Q. Will I have pain after my surgery?

A. Sorry, but yes. One of the anesthesiologist's main goals is to make you as comfortable as possible after your surgery, in addition to during the operation. A number of different techniques can be used to minimize post-operative pain. In many cases, local anesthesia can be given in the area of surgery that works for 5-8 hours. In addition, narcotics and aspirin-like drugs are given both during and after surgery. Your NEA anesthesiologist will discuss spinal/epidural anesthesia and regional nerve blocks when these options are deemed beneficial. Some regional blocks can keep you pain-free for the first twelve hours or more after surgery.

Q. What is the difference between an anesthesiologist and an anesthetist?

A. An anesthetist or CRNA (certified registered nurse anesthetist) is a highly trained nurse that has completed a rigorous training program in the field of anesthesiology. An anesthesiologist is a licensed physician who has completed residency training in anesthesiology after medical school. All of our anesthetists and anesthesiologists are in the process of passing their boards or are board certified. Anesthesiologists and CRNAs work as a team to provide a high level of care during your operative experience. On the day of your surgery you will have the opportunity to meet the specific NEA anesthesia providers assigned to your care.

Q. Why can't I eat or drink anything prior to my operation?

A. It is absolutely essential that the stomach be empty prior to the administration of anesthesia. Many of the drugs given during an operation inhibit the body's ability to protect the lungs from the acidic contents of the stomach. Without these airway reflexes, stomach acid can burn the lungs and create a potentially life threatening condition called aspiration pneumonia. No food or drink should be consumed within eight hours of your surgery. If you have been instructed to take medicines on the morning of your procedure, you may take them with a small sip of water.

Q. Will someone be with me during the entire operation?

A. Absolutely. An anesthesiologist or a member of the NEA anesthesia team will be with you from the moment you are brought into the operating room to the time that you are transported to the recovery room. The NEA anesthesia team is made up of the attending anesthesiologist and a CRNA (certified registered nurse anesthetist). The anesthesia team reviews your medical history and formulates the best anesthesia plan for your surgery. The attending anesthesiologist will be present at the time you go to sleep and during your emergence from anesthesia. The attending is in constant contact with the CRNA and can be called into the room at any moment. Many patients feel comforted by the fact that two anesthesia experts are paying careful attention to them. An NEA anesthesia provider will be with you 100% of the time.

Q. If I am having a spinal or regional nerve block does that mean I am going to be awake during the surgery?

A. Only if you want to be. Many patients like the option of regional anesthesia as it allows them to feel no discomfort but to remain conscious so that they hear the surgeon's explanations of what they are doing. Others prefer not to hear anything during the surgery. Once the block is performed, the anesthesiologist can give you mild sedatives that put you in a light state of sleep. NEA anesthesia providers will always consider your own preferences in designing the optimal anesthetic for your individual case.

Q. Will I be sick to my stomach after surgery?

A. Post-operative nausea and vomiting (PONV) is one of the most common side effects of anesthesia. It occurs more commonly in people who experience motion sickness or who have been nauseous after previous anesthetics. Also, certain types of surgery lead to a higher likelihood of PONV. For patients with a higher risk of PONV, the anesthesiologist will suggest different anesthesia options that attempt to minimize PONV. Anti-nausea medicines will be administered intra-operatively to prevent stomach sickness. The anesthesiologist will also order a number of anti-emetics in the recovery room. These medications and improved understanding of PONV have lead to much lower incidences of post-operative nausea than in the past.

Q. Should I take my usual medicines before surgery?

A. It is important to have your medication list carefully reviewed prior to your surgery. Some medications, such as most blood pressure medicines, should be continued on the day of surgery. Others, such as diuretics and glucose lowering medicines may be held. Medicines that may decrease the body's ability to form a blood clot (Aspirin, Plavix, Motrin, Coumadin, etc.) may need to be held for 7-10 days. For patients with coronary artery heart disease, your medical doctor may choose to continue these blood thinning medicines. Each patient's pre-operative medication instructions are a result of a coordinated decision between your surgeon, anesthesiologist, and medical doctors. Make sure that you have a clear understanding of this very important issue and that you let your doctors know about any medications you take.

Q. Can I drive home after my anesthesia?

A. No. It is mandatory that each patient be taken home by a designated escort. Subtle effects of your anesthetics have been shown to last up to twenty-four hours. With the development of new medications, some patients may feel like they can drive but studies have shown poor reaction times, which may endanger the patient and everyone around them. Whenever possible, it is suggested to have someone stay with you for the first day after your surgery. Your safety is NEA’s major concern and it is safest to have someone with you.

Q. Have you done this before? Are you old enough to be my anesthesiologist? Where did you train, anyway?

A. We would like to thank all of our patients for complimenting us on our youthful appearances. All of the anesthesiologists in our group are either board eligible or board certified. Board eligible means a doctor is currently in the process of taking their boards after completing their residencies in anesthesia. NEA anesthesiologists come from the finest training hospitals in the country. We insist on the same level of excellence and expertise in our nurse anesthetists. Our training and experience should come as a great comfort to our patients. You are in good hands, so take a deep breath and relax.

Q. How soon after surgery can I resume breastfeeding?

A. Many of the anesthetics which are given during surgery have been shown to be excreted in breast milk at extremely low levels and would be safe for your baby. However, the most conservative suggestion is to set aside frozen breast milk and pump and discard the milk for the first twenty-four hours after your surgery.

Q. Should I stop smoking before my surgery?

A. Quit now! After you read this answer take all of your cigarettes and throw them into the garbage. There is an increase in mucous production in your lungs a few days after you stop smoking. There are no studies that show that this increase can cause any difficulties with anesthesia. In fact, stopping right before surgery may raise the oxygen levels in your body and promote better wound healing. Whenever possible, the most positive effects from smoking cessation occur 3-6 weeks before surgery. You can find the materials that the American Society of Anesthesiology has prepared to help you quit smoking. Please discuss nicotine replacement therapy with your medical doctor.

Q. Is there any chance I will wake up during my surgery?

A. Being awake during surgery, or "awareness," has received much attention in the mainstream media. Many patients are apprehensive about the possibility of waking from general anesthesia and being unable to communicate this to anyone. While such a scenario is truly scary, you may rest assured that it is exceedingly rare. The incidence of awareness has been reported to be about 0.007% and is probably even lower for elective surgery. We have developed an awareness protocol that together with careful monitoring of your vital signs will make awareness an extremely remote possibility. Keep in mind that awareness refers to general anesthesia. Regional anesthesia, where a portion of the body becomes numb, is often accompanied by a "twilight sleep" where periods of short wakefulness may occur. An anesthesiologist prefers these short periods to ensure that you are comfortable and pain-free. Your NEA anesthesia provider will thoroughly discuss your anesthesia options with you on the day of your surgery.

Q. Are spinals safe?

A. In today's anesthesia practice spinals are extremely safe. Twenty years ago, spinal anesthesia could lead to headaches, back pain, and even paralysis. These injuries were due to the large size and shape of the spinal needles. Patients had to lay flat for twenty-four hours to reduce their chance of getting a headache. Nowadays, with smaller, more advanced needles, spinal headaches are much rarer and patients do not have to stay in bed. Moreover, the anesthesiologists have new, very effective ways of getting rid of spinal headaches. The likelihood of back pain after surgery is most often related to the position you are in during the surgery. The chances of nerve injury or other problems with spinals have become so low that spinal anesthesia has become the technique of choice for many procedures. Your NEA anesthesiologist will discuss all of your anesthesia options and risks at great length on the day of your surgery.

Q. Do I have to see my doctor and have tests prior to my surgery?

A. The need for a medical clearance from your doctor and lab testing depends on your age, medical history, and the type of procedure you are scheduled for. For healthy patients undergoing minor surgical procedures, no blood work or doctor visits may be necessary. Anesthesiologists have minimized pre-operative labs in an effort to reduce costs while maintaining high levels of patient safety. The goal of labs and medical clearance is to assess risks of anesthesia and ensure that you are in the best possible condition for your surgery. Review of pre-operative tests and clearance notes will help your anesthesiologist formulate the safest anesthetic technique specifically tailored to each patient.

Q. Will I have an allergic reaction to the anesthesia?

A. Allergic reactions to anesthetics are quite rare. Your NEA anesthesia provider will review your allergies to all medicines. Many patients are allergic to penicillins or other antibiotics. It is also important to recognize and address possible allergies to foods or latex. For patients with a recognized allergy, the anesthesiologist will carefully avoid exposing you to those agents. Your anesthesiologist is trained to respond to the early signs of a potential allergic reaction and institute immediate treatment when necessary. If one of your relatives or family members have had an allergic reaction to anesthesia, it is important for you to get as much information about what happened to them during surgery as possible. Allergies to anesthetics are not passed down from generation to generation but depend on past exposure to the medicine, which gives the allergy time to develop. There are other serious genetically linked reactions to anesthetics that are important to identify. Malignant hyperthermia is a condition that causes patients who are exposed to certain anesthetics to develop a life threatening elevation in temperature. Some people may also have a genetic defect that makes muscle relaxant effects last for much longer than usual. Your NEA anesthesiologist will discuss your allergic history and ask whether any of your family members have ever had a problem with anesthesia. If a potential problem is identified, the anesthesiologist will choose an anesthesia technique designed to ensure your safety.†

Q. Do you accept my insurance?

A. Northeastern Anesthesia participates with most major insurers. A current listing of our participating carriers can be found on this website. Any billing questions can be referred to us at 914-666-8866.

If you have any additional questions, please donít hesitate to contact Northeastern Anesthesia.

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