Anesthesia and Pain Management

Anesthesia and Pain Management

• An anesthetist is a physician (anesthesiologist) or nurse (nurse anesthetist) responsible for controlling a patient’s state of consciousness (awake to asleep), managing their pain, maintain their breathing and oxygenation, and monitoring their vital functions during surgery.
• The four basic categories of anesthesia are local, regional (e.g. spinal), intravenous, and general
• Specializations exist within anesthesia especially at the large university hospitals, for example, cardiac anesthesia, neuroanesthesia, etc.
• You may not be able to choose your anesthesiologist but you should be able to speak with them before surgery.
• Things to discuss with your anesthesiologist include your medications, history of dental work involving bridges, caps, etc., allergies, past reactions to anesthesia.
• Pain management is a sub-specialty of anesthesia that takes care of patients with severe post-operative pain while in the hospital and those patients with chronic pain syndromes
• In general, the shorter the duration of your anesthesia and the less medication you receive, the easier and faster your recovery from anesthesia.

WHAT DO ANESTHESIOLOGISTS DO?

Anesthetists, which include anesthesiologists and nurse anesthetists (CRNA), allow surgeon’s to perform longer, more complicated and more invasive procedures on patients. They control patients’ state of consciousness, manage their pain, maintain breathing and oxygenation, and monitor vital functions during surgery. This has led to better patient outcomes and made new surgeries possible. Additionally, subspecialities of anesthetist have emerged including cardiac, obstetrical, pediatric, ICU and pain management anesthesiologists.

WHAT KIND OF ANESTHESIA SOULD I GET?

The rule of thumb for choosing anesthesia is that one should choose the safest and simplest anesthesia that is suitable for the procedure and for the patient. In general, the simpler the anesthesia, the safer it is and the better you feel afterward. No anesthetic technique is right for every person or every procedure, so ask lots of questions.

WHAT IS GENERAL ANESTHESIA?

This is the most complete and deepest form of anesthesia, and is also called being “put to sleep.” General anesthesia (GA) is characterized by three effects:

• Total loss of consciousness, including amnesia of the entire procedure
• Complete loss of voluntary movement
• Total analgesia or freedom from pain

While you are under, it is the anesthesiologist’s role to monitor and control the patient’s vitals and proper functioning, in addition to safely bringing the patient out of anesthesia.

WHAT ARE THE RISKS OF GENERAL ANESTHESIA?

The principal risk of GA is that patients can lose their ability to breathe on their own and certain involuntary, protective reflexes. Your epiglottis normally prevents material from entering the lungs from your stomach. We are all familiar with the experience of food or drink “going down the wrong pipe.” This can result in a serious condition called “aspiration pneumonia.” Therefore, an “endotracheal tube” is frequently put into the trachea to control breathing, prevent aspiration of stomach contents, and guarantee the delivery of gases to the lungs.

Although careful monitoring is imperative throughout, the riskiest portions of the procedure are the first several minutes when general anesthesia is being induced, and at the end when the patient is being awakened. As one medical school professor put it, putting a patient to sleep is like flying a plane; the most difficult parts are the takeoff and landing.

WHAT OTHER KINDS OF ANESTHESIA ARE THERE?

DO I GET TO SPEAK TO MY ANESTHESIOLOGIST?

You should ask to speak with your anesthesiologist before surgery. For ambulatory, same-day procedures, you may meet with him or her when you have your preadmission testing. For traditional admission, you usually meet the anesthesiologist the evening before surgery. You and your surgeon already should have had some discussion regarding the choices of anesthetic techniques.

WHAT QUESTIONS SHOULD I ASK MY ANESTHESIOLOGIST?

You shouldn’t hesitate to ask your anesthesiologist questions, nor forget to discuss important aspects of your history like past reactions to anesthesia, medications and allergies. At a minimum, you should ask the following questions:

• What are my anesthesia options?
• Which type of anesthesia do you recommend? Why?
• What are my risks?
• How will I feel after the anesthesia?
• What do I have to do to prepare for anesthesia? Should I remove dentures or refrain from eating?
• How will I be monitored? Do you use a pulse oximeter and a CO² expiratory gas monitor?

Ask more questions about anything you don’t understand. Your physician should be willing and able to explain all of this to you.

DO I GET TO CHOOSE MY ANESTHESIOLOGIST?

Patients should always have the right to choose their own anesthesiologist, but that doesn’t always happen. Unless you or someone you know has had a particular anesthesiologist previously, you are not usually an informed consumer. Therefore, the best approach is to ask the surgeon to recommend an experienced, board certified anesthesiologist with whom he or she has worked on similar cases.

WHAT TESTS ARE NECESSARY BEFORE ANESTHESIA?

Pre-anesthesia lab tests are generally the same required by your surgeon. Anesthesiologists will use your EKG and chest X ray, as well as your normal blood workup and history to assess whether or not you are at increased risk for any anesthetic technique. Don’t be alarmed if you get a call soon after your pre-op testing requiring further or repeat tests; your anesthesiologist may not get to see the results until a day or so later, but in most cases, finding an abnormal value does not indicate a new or serious illness, nor even delay the procedure. The most common reasons for repeat tests are lab error or losing the specimen.