To give you the best care possible, we employ the concept of the “Anesthesia Care Team”. Your Anesthesia Care Team will consist of an Anesthesiologist and a Nurse Anesthetist. The anesthesiologist is a medical doctor who is specially trained in perioperative care. The Nurse Anesthetist is a specially trained Registered Nurse. They will work together to provide an anesthetic to suit your needs. The Department of Anesthesiology may use the services of other practitioners, including students under the direct supervision of the Anesthesia Care Team as they deem advisable.
After reviewing your medical history, performing a focused physical exam, and discussing the options with your surgeon your Anesthesia Care Team will formulate an anesthetic plan that is tailored to suit your needs and your procedure. This plan along with other suitable options will be presented to you. You should feel free to ask any questions at this time. Although this plan will be the basic framework of your anesthetic, there may be unexpected events during your surgery that may require us to deviate from this plan.
Routine and special monitors – An electrocardiogram (ECG or EKG), a blood pressure cuff, and a pulse oximeter are monitors that are always used for every anesthetic plan. In addition to these, we frequently use an end-tidal carbon dioxide monitor, a temperature probe, a precordial or esophageal stethoscope, a nerve stimulator, and an EEG based awareness monitor. There are also monitors attached to a mechanical ventilator that are used. More specialized monitors include an arterial blood pressure monitor (an A-line), central venous pressure monitors (CVP and Swan Ganz catheters), and lumbar drains. You will be informed of any special monitors that may be used in your procedure.
Types of anesthesia – There are several types of anesthesia that can be used based on your procedure, medical history, surgeon preference, patient preference and anesthesiologist preference. You will be informed about this as part of the anesthetic plan.
Postoperative pain management – The management of pain after your surgery is important to us. Once again, based on your procedure, medical history, and other considerations, we may be able to offer some methods to better treat your postoperative pain.
After arriving in the operating room, several monitors will be applied
routinely during your procedure.
They include:
There are also monitors or devices that may be placed only in certain
specific circumstances.
They include:
MAC stands for Monitored Anesthesia Care. Monitors to evaluate the heart (EKG), oxygenation (Pulse oximeter), and blood pressure are used. With this category of anesthesia, patients can expect to receive sedation, which is usually with a variety of medications administered through an intravenous catheter. These medications are very effective for treating anxiety and pain. A sleepy state, also sometimes called twilight anesthesia, is achieved before the start of the procedure. Breathing tubes are not required as patients continue to breathe without assistance. Supplemental oxygen is usually administered through a plastic facemask or nasal prongs. The medicines administered usually cause a state of amnesia so patients are unlikely to remember much of what happens in the operating room. Since this is not general anesthesia, the patient may find that they can hear voices and experience some sensation. Surgeons often inject local anesthetics to numb the area they are operating on so that the patient will not experience any pain. The level of sedation can be adjusted to the patient’s level of comfort.
Benefits: By using MAC anesthesia, the patient can avoid the side effects of general anesthesia. Patients are usually able to leave the recovery room and return home much sooner.
This type of anesthesia involves a complete loss of consciousness. Monitors for the heart (EKG), oxygenation (pulse oximeter), blood pressure and temperature are used. Supplemental oxygen is given through a facemask. Medications are then given through an intravenous catheter to induce unconsciousness in the patient. After ensuring unconsciousness, a breathing tube is usually inserted in the mouth.
There are two types of breathing tubes that can be used. For procedures that do not involve the muscles of respiration, and where muscle relaxation is not required, a laryngeal mask airway (LMA) is commonly used. This type of breathing tube rests in the throat, and does not extend into the trachea (your windpipe). Usually, the patient breathes on his/her own, and a ventilator is not used. The second type of breathing tube is an endotracheal tube (ETT). This plastic tube is inserted into the throat past the vocal cords and into the trachea. A cuff is inflated to form a seal so that oxygen and anesthetic gases can be delivered with a ventilator.
During the procedure, muscle relaxants may be used so the surgeon can gain better access to the operative site. Anesthetic gases, as well as intravenous medications, may be administered throughout the procedure to keep the patient asleep and without pain. At Christiana Care, a special monitor called the BIS© monitor is used to evaluate the level of consciousness during surgery. This helps the anesthesia provider adjust the anesthetic level so the patient does not have intraoperative recall, while also avoiding the over-administration of medicine. The BIS© monitor is placed on the forehead and works by evaluating electroencephalographic (EEG) and electromyograhic (EMG) waves. The chance of intraoperative recall occurring is very small with this monitor in place.
Upon awakening from general anesthesia, the anesthetic gases are turned off and the breathing tube is removed as soon as the patients is breathing on his/her own, and begins to respond appropriately. On rare occasions, or for very extensive procedures, the breathing tube may be left in place until certain criteria are met so that the breathing tube can be removed safely. This may occur in the post anesthesia care unit (PACU), or one of the critical care units.
Benefits: General anesthesia is sometimes the only option available for major operations. This option often provides the best operating conditions for the surgeon. The patient will be completely unconscious and unaware of anything happening in the operating room.
This type of anesthesia involves placement of local anesthetics to numb the nerves of the spinal canal. This results in numbness of the legs, abdomen, and occasionally the chest area, as well as paralysis of the muscles in these areas.
Spinal Anesthesia: After numbing the skin in the lower back, a very thin needle is inserted to deposit a small amount of local anesthetic in the spinal canal to numb the nerves. The numbness usually lasts about two to four hours. The time period can vary from person to person, and will also depend on how much, and what kind of local anesthetic is given. The patient will feel warmth or a pins and needles sensation in the legs as the nerves are blocked. Within a few minutes there will be loss of sensation to cold and sharp objects. Feelings of light touch and pressure may remain throughout the procedure, and is normal. The patient will be tested for loss of sensation to pain prior to starting the procedure.
Benefits: Spinal anesthesia works well in providing good pain control for surgery. Before the patient experiences severe pain, pain medications can be given as the block wears off. Very little local anesthetic is given, so the patient can be wide awake or sedated. Pregnant patients will benefit, as there is minimal medication to interact with the fetus.
Epidural Anesthesia: This is very similar to spinal anesthesia. The major difference is that a catheter is introduced through a needle in the low or mid back. The catheter can remain for several days providing continuous delivery of local anesthetics, which continue to numb the nerves and provide pain relief to the surgical area. The catheter does not penetrate the membrane covering the spinal canal, so the patient is not at risk for developing a spinal headache unless the membrane is accidentally punctured. Because a catheter is left in place, spinal anesthesia, as opposed to epidural anesthesia, is well suited for long procedures of the lower extremities or where post operative pain control is desired. At CCHS, epidural anesthesia is commonly used for thoracic surgery, radical prostatectomy, and for obstetric patients in active labor.
Benefits: By using epidural anesthesia, the side effect of general anesthesia can be avoided. Epidural anesthesia is usually a very effective means of postoperative pain control.
Local Anesthetics can be injected into specific areas to numb the nerves that provide sensation to the site where surgery is planned. Typical areas that are blocked include:
Benefits: Epidural anesthesia provides good postoperative pain control. The block can last for many hours, so as sensation returns, the patient can take pain medications to control the pain before it becomes severe. Also, general anesthesia is usually not required, so its side effects can be avoided.
The management of postoperative pain is an essential part of your recovery process. Effective pain control can help to reduce stress, reduce the risk of post surgical complications, and speed up your overall recovery. There are different types of pain control available to you depending on your condition and your planned procedure. You can discuss these options with your anesthesiologist during your anesthesia interview. Frequently, your pain can be handled simply with oral pain medicines (pills or syrups) or intravenous (IV) pain medicines. Some procedures allow us to offer regional anesthetic techniques that focus the administration of numbing medicines and pain medicines directly to nerve bundles. These regional anesthetic techniques, also known as nerve blocks, are beneficial in many ways. One benefit is the reduced need for systemic pain medicines (medicines that go all over your body, particularly the brain) thereby lowering the chances of over-sedation, slowed breathing, disorientation, and nausea and/or vomiting.
This type of pain control involves the placement of a very thin catheter into the epidural space along your spine. A pump is then attached to the catheter and medicines (typically a narcotic like morphine) and a local anesthetic (like novacaine), are absorbed by the nerves in your spine in a continuous manner.
Epidurals are most commonly used for postoperative pain for patients undergoing major chest, abdominal, or pelvic surgery. Depending upon the type of surgery and your medical condition, this may be an effective way to treat your pain after surgery.
Possible short-term side effects may include itching, nausea and vomiting, muscle weakness and numbness, and difficulty urinating.
The following blocks are frequently used for postoperative pain control after surgery.
These nerve blocks can last for a few hours or up to 18-24 hours depending upon the area and type of medicine injected.
Because these blocks are performed with a one-time injection, you will experience pain when they wear off. It is recommended that you take an oral pain medicine when you start to experience pain. Yet, once again, the benefit of needing less systemic pain medicines (medicines that go all over your body, particularly the brain) during the procedure itself thus lowering the chances of over-sedation, slowed breathing, disorientation, and nausea and vomiting.
Preparing for Surgery | Day
of Surgery (Before) | Day
of Surgery (Operation) | Day
of Surgery (After)
Frequently Asked Questions | Glossary
of Terms
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