Patient Resources: Anesthesia & You

An Introduction to Anesthesia

Anesthesiologists
Anesthesiologists are physicians who complete a four-year residency after medical school that focuses on providing anesthesia of all types. Many MPAS anesthesiologists have additional subspecialty training. All members of MPAS must become board certified within 5 years of joining our practice.

Anesthesia Care Team
Certified Registered Nurse Anesthetists (CRNAs) are additional members of the Anesthesia Care Team. All MPAS CRNAs are experienced and well trained. After graduation from Nursing School, a CRNA candidate is required to perform 1½ years of Intensive Care Unit (ICU) nursing, followed by two years of anesthesia training in an accredited training program. Passage of a Certification Examination is required before practicing as a CRNA.

A member of your Anesthesia Care Team, either the anesthesiologist, CRNA, or both will be with you throughout your surgery. Your Anesthesiologist will be present with a CRNA during the start of the anesthetic and will be immediately available for your care during the course of surgery and recovery.

Choice of Anesthesiologist
We make every effort to honor the requests of both patients and surgeons for a particular anesthesiologist. Our daily scheduler will assign your anesthesiologist, if not request is made.

Preoperative Preparation
Your surgeon will decide which lab tests to obtain before your surgery. If your medical history is complex or if you have particular concerns, an evaluation by one of our anesthesiologists before the day of your surgery may be appropriate. Hospitalized patients may be seen by an anesthesiologist the evening prior to surgery. Most of your regular medications can be taken on the day of surgery with small sips of water. Several days before your surgery you will be given specific instructions about your medications by a registered nurse from the surgery department. Food and beverages must be avoided after midnight before your surgery. Under certain special circumstances your surgeon may permit small amounts of water prior to your surgery. Patients who come from home on the day of surgery will be admitted in the same day surgery unit. After being transported to the pre-op area, you will meet with your anesthesiologist. A history and physical, with particular emphasis on previous anesthesia experiences, will be performed. A family history of problems with anesthesia will be important for you to mention. After consideration of your health history, your surgical procedure, and your preferences, your anesthesiologist will formulate an anesthetic plan that best suits your needs.

Anesthesia Types
There are three major types of anesthesia: general, regional, and local. General anesthesia is defined as a state characterized by deep sleep, analgesia, muscle relaxation and depression of reflexes. Under general anesthesia, you will have no awareness of the surgical procedure. With regional or local anesthesia, an anesthetic drug is used to numb the surgical area. Regional anesthesia includes spinal and epidural anesthesia as well as specific nerve blocks. Often intravenous sedatives are given in addition to your regional anesthetic to provide added comfort and relaxation during your surgery. MAC or Monitored Anesthesia Care is local anesthesia with intravenous sedation.

General Anesthesia
Induction of general anesthesia begins in the operating room with an intravenous injection of medication. The anesthetic state is maintained by a combination of inhalation gases, and intravenous narcotics, which are dosed as needed. Commonly, a small breathing tube (endotracheal tube) is inserted into your windpipe through your mouth after you are asleep. Inhalation anesthetics are delivered through this tube. Sometimes the anesthetic is delivered through a special facemask. Once surgery is complete, the anesthetic gases are discontinued and a return to the awakened state occurs shortly thereafter. The breathing tube is usually removed in the operating room.

Regional Anesthesia
Regional anesthesia includes spinal anesthesia, epidural anesthesia as well as specific nerve blocks.

Spinal anesthesia is administered by placing a special needle in your lower back below the level of your spinal cord. A spinal provides a rapid dense numbness. A small amount of local anesthetic is administered through the needle and the numbness begins almost immediately. The needle is removed after the injection of medication.

Often intravenous sedatives are given in addition to your regional anesthetic to provide added comfort and relaxation during your surgery.

Your surgeon and anesthesiologist may recommend a dose of a long acting narcotic be given through the spinal needle along with the local anesthetic (intrathecal administration of narcotic). The purpose of this additional medication is to provide pain relief during the immediate post operative period which may last up to 24 hours. This technique works well for certain types of surgeries, but is not appropriate in all situations.

Although uncommon a headache may develop after a regional anesthetic. If it occurs, the headache may last a few days. If so, there are several types of treatment available.

Epidural anesthesia is administered by placing a needle in the epidural space, just outside the sac that holds the spinal fluid. Next, a tiny flexible tube is inserted through the needle. This tube will be left in place during your surgery; however the needle is removed once the tube is in place. A narcotic solution, local anesthetic or a combination of narcotic and local is administered through the tube. This anesthetic solution, which bathes the nerves and blocks the pain, is continually administered through this epidural tube. Epidural anesthesia is typically used along with sedating medications or a general anesthetic. Based on the type of surgery the catheter may be removed at the end of the surgery or left in place to manage post operative pain.

Although uncommon, (1% or less), a headache may develop following an epidural anesthetic. This occurs if the needle nicks the sac that holds the spinal fluid. If it occurs, the headache may last several days. If the headache persists, there are several types of treatments available.

A nerve block interrupts the pain signal from the area of surgery to the brain, therefore decreasing the feeling of pain. Patients are given oxygen and a small amount of intravenous sedation prior to the nerve block. A special needle that emits a pulse of energy from the tip allows the anesthesiologist to identify the nerve. Once the nerve is located local anesthetic is injected into the area. The block takes effect in approximately 10-20 minutes and can last up to 24 hours. This technique is used along with sedating medications or general anesthesia. Nerve blocks are usually used for surgical procedures on the extremities. Nerve injury can occur, however is very rare.

Local Anesthesia
Monitored Anesthesia Care (MAC) involves the administration of intravenous sedatives by your anesthesiologist and administration of local anesthetics by your surgeon.

Care During Procedure
With all types of anesthesia, a member of the anesthesia care team (Anesthesiologist and/or CRNA) is with you at all times in the operating room. During your surgery, the anesthesia team member directs the anesthetic and monitors all vital functions, such as heart rate and blood pressure.

Postoperative Care
After awakening from anesthesia in the operating room you will be brought into the post anesthesia care unit (PACU). Nurses trained in the recovery of surgical patients will monitor you. Medications to treat pain, nausea or shivering will be prescribed by your anesthesiologist. When your vital signs (blood pressure, heart rate, etc.) are stable and pain is under good control you will be discharged from the PACU. Inpatients are discharged to their hospital room. Outpatients go to the phase-2 recovery unit prior to going home.

More Questions
If you have additional questions concerning your anesthesia please visit our website at www.mpasohio.com, in particular the resource section. If you need to arrange a pre-operative consultation with one of our anesthesiologist, please call our anesthesia office at 614-566-4919.

Billing for Anesthesia Services
You will receive a bill from Midwest Physician Anesthesia Services, Inc. separate from your hospital bill. This bill will reflect all the services performed by your anesthesiologist or CRNA during your hospital stay. The type of procedure, your physical condition, the total time of anesthesia, and the performance of special procedures determine the cost.

Insurance coverage for anesthesia varies greatly. Your individual policy may or may not cover the full charge. We will submit your claim on your behalf to your insurance and according to your insurance you may be responsible for the balance. If you have questions regarding Anesthesia charges, please call the MPAS Billing Department 614-884-0641 or toll free 866-300-6019.

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To Schedule a Pre-Operative Consultation call 614-566-4919 Monday through Friday between the hours of 7:30a.m. to 3:00p.m.

Post Operative Questions please call 614-566-4535 Monday through Friday 7:30a.m. to 3:00p.m. Nights and Weekends please call Riverside Main phone number 566-5000 and ask for the anesthesiologist on call.

Billing Questions please call 614-884-0641 or toll free 866-300-6019.