General Anesthesia is the most common form of anesthetic technique and is offered for all surgeries, but other methods can be employed. General anesthesia renders a person unconscious and blocks all pain sensation during the surgery. When a patient "wakes up", they will have a mild amount of pain and may experience postoperative nausea and vomiting (PONV). We use powerful medications to prevent and alleviate these conditions. During all surgeries your vital signs (blood pressure, electrocardiogram, and oxygen levels) are monitored and recorded. We also have Bispectral Index Monitoring (BIS) that monitors brain activity and gives us an indication of your depth of anesthesia.
When surgery is on the arm or shoulder, we can do different types of upper extremity blocks. If surgery is being performed on the body below the waist, we can perform one of a variety of lower extremity blocks. The specific block will be discussed and agreed upon between the patient, anesthetist and anesthesiologist prior to surgery.
Interscalene block is used for anesthesia for shoulder surgery. This block is primarily used for post operative pain relief and can last up to 24 hours. The block is performed prior to the surgical procedure, and the surgery itself is done under general anesthesia.
Axillary block is used for surgery on the forearm and hand and is also performed prior to surgery. This technique can also last up to 24 hours, giving good postoperative pain relief.
Spinal Anesthesia is administered by placing a needle in the lower back after the skin is numbed with local anesthetic. Once the needle is in the right place, medication is injected and the needle is removed. The spinal lasts for about 1.5 to 4 hours depending on the type of anesthetic used. Spinal anesthesia is used for Caesarean section, and several other procedures.
Epidural anesthesia or analgesia is very similar to the spinal technique, except a catheter may be placed in the epidural space, and local anesthetic and narcotic can be continuously infused. This technique is most commonly used for Labor.
Childbirth / Labor Epidural
An epidural catheter is a type of "regional anesthesia" where the anesthesiologist places a small tube, or catheter, in your low back to deliver medication that will decrease feeling in the lower part of your body. You must be in active labor before an epidural is placed. You may be placed on your side or in a sitting position during the placement. The lower part of your back is cleaned and the skin is numbed before the catheter is put into place. The catheter is taped to your back, and the anesthesiologist will give you a test dose of numbing medicine to make sure that the catheter is properly positioned. An infusion pump is then connected to the epidural catheter to deliver medicine to the nerves of the lower part of the body. Each contraction will feel better and better, but it can take up to 15 minutes to have pain relief. You will still feel the pressure of contractions after the epidural placement, but the discomfort will be much less severe. This sensation of pressure during the contractions is important, since it will help you to properly synchronize your pushing with the contractions during the actual birth of your baby.
Labor Epidural Risks
Complications, although very rare, can occur despite the best of care. With close supervision and monitoring, your anesthesiologist will quickly detect and treat any problems that may occur. If your blood pressure drops, your anesthesiologist may need to give you fluids and/or medications through your IV catheter. If you have a reaction to the pain medicine, your anesthesiologist may need to give you medications through your IV catheter to counteract the reaction. In rare cases, the spinal sac may be entered during the placement of the epidural catheter. This may cause a headache. The headache typically occurs while sitting upright or standing. It can usually be treated by giving fluids, pain medicine, and by lying flat. Other treatments are available if the headache lasts for more than three days.
Anesthesia for Caesarean Delivery
Many women know in advance that they will deliver their babies by Caesarean Section delivery because of a prior Caesarean Section delivery or the size of their baby. Sometimes the mothers or baby's condition during the delivery might demand an urgent Caesarean delivery.
Your anesthesiologist will determine the best and safest type of anesthesia for the Cesarean Section based on your past and present medical condition, and the condition of your baby. Both of the two common types of regional anesthesia (spinal or epidural anesthesia) will make you numb from the chest down. If time does not permit the placement of regional anesthesia, then you will have general anesthesia. If you know ahead of time that you will have a Caesarean Section, you may receive a spinal anesthetic. The procedure is similar to that of an epidural but instead of placing a catheter, a small dose of medication is placed directly into the spinal sac through a needle. The risks of a spinal are similar to those of an epidural and are treated in the same way.
If you already have an epidural catheter in place for labor and delivery, then the anesthesiologist may simply give stronger medicine through the epidural catheter for the Cesarean Section. If you have a regional anesthetic (spinal or epidural) for Cesarean Section then the anesthesiologist may provide a long acting pain medicine in addition to the numbing medicine for the Cesarean delivery.
In rare cases, the condition of mother or baby might demand an urgent Caesarean Section. In these cases, your anesthesiologist may decide to use general anesthesia. Medication is injected through your IV catheter to induce general anesthesia. General anesthesia provides rapid unconsciousness and pain relief, so that your baby may be delivered quickly and safely.
When a general anesthesia for Caesarean Section is needed, certain precautions and procedures will be followed to ensure a safe delivery
You might be given an antacid to reduce your stomach acid.
A breathing tube will be placed in your "wind pipe" after you are unconscious.
These precautions are needed because of the danger of any undigested food or liquid in your stomach finding its way into your lungs during the surgery and causing damage to your lungs. This hazard can be reduced by remembering to not eat or drink anything after your labor pain begins unless permission is given by your obstetrician.
Risk of Anesthesia
All operations and anesthesia involve some degree of risk. The nature of your operation and your overall pre-operative condition are important factors that are considered when estimating the risks for your particular operative experience.
The most common complication is nausea and vomiting. This occurs more frequently in children, those susceptible to motion sickness and those who have had such previous experiences with anesthesia. If you are diabetic, obese, or pregnant you may be more prone to nausea. There are many methods to minimize both the severity and frequency of nausea and vomiting. If you have a history of motion sickness, or have experienced post-operative nausea and/or vomiting after previous surgeries, please inform your anesthesiologist so that extra preventive steps can be taken.
Inhaling stomach contents into the lungs is a more serious complication. It is important not to eat or drink anything prior to your surgery. You may be given a preoperative medication to reduce the amount of your stomach’s contents. Finally, a breathing tube may be inserted during anesthetic induction to prevent these contents from spilling over into your lungs.
Other complications include, but are not limited to, low blood pressure, high blood pressure, irregular heartbeats, heart attack, allergic reactions, cardiac arrest, airway blockage, lack of oxygen, physical injury (such as chipped teeth, loss of teeth), muscle cramps, and death.
When a pressure tourniquet is used on an operated limb, skin nerve and muscle (that are all necessarily compressed) are all potential sites of injury. Short-term complications such as sore throat, headache, hoarseness, drowsiness, muscle aches, and fatigue are common during the first several days following surgery.
Regional anesthesia, involving the use of local anesthetics that produce a loss of sensation in a limited area, can produce systemic reactions that can cause dizziness, ringing in the ears, “a funny feeling”, loss of consciousness, seizures, and cardiac arrest. During major blocks, the blood vessels may relax and cause low blood pressure. Infections at the site of the injections can range from inconsequential to life threatening. Epidural, spinal blocks may also be associated with headaches that may last for several days that require special treatment and difficulty emptying the bladder.
Fortunately, the occurrence of these and other potentially serious adverse events following either general or regional anesthesia is relatively rare.
Complications from anesthesia have declined dramatically over the last 25 years. Since 1970, the number of anesthesiologists has more than doubled and, at the same time and at virtually the same rate, patient outcomes have improved. In just the last decade, estimates for the number of deaths attributed to anesthesia have dropped 25-fold from 1 in 10,000 anesthetics to 1 in 250,000 today.
All this has occurred during a time when the youngest of premature infants in neonatal units survives intricate, lifesaving procedures, and 100-year-old patients undergo and recover from major surgeries that were once thought to be impossible.
Professional Service fees
Like other medical specialists, Pioneer Anesthesia Consultants, LLC. will charge for professional services, and this fee will be separate from the surgeons fee or the hospital's charges. This charge reflects the high level of professional care that the anesthesiologist provides for you.