Once you and your NEA anesthesiologist have agreed to an anesthetic plan you will be asked to sign a consent form for anesthesia. The consent explains and highlights some of the potential complications of the particular type of anesthetic you and your NEA doctor have decided on. After the consent is signed, the anesthesiologist will give you an intravenous catheter, through which fluids and medicines are received. The next phase of pre-operative care depends on the type of anesthetic being administered.
Regional, spinal and general anesthetic techniques
A regional anesthetic technique or epidural catheter insertion can be performed in the holding area after a sedative is given for relaxation. Spinal anesthesia and general anesthesia are administered in the operating room. For these types of anesthetics, you will also be given a sedative just before being transported into the operating room. The sedative allays anxiety—patients often tell us they remember almost nothing about their trip into the operating room. An NEA anesthesiologist would never administer deep sedation prior to arriving in the operating room since it is not safe to do so until a patient is properly monitored.
Patient monitoring in the OR
Inside the operating room you will be asked to assist in moving to the operating room table. Monitors will be placed on you that allow your vital signs to be continuously evaluated during the operation. A pulse oximeter is an infrared device that gets placed on your finger and monitors the amount of oxygen carried to the vital organs in your body. Your blood pressure will be checked with a blood pressure cuff at frequent intervals. An electrocardiogram is connected to you that constantly shows your heart rate and rhythm. It will also help to detect other subtle cardiac abnormalities, should they arise. Additional oxygen is supplied through a mask or a nasal cannula.
What to expect with spinal anesthesia
If you are having a spinal anesthetic, the NEA anesthesiologist typically administers sedation while performing the spinal in order to make the patient relaxed and comfortable. Spinal anesthesia is performed with the patient in a seated position or lying on his/her side. The NEA doctor places a local anesthesia in the skin and injects the anesthetic into the fluid that surrounds the spinal cord. Many people are fearful of spinal anesthesia because they worry about discomfort during its administration. In actuality, it is very well tolerated, especially when medicines are given before any of the needles are placed into the spinal fluid. Many of our patients do not even remember the spinal.
Once the spinal is administered, the lower half of the body becomes numb. Some patients prefer to remain awake during surgery since they understand they will feel no pain. Others prefer not to hear anything and a mild sedative is given to provide a light sleep.
What to expect with general anesthesia
If you are having a general anesthetic, oxygen will be given to you through a mask for a few minutes while your initial vital signs are recorded. The NEA anesthesiologist will make sure that you are comfortable and that all pressure points on your body are appropriately padded. He/she will tell you when he/she is administering the medicine that will make you fall asleep. The same medicines that render the patient unconscious also alter the normal mechanics of breathing.
Laryngeal mask airways and endotracheal tubes to help with breathing
One of the most important roles of the anesthesiologist is to assist, or sometimes control, a patient’s breathing. At times a breathing device called a Laryngeal Mask Airway is inserted in the back of your throat to accomplish this task. For other procedures a device called an endotracheal tube is inserted between the vocal cords into the windpipe. Reasons for using this tube, which secures the airway, include providing safer conditions for performing more complex surgeries of the head, neck, abdomen, and chest. An endotracheal tube is essential for certain procedures requiring muscle relaxation or for those patients whose anatomy makes it the clear choice for safely maintaining an airway. Patients with reflux disease or those having emergency surgery are also well served by the placement of an endotracheal tube.
Maintaining normal body temperature during surgery
Once a safe and secure airway is established, the NEA anesthesiologist will turn his/her full attention to the previously placed monitors. In addition to the patient’s cardiorespiratory status, the patient’s temperature is also monitored and measures are taken to ensure the patient remains normothermic (normal body temperature) during surgery. This will include the use of warming intravenous fluids as well as specially designed heated air devices. By carefully administering intravenous and inhalational anesthetics the depth of anesthesia can be controlled.
Waking from anesthesia at the end of surgery
At the end of the procedure the NEA anesthesiologist will cease administering anesthetic agents and patients will typically awaken shortly after the conclusion of surgery. This occurs because most anesthetics are quickly metabolized allowing for the rapid dissipation of their effects on the body. The proper and successful timing of waking the patient at the conclusion of surgery is both art and science.
For routine operations, airway devices are removed at the conclusion of surgery. Patients typically have no recollection of having had anything placed in their mouths and throats. A mild sore throat may occur in about a third of patients, but this resolves on its own over the next 24 hours. NEA anesthesiologists have the training and expertise to ensure that the patient has a safe emergence from anesthesia and arrives in the recovery room awake (although somewhat sleepy), comfortable and with no recollection of any prior operative events.
Please contact Northeastern Anesthesia Services for any questions about anesthesia or pain management for surgery.
AwarenessThe media has certainly done its part to get people thinking about intraoperative awareness. From multiple late night news reports, to the movie, "Awake", patients' preoperative anxiety levels have risen noticeably. This issue is without doubt, one of the more common concerns expressed to us by patients before their operations and as such deserves a thorough explanation.