychological stress.
Anesthesia itself does not cause this to occur.
What needle are you referring to when you state that
the pain is incredible? Is the act of starting an IV painful for
you? If so, the nurse or physician starting the IV could use some
local anesthetic at the IV site to minimize the pain. If you are
referring to a needle being used during surgery to numb the area
being operated on, then it is possible that your level of sedation
may need to be increased so that you don't experience discomfort
with the injections. Other rare causes of IV pain include infiltration
(where the IV solution goes outside the vein into the surrounding
tissues) and the use of propofol in a hand vein, which occasionally
will result in a burning sensation.
Demerol and valium are not necessarily superior to
other drugs for comfort during surgery. Valium has been associated
with pain during IV injection. Without knowing what the source of
the pain is that you are referring to, it is difficult to answer
your question. Please consult with your primary care physician,
your surgeon and any future anesthesiologist that cares for you
to address these concerns.
I
have had 3 operations within 1 1/2 years. I am on dialysis, have
a kidney transplant, and a hip replacement. My wife says that I
have lost my memory. For instance, I don’t remember movies
we saw, I don’t know where I put things, and I think my whole
way of thinking is in slow motion. Could having that many operations
in such a short time cause my memory loss? -
TOP
In a person with kidney failure receiving dialysis,
it is the kidney problem, and the effects of the dialysis treatments,
that are far more likely to cause memory problems than the anesthesia
or surgery. If you have successfully had a transplant you will be
taking immune suppression drugs that may also be affecting your
mental function. Anesthesia medications are cleared from the body
within hours, or at the most, days.
Having said this, it is also true that the impact
of anesthesia on recovery of brain function has become an important
area of research. There are some who believe that general anesthesia
can cause long term effects on memory in the elderly. But there
is not a lot of evidence to support this conclusion, and the vast
majority of people who undergo anesthesia and surgery recover their
mental function quite soon afterwards.
Is
anesthesia the medicine that makes you sleep or does it reduce the
pain? -
TOP
Anesthesia refers to the state of not feeling pain.
It can be because the patient has been made unconscious (asleep),
through the use of drugs (many of which are called "anesthetics")
or because the area to be operated upon has been made insensitive
to pain through the injection of local anesthetic drugs. In short,
anesthesia is the state of being insensitive to pain; anesthetics
are the drugs that create the insensitivity. The term "anesthesia"
doesn't apply to a single agent or class of drugs
A "local anesthetic" numbs the area where
it is placed (like the dentist numbs the gums). Anesthetic agents
that make the patient drowsy and relaxed (sedation) are the same
drugs used in higher doses to cause unconsciousness for a general
anesthetic. General anesthesia ("all the way asleep")
always includes pain relieving medications, usually narcotics like
morphine or fentanyl, as well as drugs to induce and maintain unconsciousness,
achieved with a variety of intravenous medications (Propofol, Pentothal,
Etomidate) and/or inhaled anesthetic gas (isoflurane, sevoflurane).
Your anesthesia care team may use the word "anesthesia"
to refer to the whole anesthesia care plan, whether the plan is
local numbing medicine, sedation, numbing of a larger area (including
spinal, epidural or arm/leg blocks), or a general anesthetic.
I
had surgery in January 2003 in which a tube was placed down my throat
as a routine matter. Since that time, I have noticed that sometimes
it seems like food or beverages take longer than normal or necessary
to get from my throat to my stomach. It's not particularly uncomfortable
unless I've imbibed something rather hot that gets "stuck"
for awhile in the area behind my sternum maybe an inch or two below
my collarbone. I'm wondering if this is caused by the insertion
and removal of the tube. Also, I have to have the same surgery on
my other hand fairly soon, so, if the tube caused this, is there
some way that I could have surgery without a tube? Thanks! -
TOP
Although swallowing difficulties can occur after
anesthesia, symptoms are usually of brief duration. A continuing
symptom of food or liquids "sticking" in the throat for
months can be due to a serious unrelated medical condition. You
should immediately see your internal medicine or family medicine
physician for diagnosis and treatment of this problem. Diagnosis
and treatment may also involve referral to an otorhinolaryngologist
(ear, nose and throat physician).
Anesthesia for hand surgery can be accomplished in
a variety of ways, depending on the procedure (i.e., carpal tunnel
release or tendon repair) and the surgeon and patient's preferences.
Regional anesthesia (or a "block") involves numbing just
the arm with injections of numbing medicine, either at the top of
the shoulder (interscalene or infraclavicular block) or in the armpit
(axillary block). If appropriate for the surgery, numbing medicine
may also be administered in the vein (Bier block), at the elbow
or wrist, or just at the area of incision and surgery ("local").
When any block is administered and used for surgery, sedation medicines
are usually given intravenously (in an IV) to help you feel relaxed,
comfortable and sleepy during the procedure. Use of a regional technique
avoids the need for general anesthesia and a breathing tube in the
windpipe (endotracheal intubation).
The optimal choice for your anesthetic will be made
before your next hand surgery when you discuss your concerns and
preferences with your anesthesia team and surgeon.
I
have been told that I will be undergoing the TIVA sedation with
a mix of several IV drugs. I am terrified that I will be aware or
feeling anything during this procedure. Some of the drugs include:
valium, a drying agent, a steroid, fentanyl, lorazepam and others
that I cannot recall. I have been told that this will not be conscious
sedation - it will be deeper. However, I will not be needing intubation,
so it will not be general either. So, I know it will be deeper than
conscious, and lighter than general. I have asked questions. They
have answered - yet I am still confused. Could you please tell me
if this is typically the type of thing that I will know what is
going on - or awake? Thank-you in advance. -
TOP
TIVA stands for Total IntraVenous Anesthesia: all
the medications you receive will be administered through an IV catheter
and you will not receive anesthetic gas. The different levels of
sedation ARE somewhat confusing and often leave patients wondering
just what their experience will be.
In the past, there was either "awake" in which a patient
was aware and quite conscious, or "asleep", usually with
a full anesthetic and intubation. Now there are many, many levels
in between, states ranging from "happy, pleasant and relaxed"
(light, "conscious" sedation in which a patient will readily
respond to words or a light touch) to "snoozing away and not
aware anything at all is happening" (deep sedation). At this
deep level of sedation, the patient is breathing on her own, but
is usually not responsive to talking or touch. Most commonly, there
is no awareness at all or at most, slight recognition that there
is some movement by the surgeon. For any dental procedure, there
will still be a generous amount of local anesthetic injected into
the gums, but unlike the dentist's office, you will not know when
the injections are being done.
All the drugs you mentioned are combined to give optimal sedation
for the procedure and a comfortable recovery afterwards. The steroids
prevent swelling and inflammation, the Valium (or Versed, from the
same family of drugs) provides a very pleasant sedation and amnesia
(unawareness), the fentanyl is for pain, and the drying agent decreases
oral secretions. Another drug, Propofol, may be used to maintain
a very pleasant asleep and dream-like state (patients often report
very good dreams). You should only be aware of arriving in the operating
room, monitors being applied and drifting off to sleep. You may
drift in and out of vague awareness of being in the operating room
(perhaps seeing the operating room lights or hearing the staff talking),
but you should not experience pain or anxiety. Most patients awaken
in the recovery room, feeling good, clear-headed and surprised that
their procedure is over.
Your concerns and fears are quite legitimate, so please do continue
to discuss them with your surgeon and anesthesia team, especially
on the day of surgery. Many of us have had quite unpleasant dental
experiences in the past and those remembered fears often escalate
as the time of surgery approaches. Planning and discussing an ideal
anesthetic is the best thing you can do to deal with your apprehension!
I
am currently researching Ambulatory Care Centers and the current
trend. I am attempting to show an advantage from a cost and earnings
standpoint. Please provide references for articles that could support
this. Thank you. -
TOP
While we could find no specific articles addressing
your question, we do suggest that you consult medscape search, pubmed,
IMS Health, and PhRMA for supportive data.
I
am having a right inguinal hernia repair, without any type of complication.
What type of anesthesia do you most recommend? -
TOP
We recommend a field block with local anesthetics
for uncomplicated repair of an Inguinal Hernia. A field block will
provide comfort throughout the entire surgery as well as provide
postoperative pain relief. It is common for patients to also receive
intravenous sedation along with the field block. Sedation will provide
amnesia and prevent anxiety one may feel about being in the OR.
For
oral surgery, what blood pressure is too high to put someone under?
198/106 was my # b4.
- TOP
High blood pressure may make anesthesia and surgery
hazardous. In patients whose blood pressure is very high before
surgery, anesthesia tends to exaggerate both the highs and lows.
These fluctuations can cause problems with the heart, brain and
kidneys, leading in some cases to heart attacks or strokes.
High blood pressure readings may be due to anxiety
at the preop visit or related to true hypertension. We recommend
that you see your primary MD and get your BP checked a few times
before surgery. If you have hypertension, then you can be started
on blood pressure medication and controlled prior to elective surgery.
Although there is no exact level of blood pressure
that divides acceptable blood pressure from blood pressure that
is too high, most anesthesiologists would seriously consider canceling
an elective operation if the diastolic (the lower number) was at
or above 110, or the systolic (upper number) was above 200 - 220.
The operation may need to be postponed to allow for proper diagnosis
and treatment of the blood pressure to bring it down to acceptable
levels.
A blood pressure reading of 198/106 meets the criteria
for severe hypertension, which puts a patient at risk for stroke,
coronary events and kidney failure. While the data is skimpy, many
physicians believe that hypertension should be brought under control
slowly – over as much as six weeks – before considering
elective anesthesia and surgery. The possibility of stroke, heart
ischemia and the status of kidney function should be investigated
before elective surgery.
Our
daughter will have ear reconstructive surgery; our plastic surgeon
stated the surgery can be performed in an out-patient surgery setting.
Is pediatric surgery safe in this setting? Is there an accrediting
agency that approves a facility for pediatric surgery?
- TOP
Many pediatric cases can be safely performed at an
Outpatient Surgery Center, especially when they are minor procedures.
Surgery Centers involved in pediatric surgery are usually equipped
to handle many different levels of anesthesia for this population.
In addition, centers which perform a high volume of pediatric cases
may have an anesthesiologist who has had additional training in
pediatric anesthesia. Other than agencies that accredit surgery
centers in general, we are not aware of any specifically for pediatrics.
What
kind of operation is appropriate for ambulatory surgery?
- TOP
Appropriate
procedures for ambulatory surgery are those associated with postoperative
care that is easily managed at home, and with low rates of postoperative
complications that require intensive physician or nursing management.
Lists of ambulatory procedures quickly become outdated simply because
they exclude certain procedures which in a short time may become
routine in ambulatory settings. Length of surgery is not a criterion
for ambulatory procedures because there is little relationship between
length of anesthesia and recovery.
Where
does ambulatory anesthesia take place?
-
TOP
Ambulatory
surgery occurs in a variety of settings. Some centers are within
a hospital or in a freestanding satellite facility that is either
part of or independent of a hospital. Physicians' offices may also
serve as locations for these procedures.
Is
ambulatory surgery riskier if I smoke?
- TOP
In
general, smoking very well may increase the risk of respiratory-related
problems associated with the administration of anesthesia. For most
ambulatory surgery procedures, though, the risk is still quite low.
The overall risk, including the risk of death, while not impossible,
is still quite low also. You may be able to eliminate smoking as
a risk for your anesthetic care if your anesthesia can be provided
with a regional technique, such as numbing the area of surgery,
along with sedation, instead of general anesthesia. Very heavy smoking
may also influence your operation through its effects on wound healing.
What
actually goes on when I have an outpatient surgery procedure?
- TOP
The
anesthesiologist will carefully assess your medical history and
perform a directed physical examination during your preoperative
assessment. He/she will then discuss with you the risks and benefits
of your anesthetic options based on your medical status, the anticipated
procedure, it's duration, and your surgeon. After informed consent,
the anesthesiologist will then formulate your anesthetic plan, medicines,
and monitoring. Throughout the anesthetic and surgery, your physical
status will be monitored and treated to maintain your safety, and
anesthetics will be delivered for analgesia. This same level of
care will continue during your recovery, guided by your anesthesiologist.
What
are some risks, besides death, of outpatient surgery?
- TOP
In
general, the risk of a major complication in an otherwise healthy
patient is extremely low, but not impossible. There is always the
chance that a patient may have a reaction to a medicine, for example,
that may not always be predicted. Sometimes this may be life-threatening,
but this is the very reason that your physical status will be so
closely monitored throughout the perioperative period. These "worst-case"
scenarios include death, permanent or reversible neurologic injury,
heart attack, among others. More common scenarios include nausea
and vomiting, sore throat or hoarseness, dizziness, tiredness, headache,
muscle aches, pain, etc, most of which are easily managed.
I
need to take narcotics because of pain. Is my risk of anesthesia
increased?
- TOP
As
for narcotic use, this most likely will not affect your anesthetic
risk at all. It may make you more tolerant to the effects of narcotics
that may be planned within your anesthetic, meaning that it may
take additional pain medication to render you comfortable. The use
of local or regional anesthetics may allow for easier and more thorough
control of your pain.
Are
patients who are on medications for psychiatric diseases (e.g.,
bipolar disorder) appropriate for ambulatory surgery?
- TOP
These
patients should consult preoperatively with the anesthesiologist,
who will review their medical histories, medications, and planned
procedures. In general, as long as patients are clinically stable
on their medical regimens, they can be safe candidates for ambulatory
surgery, and the risk of stopping medications may be greater than
the anticipated risks of anesthesia in combination with the medicines.
There may be exceptions to this, as with MAO inhibitors for depression.
The consulting anesthesiologist will review these risks with each
individual patient to plan the safest anesthetic. Your medicines
may cause some side effects in combination with anesthetic medicines,
but these may be anticipated and should not prevent you from having
surgery on an outpatient basis.
What
is anesthesia? -
TOP
Click
on the Image to see RealVideo
Film
clip courtesy of the Illinois Society of Anesthesiologists
Note:
View the video clips on this site with the FREE RealPlayer
What
are the different kinds of anesthesia?
-
TOP
Click
below to see RealVideo about Local Anesthesia
This
video provided by The Nemours
Foundation, Wilmington Delaware, ©1995
Click
below to see RealVideo about General Anesthesia
Should
outpatient surgery be performed in very young children?
- TOP
Premature
infants (gestation age < 37 weeks) who are younger than 50 weeks
postconceptual age should not leave an ambulatory surgery center
for at least 23 hours after a procedure because they are at risk
of developing apnea (stopped breathing) even without a history of
apnea.
Is
ambulatory surgery safe for very old individuals?
- TOP
Advanced
age alone is not a reason to disallow surgery in an ambulatory setting.
Age, however, does affect the pharmacokinetics of drugs: short acting
drugs take a longer time to be excreted in older individuals. It
is important to realize that most medical problems that older individuals
may experience are not caused by age, but by specific organ dysfunction.
For that reason, all individuals, whether young or old, deserve
a careful preoperative history and physical examination by a physician.
What
are the responsibilities of the ambulatory patient in terms of going
home after a procedure?
- TOP
Patients
undergoing ambulatory surgery should have someone to take them home
and stay with them afterwards, if necessary, to provide care. Before
the procedure, the patient should receive information about the
procedure itself, where it will be performed, laboratory studies
that will be ordered, and dietary restrictions. The patient must
understand that he or she will be going home on the day of surgery.
The patient, or some responsible person, must be able to see that
all instructions are carried out. Once at home, the patient must
be able to tolerate the pain from the procedure, assuming adequate
pain therapy is provided. The majority of patients are satisfied
with early discharge.
What
are the restrictions of food before ambulatory surgery?
- TOP
To
decrease the risk of aspiration of gastric contents into the lung,
patients are routinely asked not to eat or drink anything for at
least 6-8 hours before surgery. Clear liquids may be allowed up
to 3 hours before surgery. Coffee drinkers, if allowed to drink
3 hours before surgery, should drink their morning coffee at that
time. Ask your anesthesiologist to be certain: the time limits for
food or clear liquids before surgery can be institution and practioner
specific.
I
have a history of panic attacks and I need to undergo sinus surgery.
Is it possible that this condition may cause problems during the
anesthetic or that my panic attacks may worsen after anesthesia
and surgery?
- TOP
Most
patients who are about to have surgery experience at least some
anxiety or nervousness beforehand. A person with a history of panic
attacks is likely to have a more difficult time with this. Without
knowing more about your exact condition and what triggers your attacks,
we can offer only a few general suggestions that might help allay
your anxiety and increase your chances of having a less stressful
time:
-
Ask for an interview, or at least a telephone call, with your
anesthesiologist. Studies have shown that the best pre-surgery
anxiety reliever is an interview with the anesthesiologist.
-
Find out whether additional anti-anxiety medication can be prescribed
for you to take the night before and/or the morning of surgery.
-
Consult with your primary care physician to make sure that the
current treatment for your panic attacks is optimal.
- Let
other care-givers,including your surgeon, understand that you
have a condition that may affect your ability to tolerate some
routine things before and after surgery - e.g. application of
oxygen masks and other medical devices.
What
is the maximum length of surgery in the outpatient setting if
sedation or and general anesthesia is used?
- TOP
There
are no published guidelines concerning the maximum length of surgery
that can be performed in the outpatient setting. Nor have there
been any studies that have specifically addressed this issue.
The
decision to perform a procedure in the inpatient or outpatient setting
has far more to do with the complexity, site and intensity of the
surgical procedure than with the technique or duration of anesthesia.
Patients may require inpatient admission because of the need for
postoperative nursing, pain control,and monitoring for surgical
complications, such as bleeding. Patients with complex or unstable
medical conditions also require close postoperative monitoring and
care, and may be unsuitable candidates for ambulatory surgery. During
long procedures patients become increasingly uncomfortable because
of the inability to change position, so that general anesthesia,
rather than sedation may be more appropriate.
Although
modern anesthesia techniques are associated with shortened recovery
time, patients still must remain in the outpatient facility for
a period of time after their procedure. Other limitations may be
the practical issue of how long an outpatient facility can stay
open (staffing) and how late it can be reasonably accepted for a
family member to take a patient home.
© SOCIETY FOR AMBULATORY ANESTHESIA
520
N. Northwest Highway Park Ridge, Illinois 60068-2573
Tel: (847) 825-5586 Fax: (847) 825-5658
E-mail: samba@asahq.org
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