Your care begins with a Pre-anesthetic Evaluation in which an anesthesia care professional will ask you important medical history questions and perform a brief physical exam to learn more about you prior to your visit to the operating room. This process may also include laboratory tests, electrocardiogram, and/or chest x-ray examinations. Appropriate medical consultants may also be scheduled at this time.

While anesthetized, people can vomit or passively regurgitate the contents of their stomachs into their airway. The normal gag reflexes that protect their airways are inactive under anesthesia and these fluids and partly digested solids can get into the trachea and lungs causing a severe pneumonia which can be fatal. The most important step in preventing this complication is making sure patients have empty stomachs before beginning an anesthetic. In general, we follow the accepted guidelines of no solid foods for 8 hours prior to an anesthetic. We usually allow clear liquids up to 2 hours prior to anesthesia induction. Newer research has shown that, in people with normal stomach functions, clear liquids readily pass through the stomach within two to three hours and, according to some studies, may lower the acid content compared to a strict fast. Also, most patients with normal digestive systems empty their stomachs of solids within six hours.

However, it is important to understand that these guidelines don't apply to patients who have conditions that are known to delay stomach emptying: diabetics, peptic ulcer disease, morbid obesity, and those involved in a trauma, among others. Your anesthesiologist is ultimately responsible for your safety during surgery; their assessment of the situation and judgment of how to proceed are the best for your specific case.

You should consult your anesthesiologist and surgeon on which of your regular medicines to take prior to surgery. These physicians may also consult your regular doctor. In general, you will be advised to take most of the maintenance medicines that you are on. There are several types of medicines that you may be advised to hold for a period of time prior to surgery. These may include “blood thinners” such as Coumadin or Plavix.

In addition, it is very important to inform your care providers of any non-prescribed medicines, “over-the-counter” medicines, or herbal medicines/remedies that you are taking. Excessive or frequent alcohol use is also important information for your physicians.

Finally, any use of illicit drugs like marijuana, cocaine, “crack”, or “meth” needs to be reported to your Anesthesia Care Team. Even though divulging this information may be embarrassing or uncomfortable, some of these drugs can cause life-threatening interactions with several of our anesthetic medications. Not reporting use of these drugs can put your life at risk during an anesthetic.

In general, there are three broad types of anesthetic methods: 1) monitored anesthesia care (“MAC”), 2) regional anesthesia (a “block”) and 3) general anesthesia (“going to sleep”). There are also combinations of these methods. It is very important to realize that certain types of anesthetic methods may not be appropriate for a particular surgery, a particular surgeon, or a particular patient. Please see “What type of anesthesia will be best for me?”

“MAC” are the initials for “Monitored Anesthesia Care”. Medicine may be injected into the intravenous line to sedate you and make you sleepy while the surgeon numbs the surgical site. You may recall being in the operating room, but, if you hurt at all, more numbing medicine and/or intravenous medicine will be administered to relieve any discomfort. We are there to watch over your heart, blood pressure, and breathing to make sure you are safe and comfortable. Usually, if you feel you are too awake and would like additional sleepy medication, we can provide this.

An area of the body that includes the surgical site is numbed by placing medicines near nerves that supply that area. The skin above the spot to be numbed is cleaned with an antiseptic and numbed with a local anesthetic. Next, a needle is placed through the numbed skin near the nerves we are trying to anesthetize -- either in the epidural space, the spinal space, or those going to your arm or leg. These nerve blocks usually will need to be performed with you comfortably awake. You can be sedated prior to the block but we will usually need to communicate with you to make sure we place the needle in the correct place. After we know you are numb from our medicine, we usually can get you as sleepy as you would like during the surgery itself. A small sore spot around the injection area for a day or two is common. The risks for spinal and epidural anesthesia include a possible spinal headache which can be treated. Other very rare risks include an infection called meningitis, and bleeding in or around the spine or spinal cord. Although very unlikely, either can result in the need for surgical treatment and can cause permanent nerve damage. With any regional anesthesia technique it is remotely possible to cause seizures and very rarely nerve damage. Finally, we will not let you hurt. We always are ready to give you general anesthesia if you are uncomfortable or anxious.

“General Anesthesia” is the term for an anesthetic that involves “going to sleep”. An unconscious state is induced using medicines through an intravenous catheter. Your skin will be injected with numbing medicine prior to starting the IV catheter. (Most children will have their IV started after they are asleep.) After you are asleep a breathing tube or airway device may be placed in your mouth or nose to help you breathe. This may cause a scratchy, sore throat for a day or two after surgery. Without preventative medicines given by your anesthesia team, on average 20-40% of patients having surgery get some degree of nausea or vomiting. Some anesthesia drugs cause nausea, postoperative pain medicine causes nausea, and some types of surgery themselves cause nausea. Your anesthesiologist will attempt to prevent nausea and vomiting where indicated and will aggressively treat either if they occur. Rarely, teeth may be injured if placing the breathing tube is difficult, or you bite wrong while asleep. Usually, you will wake up somewhat sleepy in the recovery room.

The anesthesiologist will consider several factors when choosing your anesthesia:

a) Your medical history & physical examination. The anesthesiologist will consider other surgeries you have had and any conditions you have (such as hypertension, coronary disease, emphysema, diabetes, liver disease, or peripheral neuropathies as examples) which may affect your anesthetic course. You also will be asked whether you have had any allergic reactions to any anesthetics or medications or whether any family members have had reactions to anesthetics.

b) The reason for your surgery and the type of surgery which may determine the type of anesthetic type that is possible.

c) Your preference and the surgeon’s preference (if any) for the type of anesthesia.
The ultimate decision of the type of anesthesia for your care will depend upon a discussion with the anesthesiologist about your anesthetic options. Some of these options may be limited by the type of surgery or your health history. For those surgeries in which you have a choice of anesthetics, the anesthesiologist will help you decide which anesthetic will be best for you.

Like everything else we do in life, undergoing anesthesia involves some risk. These risks include, but are not limited to, nausea, vomiting, achy muscles, a sore throat, chipped teeth, allergic reaction to one of the medicines given, injury to or malfunction of major organs such as your heart, lungs or brain, or even death. The risk of something significant happening that cannot be handled by the care team is very small for someone in otherwise good health. This wonderful safety record is the result of a having highly trained professionals administering the anesthetic along with state of the art monitoring devices.

Anesthesia recall occurs when a patient undergoing general anesthesia for a procedure is conscious during some part of the operation and has memory of the incident. In general this is a very rare occurrence. There are several instances where awareness is more likely, but still rare. These include, trauma patients undergoing general anesthesia and patients undergoing general anesthesia for emergency caesarian section. In the past, patients undergoing general anesthesia for heart surgery were at an increased risk for awareness, but this risk has decreased with new techniques. For the general population, the risk of recall or awareness is very small.

It is important to discuss any allergies you may have with your anesthesiologist. Some of these medications may have cross reactions with medicines used for your anesthetic. Occasionally, the reactions you have had may not be true allergies, but common side effects of the medicine that can be treated, if that particular medicine is required. For example, itching is a side effect of some narcotic medicines. Other narcotic medicines may work with decreased itching, or maybe that narcotic medicine can be used (because it works so well on pain for a particular case) and the itching treated with another medicine.

Malignant Hyperthermia (MH) is a rare but life-threatening condition that occurs approximately one in 50,000 anesthetics. It takes its name from the high fever (up to 108 degrees) that is one of the signs of the disease. MH is a genetically transmitted disease although it can appear without any previous family history, especially in patients with certain neuromuscular diseases like muscular dystrophy. The basic event in MH is a “run-away” metabolism of the body which can lead to cardiac collapse, brain injury, and even death. The disease can be triggered in susceptible patients by several commonly used anesthetic drugs.

The signs and symptoms of MH are often quite dramatic when it occurs but fortunately there are established protocols and medicines to quickly treat this syndrome if it does occur. It is also vitally important to report a history of MH in the patient or patient’s family members to the anesthesia team. This will allow them to use a type of anesthesia that is not associated with triggering MH. If an episode of MH occurs, the patient’s family will often be encouraged to undergo testing to determine their potential risk of developing the syndrome themselves.

In most cases, you can receive sedation prior to going to the operating room. This medicine will relax you and decrease your anxiety for the trip back to the OR. It will not “knock you out.” It is important though that all paperwork and consents are completed and checked prior to you receiving sedation. In some cases, sedation will not be given because it may interfere with your care prior to, during or after the operation. Some plastic surgery cases require the patient to stand and be “marked”. Sedation is usually held until after this is done. In some neurosurgical or vascular operations, sedation prior to the operation can linger on after the case and interfere with neurological exams of the patient. In emergencies, where the patient has not been fasting, sedation may be withheld to protect the patient from vomiting the contents of the stomach into the lungs.

This is a practice that varies significantly among groups and facilities. There have been multiple studies which, in all, are inconclusive as to the benefits of parents being with their children at the induction of anesthesia. It is in our nature as parents to want to be supportive and protective of our children in these stressful times. The problem occurs when our need to support our child impacts on the anesthesiologist’s ability to care for the child during the induction of anesthesia. The anesthesiologists of ACMG have decided, based on a wide and varied practice experience, not to allow parents to accompany the child during induction. With the benefits to either the child or the parents in question, and the real possibility of interfering with the safe induction of anesthesia, we feel this is the most appropriate approach. Most children will receive a preoperative sedative by mouth prior to arriving in the receiving area. This medicine will make the child “loopy” but is not the anesthetic. This sedative also has amnestic properties, meaning that the child will most likely have little memory of the trip to the OR. You will accompany the child to the receiving area where you will meet the members of the Anesthesia Care Team (ACT) who will discuss the anesthetic plan with you and answer any questions you may have. The child will then be escorted to the OR by members of the ACT and the OR team.

After the operation, the child is usually taken to the post anesthesia care unit (PACU) or “recovery room”. While in the PACU, the child will finish recovering from the anesthetic, under the watchful eye of a specially trained RN who is supervised by the staff anesthesiologist. Once the patient has stabilized and has his/her pain addressed, he/she will be brought back to you in the room. Time in the PACU averages from thirty to ninety minutes.

Yes, a member of the Anesthesia Care team (either the anesthesiologist or the CRNA) will be with you throughout the operation. The anesthesiologist will be present or immediately available at all times. Please see "Who will take care of me during my surgery/procedure and afterwards in the Recovery Room?" for more information.

Your anesthesiologist will decide, based on your health and the complexity of the operation, what to use to monitor your vital signs while you are undergoing anesthesia. At minimum, your blood pressure will be monitored with a BP cuff, your heart will be monitored with an EKG, and the oxygen content of your blood will be monitored with a pulse oximeter. Patients undergoing more complex operations or those who have multiple medical problems may require more sophisticated, invasive monitors such as arterial lines, central venous lines or pulmonary artery catheters. Trans-esophageal echocardiography may be used on patients will sick hearts. Again, your anesthesiologist will discuss these monitors with you.

Nausea and vomiting are two of the more common unpleasant side effects of anesthesia. Nausea and vomiting are also more common after particular operations such as sinus or nose surgery, intra-abdominal surgery, and breast surgery. Certain groups of people are at higher risk for N/V after anesthesia. Young female patients are one of these high risk groups. For those groups of people in high risk groups or those people undergoing high risk procedures, a regiment of pre-treatment with anti-nausea medications along with intra-operative anti-nausea medications decreases the risks of N/V post-operatively.

One or a combination of techniques may be used to control your pain during surgery and after surgery. If you undergo general anesthesia, the anesthetic medicine itself has analgesic (pain blocking) properties. If you undergo spinal anesthesia, the medicine used for the block acts as an analgesic (pain blocker). Narcotic and non-narcotic pain medicines may be given during or after your operation, to help ease your pain. Epidurals may be used for pain control after certain operations, including those that involve chest incisions or upper abdominal incisions. Your anesthesiologist can answer any questions you have about your pain control prior to your surgery.

The time you spend in the “recovery room” or Post Anesthesia Care Unit (PACU) varies with the patient, the anesthetic and the operation itself. You are in the recovery room long enough to make sure you have recovered from the anesthetic to the point you are good and awake, your pain is reasonably controlled, and your vital signs are stable. Nausea or vomiting should also be controlled prior to your discharge from the PACU.

More and more operations are being done as outpatient procedures. We are continuing to find less invasive ways to complete procedures so that patients can safely recuperate in the comfort of their own home. There are still many operations that require you to be admitted for the operation because of special postoperative care or observation. This extra care may be the result of the operation itself or because of medical problems the patient has. For example, patients with sleep apnea may require admission after an operation that someone without sleep apnea could safely be discharged home on the day of surgery. In extreme cases, patients may be admitted into the ICU postoperatively, where they can receive even more specialized care.

The time before you can eat or drink varies in time according to the kind of anesthesia you received, the length of the anesthetic, your personal responses or reaction to anesthesia, and the operation itself. For an outpatient procedure that requires only minimal sedation with local anesthesia, you may be eating and drinking prior to leaving without any problems. For an outpatient procedure such as a knee surgery where you were asleep for some time, you should be able to tolerate liquids and clears prior to discharge but you may stimulate nausea and vomiting if you have a heavy meal immediately after leaving. In some cases, such as operations that are in or around the abdomen, your stomach and intestines may be stunned and it may be several days before you will be able to tolerate liquids or solids. In this case it is a result of the operation and not secondary to the anesthesia. Lastly, every person has varying susceptibility to nausea and vomiting post operatively. If you have a history of post operative nausea and vomiting, please tell your anesthesiologist. There are several things that he or she can do to decrease the chances of you being sick after surgery. In any case, it would be wise to eat lightly at first to make sure your stomach is up to tolerating food.

There are several options for controlling or mediating the pain of labor. Multiple non- or minimally-invasive techniques such as deep breathing, meditation, visualization or massage that mediate labor pain are available. These techniques can be discussed in detail with your obstetrician, midwife or nurse. Another option is the use of IV narcotic pain medicines (for example, Demerol or Stadol). This is a minimally invasive technique since you will already have an IV started on your arrival but narcotics give a varying degree of relief from the pain of labor. The main limiting factor for these medicines is their effect on your breathing and the babies breathing after delivery. Since the medicine is given into your vein and circulates in your blood, the baby will receive some of this medicine across the placenta. Some narcotic pain medicine is safe for you and your baby; a lot is not.

The third option is what is called an “epidural”. An “epidural” is a catheter that is placed in your back into the “epidural” space surrounding your spinal cord by one of the anesthesiologists. Medicine is given through the catheter which numbs the nerves that go to your stomach, back and bottom. The nerves to your legs come out near this same area so patients well often have numb and/or heavy legs as well. The goal for pain relief with an epidural is around 75-90% - in other words to make the labor pain manageable or tolerable. Epidurals are more invasive plus they can have side effects and risks also. The most common, but still rare, problems include clinically significant drops in blood pressure, bleeding, nerve injury, and headaches. The placement, benefits, side effects and risks of epidurals are covered in detail in our “Epidural Consent” DVD you will see on your admission.

Because there are medical risks involved any time a patient undergoes anesthesia, we utilize a team of anesthesia specialists, which always includes an anesthesiologist and usually includes a nurse anesthetist as well to care for you. Most of our patients are cared for with the “Care Team” method of an anesthesiologist/certified registered nurse anesthetist (“CRNA”) team although, in some circumstances, our patients are cared for solely by an anesthesiologist. In either case, there will be an anesthesiologist and/or CRNA with you during the entire time of your procedure.

After your procedure is completed, you will transported by the anesthesiologist/CRNA to the Post-Anesthesia Care Unit (PACU or “Recovery Room”) where you will be cared for by nurses specially trained in post-anesthesia care. The anesthesiologist is also immediately available for your care during this period as well.

Your anesthesiologist will be one of the members of Anesthesia Consultants Medical Group (ACMG) who are all physicians licensed in the state of Alabama. An anesthesiologist is a specialist in Perioperative Medicine who is involved in the care of a patient prior to, during and after surgery. This includes evaluating and preparing a patient to undergo the stress of surgery, formulating an anesthetic plan, and then caring for the patient during the surgical procedure, often in conjunction with a CRNA. He/she monitors the patient's blood pressure, heart rate, breathing, and level of consciousness and analgesia as well as adjusting other parameters to provide a safe, pain-free surgical experience for the patient. After the surgery, the anesthesiologist continues to provide the care necessary to ensure a smooth emergence from the anesthetic and pain control in the Post-Anesthesia Care Unit (“Recovery Room”).

Becoming an Anesthesiologist requires many years of education. After four years in college to earn an undergraduate degree, four years of medical school are necessary to earn a Doctor of Medicine degree. He/she must then complete another four years of training in an accredited Anesthesia Residency Program. The physician may then complete another one or two years in a subspecialty of anesthesia such as Obstetrical Anesthesia, Cardiac Anesthesia, Pediatric Anesthesia, or Pain Management. All our physicians are board certified/board eligible anesthesiologists through the American Board of Anesthesiology (ABA).

An anesthesiologist is a physician just like your surgeon or internist. As such, you may receive a bill for the professional services of the anesthesiologist that is separate from the hospital bill. If you have any questions about your bill, please contact our business office.

Anesthesiologists are physicians who have completed 12000-16000 hours of clinical anesthesia training in the form of an anesthesia residency after medical school. They are medical experts who evaluate, monitor and care for patients before, during and after surgery and handle any complications that may arise. They may work alone or in conjunction with nurse anesthetists (CRNAs) in a physician-led anesthesia care team model.

Certified Registered Nurse Anesthetists (CRNAs) are registered nurses who have completed additional training in delivering anesthesia after receiving a nursing degree and completing one year working as a nurse in an acute care setting such as an ICU.

The anesthesia care team consists of a nurse anesthetist (CRNA) led by an anesthesiologist. While the nurse anesthetist delivers anesthesia and monitors the patient during surgery, the anesthesiologist evaluates the patient prior to surgery and plans the anesthetic. The anesthesiologist remains immediately available for any complications that may arise and provides care and pain management in the recovery room.