What is an anesthesiologist? (From ASA):
An anesthesiologist is a physician that specializes in providing care to a patient before surgery (this is known as pre-operative) working with the surgeon and the surgical team to provide the patient the appropriate kind of sedation and pain control for the procedure that is being performed, as well as maintaining life support during surgery (intraoperative), making certain that the patient comes out of sedation safely and as pain free as possible, and finally, looking after the patient during recovery (post-operative).
Among the many functions of the anesthesiologist during surgery is a constant monitoring of patient’s functions such as follows:
- The anesthesiologist (or nurse anesthetist) continually monitors the volume of air going in and out of the lungs.
- The anesthesiologist continually monitors the patient’s vital signs and anesthetic drugs breathed during surgery. The anesthesiologist monitors the circulation, by assessing whether the heart is doing anything that requires action by measuring whether the pumping action of the heart generates enough pressure to cause a flow of blood through the blood vessels of the body (blood pressure) and whether this flow of blood is sufficient to transport sufficient oxygen to the organs and tissues of the body.
- The anesthesiologist monitors and replaces the volumes of various fluids lost during surgery making sure that the blood volume and fluid composition of the patients' bodies is maintained at normal levels
- The anesthesiologist monitors the level of consciousness by clinical observation and special measures of the brain electrical activity, such as the electroencephalogram, or a derivative of the electroencephalogram
Is general anesthesia safe?
General anesthesia is actually very safe, and some desperately sick patients are in better condition under general anesthesia than when awake and breathing by themselves. Their vital functions, such as blood pressure, the amount of blood pumped by their hearts, etc. are improved by the anesthesia, extra medicines, and extra oxygen administered by the anesthesiologist.
According to the American Association of Anesthesiologists:” Complications from anesthesia have declined dramatically over the last 50 years. Since the 1970s, the number of anesthesiologists has more than doubled and at the same time patient outcomes have improved. While perioperative deaths attributed to anesthesia were approximately 1 in 1,500 some fifty years ago, today that number has improved nearly tenfold; that’s a dramatic increase in patient safety despite older and sicker patients being treated in operating rooms nationwide. At present, the chances of a healthy patient suffering an intraoperative death attributable to anesthesia is less than 1 in 200,000 when an anesthesiologist is involved in patient care.”
In general, for nearly all people, anesthesia is very safe and far less dangerous than the effects of surgery.
Why do I need to adhere to the fasting guidelines?
Because fasting before surgery and being placed under anesthesia is essential for your safety. The stomach needs to be completely empty to minimize the risk of inhaling stomach contents into your lungs.
When you are placed under anesthesia, all of your body functions are put to sleep making normal reactions, like swallowing, impossible. Since you are unable to control your gag reflex, if you eat something before surgery you could throw up your stomach contents into your airways, causing severe problems such as pulmonary aspiration which can be lethal. We usually recommend that you do not eat anything for eight hours or more before surgery.
Therefore, please make certain to follow all fasting instructions given to you by your surgeon or anesthesiologist.
What types of anesthesia are available?
There are four major types of anesthesia, which are administered to allow you to be free of pain. The type of anesthesia selected for you depends on factors such as your physical condition, the nature of the surgery, and your reactions to medications. These are some of the most important factors to discuss with your doctor or nurse anesthetist.
The four major types are as follows:
- General anesthesia which produces unconsciousness so that you will not feel, see, or hear anything during the surgical procedure. The anesthetic medications are given to you through an intravenous line or through an anesthesia mask.
- Regional anesthesia that produces numbness with the injection of local anesthesia around nerves in a region of the body corresponding to the surgical procedure. Medications can be given that will make you comfortable, drowsy and blur your memory.
- Monitored anesthesia care usually involves pain medication and sedatives administered through your intravenous line from your anesthesiologist. The surgeon or anesthesiologist also will inject local anesthesia into the skin, which will provide additional pain control during and after the procedure.
- Local anesthesia is injected by the surgeon to provide numbness at the surgical site.
What risks are involved with the use of anesthesia?
Essentially, the level of risk varies with your procedure, age and health and the type of anesthesia that is administered. Your surgeon or anesthesiologist/anesthetist can give you an accurate assessment of your personal risk. Generally risks fall into the following major categories:
Approximately 25% of patients who undergo surgery have heart disease. This would include coronary artery disease, high blood pressure or congestive heart failure. While heart problems (commonly referred to as cardiac disease), does not in itself prevent surgery in most cases, it can increase the risk of surgery.
Problems that could most likely to occur during and after surgery include high or low blood pressure, altered heart rhythms and, in very rare cases, a heart attack.
Headaches occur in approximately 1% to 2% of patients who have had a spinal epidural which is a type of regional anesthesia. In these cases, the patient suffers a severe headache after the medication is given. An epidural is given by the injection of a numbing medication into the cerebral spinal fluid that surrounds the spine. In rare cases, the spinal fluid leaks from the injection site and the decrease in spinal fluid causes a severe headache.
The headache is treated with pain medication known as a blood patch. This is a small amount of the patient’s blood injected as closely as possible to the original epidural site where it can clot and stop the loss of cerebral spinal fluid.
Nausea and Vomiting
Nausea and vomiting are the most common side effects of anesthesia, but both of these are far better controlled after surgery than they were in the past. IV medications can now be administered at the first hint of nausea to control the symptoms and prevent vomiting
In some cases anti-nausea medications are provided at the end of surgery to help prevent nausea during the early part of recovery from anesthesia.
Nerve Damage and Surgery
Nerve damage is very rare, but can result from general, local and regional anesthesia. While the cause of damage varies, it can range in severity from mildly annoying to disabling (in approximately 1 in 250,000 cases). In most cases, the damage is temporary and the discomfort or numbness decreases in the weeks following surgery. However, a very small percentage of patients have lasting nerve problems.
Some patients do complain of a sore throat for a few days after having surgery with general anesthesia. The soreness is caused by the insertion of the endotracheal tube through the mouth into the airway. The tube is necessary for the patient to breathe during surgery. The pain is typically minor in nature and is treated like a typical sore throat.
What are the risks of my child during anesthesia?
Actually, the risks for children are minimal since today’s anesthesia procedures are safer than ever. However, as has been mentioned above, as with all medical procedures there is an element of risk.
The specific risks of anesthesia will differ with the type of surgery and whether it is an emergency, the age of the child, and any other concerns or conditions that may exist. Also, each different type of anesthetic has a specific set of risks and side effects associated with it. Your anesthesiologist will talk to you about the various types of anesthesia that may be used for your child, and the risks and benefits (advantages and disadvantages) of each.
Also, rest assured that our anesthesiologists/anesthetists are well trained and especially sensitive to children and always take the extra time necessary to comfort your child so as to allay any apprehensions and fears they may experience.
Recovery from Anesthesia and Surgery
As surgery ends, the anesthesiologist will discontinue the anesthetic and you will usually be taken to a room called the PACU (post-anesthesia care unit) where you will be closely monitored. Often, you will also be given warm IV fluids to help counteract both the dehydration that results from the anesthesia as well as shivering that may be experienced from changes in body temperature. As the pain-relieving effect of the anesthetic wears off, you may also receive some sort of pain relief. This can be in the form of an oral medication or even morphine, depending on the surgery. Some patients recover within an hour, while others take longer to completely awaken.
After waking up, it's possible you'll deal with some of the side effects already mentioned including numbness in the area where surgery was performed. At first you will possibly feel somewhat disoriented and require some assistance to get around.
It is very common for anesthesiologists to provide expectant mothers with pain relief during labor and delivery. While many mothers choose to use natural childbirth techniques, the demand for epidural anesthesia for labor and delivery has increased dramatically over the last several years due to the proven safety and benefits of this resource. During childbirth, the anesthesiologist manages the care of two patients, providing effective pain relief for the mother while maintaining a high degree of safety for your unborn infant. In most cases, this involves the administration of local anesthetics and/or narcotics via spinal or epidural routes. In the event of an emergency cesarean section, our anesthesiologist would provide surgical anesthesia while also looking after the life functions of both the mother and the baby.