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Who are your anesthesia care providers?

Your anesthesia care will be provided using the anesthesia care team model. This means one or more anesthesiologists, often in conjunction with a Certified Registered Nurse Anesthetist (CRNA), will work as a team to care for you before, during and after surgery. Rest assured that from the time you enter the operating room until your surgery is complete and you are in the recovery area, a member of the anesthesia department will constantly be present to care for you.

Anesthesiologists are physicians (MD/DOs) with at least twelve years of education beyond high school. This includes a four-year undergraduate degree, a four-year doctor of medicine degree, and four years or more of residency training in all aspects of anesthesia.
Anesthesiologists may also specialize in areas such as pain management or intensive care medicine.

CRNAs are experienced critical care nurses who have had graduate training in anesthesia. This includes a four-year undergraduate degree and a two to three-year master’s degree in anesthesia with at least 18 months of hands-on experience. CRNAs work closely with the anesthesiologist to provide your anesthesia care.

What do anesthesiologists do?

Anesthesiologists have multiple roles that extend beyond the operating room. They are responsible for your comfort and well being before, during and after your procedure. The first step involves evaluating each patient’s medical condition before surgery and developing an appropriate, individualized anesthesia plan of care. This plan is a means of providing the best possible care for you during and after your surgery.

May I choose my anesthesiology provider?

Usually, you may choose your anesthesiologist; however, you must make that choice known in advance so arrangements can be made. Please let your surgeon know if you wish to use a specific anesthesiologist. In addition, it is a good idea to repeat the request at the time of your pre-operative anesthesia assessment. We do our best to honor these requests; however, occasionally, it may not be possible due to emergencies or scheduling issues.

What can I expect before surgery?

Frequently, people needing surgery have other medical conditions such as heart disease, asthma, diabetes or high blood pressure. Anesthesia and surgery affect your entire body, so it is important to know as much about you as possible. Anesthesiologists have extensive training in internal medicine, intensive care medicine, and medications, especially as they relate to surgery. You will have an initial preoperative assessment, completed by a registered nurse, to alert the anesthesiologist to these conditions. You may be asked to see the anesthesiologist in the days leading up to your surgery if you have extensive health problems or are having major surgery. This will allow time for evaluation and treatment of any conditions prior to the time of surgery. This may involve blood tests, x-rays, ECGs, or more extensive procedures to ensure your surgery will be completed in the safest manner. On the day of surgery, an anesthesiologist will review your medical record to make certain nothing about your health has changed, discuss the anesthetic options available, answer any questions you may have, and obtain informed consent for anesthesia.

What types of anesthesia are available and can I choose?

There are four main types of anesthesia available: Monitored Anesthesia Care (MAC), General, Regional and Local.

Monitored Anesthesia Care (MAC)
With this approach, you usually receive pain medication and sedatives through your intravenous line from your anesthesiology provider. While you are sedated, your anesthesiology provider will monitor your vital body functions. You will be very comfortable throughout your procedure and most likely asleep.

During general anesthesia, patients are made unconscious, frequently through the use of intravenous medicines. You remain asleep until the end of surgery so you experience no uncomfortable sensations. During the procedure your vital signs and anesthesia levels are carefully monitored and controlled by the anesthesia provider, using sophisticated equipment to track your bodily functions and the level of medications in your bloodstream. At the end of the surgery, your anesthesia provider will reverse the process and you will regain consciousness, usually within minutes of the completion of the procedure.

Regional anesthesia involves injections of medicine similar to Novocain near nerves to numb the part of the body having surgery. You may also receive sedatives to help you relax during the injection and surgery. Common regional anesthetics are spinal and epidural anesthetics, which are injections in the back. Other regional anesthetics can be used to numb an individual arm or leg.

For some surgical procedures a local anesthetic similar to Novocain is injected at the site of the surgery by the surgeon. This is frequently done with smaller, more minor surgeries and you will be awake during your procedure. The anesthesia provider will not be present. In certain situations several different anesthetic options may be available. Your anesthesiologist, in consultation with your surgeon and you, will determine the best anesthetic for your individual situation. We welcome and encourage your input.

Why can’t I eat or drink before surgery?

The main reason is safety. If you have food or liquid in your stomach at the time of surgery, it could put you at risk for vomiting and aspiration into the lungs, which could be life threatening.

What are the side affects of anesthesia?

Fortunately, anesthetic and surgical techniques are improving continually, resulting in shorter surgery and anesthesia times and fewer side effects. The amount of discomfort you have depends on many factors. Please be assured your doctors and nurses are experts at relieving pain and will work to that end. Keep in mind, your discomfort should be tolerable, but it may not be possible to eliminate all pain. Nausea after surgery depends on many factors. It is much less of a problem today than in the past, but if you do experience it, we will work diligently to obtain relief for you. As with discomfort, it may not be possible to completely relieve the nausea, but it should be controlled. Other side effects may infrequently occur. If you have specific concerns, please discuss them with your anesthesiologist on the day of surgery.

Can I speak with an anesthesiologist before the day of surgery?

Yes. There is an anesthesiologist on call at all times. So, if you have a concern that cannot wait, please call Exeter Hospital and they will contact the appropriate physician. For general questions, please call during normal working hours and ask to speak with the on-call anesthesiologist. Frequently, the preoperative assessment nurse can answer questions during the interview. If you wish to meet with an anesthesiologist, please discuss this with the surgeon or surgical scheduler.

What are the risks of anesthesia?

Thankfully, anesthesia has never been safer. This is the result of the excellent training of your anesthesia providers and strict national standards, developed by the American Society of Anesthesiologist (ASA) and American Association of Nurse Anesthetist (AANA) and followed at Exeter Hospital, for preoperative preparation, intraoperative care, and postoperative recovery of patients. All operations and anesthetics involve risks dependent on many factors, including your individual medical conditions and the type of surgery you are having. Major complications are fortunately very rare, and your anesthesia provider will take precautions to prevent them from occurring. The specific risks of your anesthetic will be discussed with you when you meet with your anesthesiologist. At that time, the anesthesiologist will provide you with an informed consent form to review and sign.