What is anesthesia? Types of Anesthesia

Anest hesi a: What to expect before, duri ng and after surgery

Owen E llis , MD Boul der Val ley A nest hesi ol ogy www .boul der val le yan esth esi ol ogy .com Boul der Val ley Anes thesi ol ogy

• Al l b oard cer ti fi ed p hysi ci an ane sthesi ol ogi st group

–25anesthesiologists

• Pri mar ily serv ice Bo ul der Communi ty Heal th

–Foothills Hospital–Boulder Musculoskeletal ASC–Foothills Surgery Center (at Anderson Medical Center)

• Al so cove r 4 outsi de surger y ce nter s

What i s “an esth esi a”?

An est hes ia - • Loss of sensati on and often loss of c onsci ousn ess wi th out los s of vi tal fu ncti ons arti fi ci al ly p rod uced by the admi n ist rati on of one o r more agents that bl ock the passage of pai n im pul ses al ong nerv e pathway s to the br ai n. Types of A nesthe si a

• General Anesthesi a • Sedati on

•

“l ight” vs “moderat e” vs “h eavy” • Re gi onal Anest hesi a

•

Spi nal and epi dural

•

Bl ocks

•

Lo cal

General Anesthesi a vs Sedati on

• Gen eral Anesth esi a

–Unarousable (out)•Necessary for certain procedures/surgeries•No memory of events•Often requires airway device (breathing tube)–Why do I have a sore throat?

• Sedati on

–Varies by type•Mild–Able to talk•Moderate–Sleepy but can bearoused if needed•Deep –Not easy (impossible) to arouse

Why do I have a sore throat?

Why do I have a sore throat? Why do I have a sore throat?

Why do I have a sore throat?

Why do I have a sore throat?

Why do I h ave a sore throat? Why do I h ave a sore throat?

Regi onal Anesthesi a

• Provi de anest hesi a to a regi on of the body – Largest area to smal le st area

•Spinal and Epidural•Blocks •“Local”

Spi nal an d Epi dural wi th o r wi thout se dati on

Spinal

• Si n gl e injecti on of l oca l anesth eti c in the spi n al fl u id

–Patient very numb–Cannot be used for surgery in the upper body–Time limited Epidural•Placement of “local” anesthetic just outside the Dura–Dura=spinal column wrapping–Can place a catheter–Work for pain after surgery as well

nal and Epi dural Spi nal Epi dural Bl ocks vs Loca l Both can be wi th/wi thout sedati on

Blocks

•Place local anesthesia around nerves leading to the areas of the body whereyou will be having surgery. Local•Place local anesthesia directly into the area of surgery.

Bl ocks Bl ocks -Ul trasoun d

Bl ocks -Ul trasoun d Bl ocks -Nerve Sti mul ator

What i s the pr ocess for surgery and anest hesi a

Surgeon s chedu les you for sur gery Pre -Surgery Test ing RN wi ll cal l you before sur gery. – 1 day to 4 weeks depend in g - earl ier i s better

•When scheduled•Where schedule•Your health history•Complexity of case

What i s the pr ocess for surgery and anest hesi a

• Pre Surgery Test ing wi ll – Ta ke your heal th hi story – Arr ange for any testi ng need ed whi ch coul d in cl ud e:

•Lab tests•EKG •Consults •etc.

What i s the pr ocess for surgery and anest hesi a

An anesth esi ol ogi st wi ll revi ew any charts wi th quest ions from Pre- Surgery Test ing pri or to the day of s urgery to m ake sur e al l needed tes ti ng is fi ni shed and okay . – Ideal ly thi s is 2 weeks before for bi gger surger ies so we h ave ti me to get ev ery thi ng don e to al low for as safe a surgery as possi bl e . What i s the pr ocess for surgery and anest hesi a

• You wi ll meet your anest hes iol ogi st the day of s urgery – At that poi nt you wi ll d evel op a pl an – Frequ entl y ther e is a “standard ” wa y whi ch wi ll be recommend ed

•e.g., podiatrists, total joints

What i s the pr ocess for surgery and anest hesi a

• Pl an of anes the si a – Wi ll be worked out between you a nd the anesth esi ol ogi st, wi th consi der ati on to what the sur geon need s and wa nts. – Essenti al ly pul ling from the “menu”

•General anesthesia•Spinal with sedation•Local with mild sedation

Wha t to Expect A fter

• Partl y depends on type of anest hesi a – Common thi ngs are

•Usually stay 1-2 hours after until–Awake and alert–Spinal worn off so legs have strength–Voided-sometimes–Eaten something (juice and crackers) without significant nausea•Stay longer if needed–Slow to recover–Medical issues-OSA

Com mon Si de Effects (As opposed to Ri sks)

General anesthesia and deep sedation•Nausea is 10-15% risk depending on surgery•Will be groggy afterwards•Almost no chance of remembering the operating room•Maybe sore throat•Possible pain at surgical site Regional anesthesia with or without moderate sedation•Nausea risk much lower•Only mildly groggy afterwards•Some chance of remembering being in the operating room (not pain)•Sore throat not likely•Possible pain at surgical site

Ri sks - Why everybody worri es

• Al l t ype s are ver y sa fe

–Generally was more dangerous to drive here tonight–Major risks are slightly different, but VERY low•General is not waking up or brain injury (<1:100,000)•Regional is nerve injury (<1:100,000)–Minor risks are still low•e.g., tooth injury with general anesthesia•Numbness for 1-2 weeks after regional

FAQ Wi ll the anest hes iol ogi st be wi th me the enti re t ime? Are spi nal s real ly as dangerous as I keep heari n g? I’m el derl y, wi ll anest hesi a hurt my brai n? Can I dri ve mys el f home or tak e t he bus? When can I ea t? FAQ • Wi ll I wake up duri ng my sur gery? • What about non -prescr ibed medi cati ons , incl udi n g medi cal mari juana ? • Can I request a certai n anest hesi ol ogi st ?

Thank Yo u

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