Most anesthesiologists use a combination of medicines to put you to sleep. These medicines last a short period of time (about 20 minutes). Once the patient is asleep, we place a breathing device to maintain control of breathing. To keep patients asleep, we use anesthesia gas. When the operation is over, we shut off the anesthetic and let the patient wake up. The advantage of using this complicated system is that your anesthetic can be easily tailored to be as long or as short as it needs to be.
The chance of nausea or vomiting after anesthesia has been greatly reduced because of improved anesthetic medications and the availability of several very effective anti-nausea medications which have fewer side effects. For certain operations where nausea is more likely, such as eye muscle surgery, ENT surgery and intra-abdominal surgery, we may administer anti-nausea medication through the IV before you awaken from anesthesia. If you notice nausea after your operation, please inform the nurse as early as possible. We can usually control this nausea with IV medication. Certain patients are very sensitive to anesthetic or pain medications and will continue to have nausea despite our best efforts. Fortunately, this has become an unusual occurrence. If you have special concerns about nausea, please discuss this with your anesthesiologist.
If you do not have any of the risk factors listed in the previous section, then you may have clear liquids up to four hours prior to surgery. Clear liquids include water, fruit juice without pulp, clear tea and black coffee. Do not consume any beverages containing alcohol, non-clear liquids or solid food after midnight the night before your scheduled surgery. Infants may have breast milk up to four hours prior to surgery or infant formula up to six hours prior to the scheduled time of surgery. Patients should take medications for heart conditions, high blood pressure or breathing problems at the usual scheduled times with small sips of water.
It is good to take the usual morning doses of medications for blood pressure, heart, lung and stomach conditions. Take all medications with small sips of water. You should discuss the medications you are currently taking during your pre-operative anesthesia meeting.
Yes. In addition to the surgeon’s bill and the hospital’s bill you will receive a separate bill for the services provided by your anesthesiologist. If you are a “self-pay” patient (i.e. you have no insurance, or your insurance will not cover your elective procedure), please contact our office in advance of your procedure to make the necessary payment arrangements. Our courteous and professional staff will estimate your charges, which require you to pay in advance of your procedure. Any balance due will be billed to you following the surgery.
Frequently Asked Questions: Labor Epidural
Your obstetrician may provide intravenous medications to help relax you and provide pain relief. If you wish for a more complete method, anesthesiologists may be called in to provide regional anesthetics in the form of an epidural, a spinal or both.
It is a local anesthetic delivered through a small catheter placed in the small of the back near the spinal canal. It is generally considered one of the most effective methods for patients wishing for significant pain relief but wanting to be awake and able to participate in the birth.
It is similar to an epidural but, because anesthetic is injected directly into the spinal canal, the effects are felt faster. It is more difficult to move and push via this method, however, due to greater numbness. For this reason, the epidural is the more popular method.
People on blood thinners or with a history of bleeding disorders, those with nervous system disorders, with an infection in the back or those with a history of back surgery and/or spinal abnormality may not be good candidates for these methods of pain relief. If you have specific questions about whether you are a candidate, it is possible for you to discuss this with an anesthesiologist at one of our monthly seminars (see below).
The epidural will not be placed until you are in active labor (usually at least 4-5cm dilated). You will have already been administered several liters of intravenous fluid, such that at least 1-2 liters have been given. You will be asked to position yourself on your left side or in a sitting, fetal-like position. The skin of your back will be wiped with an antiseptic solution to reduce the chance of infection. Following injection of a local anesthetic, a needle will be placed through the numbed area and into the epidural space of your spine. A catheter is then inserted through the needle and left in place after the needle is removed in order that an anesthetic may be administered continuously. The catheter is removed after the baby is born. The effects generally last 1-2 hours after that.
Risks include severe headaches, inadequate pain relief, and/or allergic reaction to the medication. Epidurals may inhibit the ability to push in some patients, which may increase the chances of a forceps delivery (a procedure which carries its own set of risks). Additionally a sudden, and possibly dangerous, drop in the blood pressure of the mother and/or baby can occur. This can usually be easily treated but, for this reason, periodic blood pressure monitoring is required. Finally, although rare, additional unexpected but severe complications may also occur. Accidental injection into blood vessels resulting in seizures, inadvertent injection into spinal canal causing temporary but total paralysis, a broken needle or catheter which may require surgical removal, post delivery back pain, weakness or paralysis of the lower part of the body, bleeding and/or infection are all unusual but distinct possibilities.
Frequently Asked Questions: Pediatrics
Most often, yes, but it is usually done after the child is asleep from inhaled anesthesia gases. Occasionally it may be necessary to have the IV in place prior to going to sleep, for instance, when there is concern over the risk of pulmonary aspiration. Your anesthesiologist will make that determination when your child is assessed preoperatively.
Yes, indeed. The risk of serious complications occurring in otherwise healthy children as a result of exposure to anesthesia is very low.
Pain and postoperative nausea may occur to varying degrees after many types of surgery; however, in most cases these effects can be foreseen and appropriate medications can be given while the child is asleep so that the impact of these conditions may be blunted. If further therapy is needed, it will be addressed during the recovery room stay.
This is not generally possible due to a variety of reasons related to hospital policy, safety concerns, and logistical considerations. If your young child fears separation then medication is available, at the discretion of the anesthesiologist, which can facilitate a peaceful trip to the operating suite.
Yes, epidurals and caudals are frequently used for postoperative pain control in pediatric patients, usually for surgeries on the abdomen or legs. Your anesthesiologist can provide you with more details.
Absolutely! At least one member of our anesthesia care team is always present “at the head of the table” throughout the operation and will check on your child in the recovery room. No pediatric patient is ever left unattended during the course of anesthesia.
By and large, the effects of the anesthetic agents will be dissipated before the child is discharged from the recovery room. However, there may be a lingering effect from pain medications given during or after surgery. Usually these medications have a time span in the range of three to four hours.
Not as a routine. The anesthesiologist will not discharge the patient from recovery room until he or she has determined that further observation for anesthesia-related complications is not warranted.