Anesthesia

Anesthesia at NYC Surgical Associates

At NYC Surgical Associates, we have our own, in-house team of skilled anesthesiologists.

We’ve taken this in-house approach to anesthesiology to ensure that our team fully understands our patient population, procedures, and are therefore able to provide the most efficient care throughout the patient process.

Types of Anesthesia

The type of anesthesia you have will depend on the procedure/surgery, your overall health, and/or your personal preference along with your Surgeon’s. The anesthesiologist will discuss all options available to you and make a suggestion for the type of anesthetic he/she recommends.

The types of anesthesia possible for your procedure/surgery are:

1. General Anesthesia (Unarousable even with painful stimulus)
2. Deep Sedation (Purposeful response following painful stimulus)
3. Moderate Sedation “Conscious Sedation” (Purposeful response to verbal stimulation)
4. Minimal Sedation (Normal response to verbal stimulation)
5. Regional Anesthesia (a region of your body is numbed) with or without a-d.
6. Local Anesthesia (a numbing medicine is injected around the area of surgery.)

General Anesthesia

General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory (breathing) function is often impaired, and for this reason, during general anesthesia, patients are normally placed on a breathing machine.

Deep Sedation

is a drug-induced depression of consciousness during which patients cannot be easily aroused and respond purposefully following repeated or painful stimulation. The ability to independently maintain breathing function may or may not be impaired. Patients may require assistance in maintaining breathing function, and your anesthesiologist is there for support should this need arise.

Moderate Sedation or “Conscious Sedation”

A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either without physical stimulation or with light physical stimulation. Typically no breathing support is needed. Patients are relaxed, comfortable, but with a mild depression in consciousness.

Minimal Sedation

A drug-induced state during which patients respond normally to verbal commands without the need for physical stimulation. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.

Regional Anesthesia

Regional anesthesia is a technique to render a portion (or region) of a patient’s body insensate (numb) to pain for a surgical procedure, as well as to provide pain relief after surgery. Peripheral nerves supply sensation to different parts of the body such as shoulders, arms, hands, legs, knees and feet. With the aid of ultrasound guidance or low level electrical stimulation, your anesthesiologist can identify the correct nerves for the surgical site and inject anesthetic agents near the nerve, rendering the surgical area numb. Once the regional anesthetic is performed patients may receive additional sedation up to and including a general anesthetic as the surgical case or patient preference warrants. As with any procedure, regional anesthesia has risks associated with it including, but not limited to infection, bleeding, temporary nerve injury, permanent nerve injury, etc. However, these risks are extremely rare, and in general, it is a very safe way to provide excellent pain relief without the need for more drastic methods. This type of anesthesia is very commonly used in surgery on the limbs, such as vascular and orthopedic procedures.

Local Anesthesia

During a local anesthetic, a numbing medicine is injected around the surgical area. The patient remains conscious during a local anesthetic. There may be moments during the surgery when you feel a pressure sensation where the surgeon is working. The benefit of local anesthesia is that there are very few side effects or complications, and recovery time is faster than for other types of anesthesia. If a large amount of local anesthetic gets into the blood circulation, you may feel dizziness, ringing in your ears, and/or an increase in heart rate.

Safety

In general, modern day anesthesia is considered extremely safe. It is unusual for healthy patients to have serious complications from anesthesia. However, a number of health problems may increase your risk of complications such as lung disease, smoking, heart disease, diabetes, kidney disease, liver disease and obesity. You will meet your anesthesiologist prior to going into surgery. Your anesthesiologist will ask some questions about your health or ask you to fill out an anesthesia questionnaire. Your anesthesiologist will discuss the planned anesthetic with you, and pick the type of anesthesia most appropriate for your procedure and health history to provide the most efficient and safe pain relief.

Anesthesia Side Effects

Feeling drowsy and tired for hours after surgery is common. Anesthesia wears off at different rates in different people. Most people are awake enough to answer simple questions within 5-10 minutes after surgery, although many have short term memory loss, so that hours after surgery you may feel as though it took a long time to wake up. Many people also feel tired enough to sleep for long periods of time after surgery even though they can easily be awakened. The pain medications you get after surgery may also prolong these feelings of sleepiness.
 Approximately one third of people undergoing general anesthesia experience some form of nausea. If nausea has been a problem with past surgeries, let your anesthesiologist know, and in general, we can modify drugs used to avoid this happening in the future. Nausea can usually be treated quickly with medications, but very few people experience nausea despite our best efforts.

Headache occurs in approximately 10% of patients and is more common in patients prone to headaches and in patients who drink coffee, due to caffeine withdrawal. Fainting can also occur, and is a medical emergency till proven otherwise. If you experience symptoms of fainting such as: nausea, giddiness, excessive sweating, dim vision, rapid heartbeat, palpitations sit down or lie down immediately. If sitting, position head between knees. If lying down, elevate feet above head level, you should become normal within a few minutes. If not, seek medical help! If you have general anesthesia you may have a soft plastic device in your throat to make sure your airway is open and air is moving in and out easily.

Even when placed very carefully, you may experience a sore throat. This usually resolves in a day or two. There are also a number of very rare but severe complications of general anesthesia such as injury to nerves, organs and possibly death. Some health problems may increase your risk of complications. Please thoroughly discuss your health with your anesthesiologist, so that all concerns may be addressed and your mind put at ease.

Frequently Asked Questions

Can I eat and drink before my surgery?

Absolutely not! If you do, you will not be able to have sedation or any sort of medication that alters your level of consciousness. In general, you need to be NPO (without any oral intake) for 6-8 hours depending on your procedure. While under anesthesia, you loose your protective reflexes such as coughing. This makes it possible to throw up during an anesthetic and easily aspirate gastric contents (in other words, whatever was in your stomach can end up in your lungs). If you have eaten or had fluids recently, there is more acid and particles in your stomach. Aspiration of this could cause extensive damage to your lungs, known as “aspiration pneumonia”. You may be asked to take some or all of your usual medications with a few sips of water before surgery - these are usually dissolved and out of your stomach by the time anesthesia starts.

Unless otherwise instructed, the minimum duration of fasting should be:

• 2 hours after clear fluids (Clear fluids are limited to water, apple juice, black coffee without milk cream or creamer, clear tea, Gatorade, and CLEAR carbonated beverages (Coke, 7UP). Clear fluids do not include alcohol. Any other fluids may result in cancellation of the procedure! No more than eight ounces (1 regular-sized cup) for adult patients.
• 8 hours after a meal containing fatty foods or meat
• Chewing gum provides the added risk of aspiration and catastrophe during anesthesia and should not be had in the 8 hours prior to your procedure.

Fasting guidelines apply to ALL patients receiving anesthesia care from the Department of Anesthesia, including general, regional and IV sedation.

You will absolutely need someone to travel with you as for a few hours you may not be completely alert, unable to take public transportation, and definitely unable to drive a car for a minimum of 24 hours. It is recommended someone stay with you for 24 hours following your procedure.

What is the job of an anesthesiologist?

Anesthesiologists are the physicians trained to administer and manage anesthesia given during a surgical procedure. They are also responsible for managing and treating changes in your critical life functions - breathing, heart rate, and blood pressure - as they are affected by the surgery being performed. Further, they immediately diagnose and treat any medical problems that might arise during and immediately after surgery.

Prior to surgery, the anesthesiologist will evaluate your medical condition and formulate an anesthetic plan which takes your physical condition into account. It is vital that the anesthesiologist knows as much about your medical history, lifestyle, and medications as possible.

What other information should I tell my Anesthesiologist?

Besides any diagnosed medical conditions and current prescription medications some other particularly important information he/she needs to know includes reactions to previous anesthetics. If you have ever had a bad reaction to an anesthetic agent, you need to be able to describe exactly what the reaction was and what your specific symptoms were. Discussing any known allergies with the anesthesiologist is very important, as some anesthetic drugs trigger cross-allergies, particularly in persons who have allergies to eggs and soy products. Allergies to both foods and drugs should be identified. It is also important to let your anesthesiologist know about both prescription medications and any over-the-counter medications you are taking, or have recently taken. Certain prescription medications, such as coumadin, a blood thinner, may need to be discontinued for some time prior to surgery. In addition, as many people take a daily aspirin to prevent a heart attack, and certain dietary supplements, physicians need to be aware of these habits, as they can prolong bleeding.

Do I need to stop herbal supplements prior to surgery?

Certain herbal products, commonly taken by millions of Americans, may cause changes in heart rate and blood pressure, and may increase bleeding in some patients. The popular herbs gingko biloba (an herb used for many conditions associated with aging, including poor circulation and memory loss), garlic (an herb often used for cardiovascular conditions and to help prevent colds, flu, and other infectious diseases), ginger, and ginseng (used as a general tonic to increase overall body tone; considered helpful in elevating energy levels and resistance to stress) may lead to excess blood loss by preventing blood clots from forming. In addition, St. John’s wort (a popular herb used for mild to moderate depression) and kava kava (another popular herb used for depression and to elevate mood) may prolong the sedative effect of the anesthetic. The American Society of Anesthesiologists advises patients planning to have surgery to stop taking all herbal supplements at least two to three weeks prior to surgery to rid the body of these substances.

Can I safely undergo anesthesia if I smoke and drink daily?

Cigarette smoking and alcohol can affect your body just as strongly than many prescription medications you may be taking. Because of the way cigarettes and alcohol affect the lungs, heart, liver, and blood, these substances can change the way certain anesthetic drug works during surgery. It is important to let your surgeon and anesthesiologist know about your past, recent, and current consumption of these.

What if I use illegal substances occasionally (such as marijuana, cocaine, amphetamines, etc.)?

Patients are often reluctant to discuss matters of illegal drug consumption, but you should remember that all conversations between you and your anesthesiologist are confidential. It is crucial that he/she know about your past, recent, and current consumption of these substances as these can cause dramatic increases in systolic, diastolic and mean arterial blood pressure, heart rate, body temperature leading to fatal cardiac arrhythmias. It is important to keep in mind that the only interest your physician has in this information is learning enough about your physical condition to provide you with the safest anesthesia possible.

How am I monitored during surgery?

Monitoring is one of the most important roles the anesthesiologist handles during surgery. Second-by-second observation of even the slightest changes in a wide range of body functions gives the anesthesiologist a tremendous amount of information about the patient’s well-being. In addition to directing your anesthesia, the anesthesiologist will manage vital functions such as heart rate, blood pressure, heart rhythm, body temperature, and breathing. He/she will also be responsible for fluid and blood replacement, when necessary. Sophisticated technology is used to monitor every organ system and its functioning during surgery.

Should I be worried?

Absolutely not. By choosing Metro Anesthesia Associates, you are in the most skilled, trained, and compassionate hands available today. Our job is to keep you safe and sound, and we take that job seriously. If you have any questions, you may reach your doctor by email at any time, and we can help put your mind at ease.