The anesthesia required for a minimally invasive procedure can differ from those of traditional surgery.

Most of the procedures that we perform require full general anesthesia to allow enough relaxation of the muscles. Modern anesthesia is very safe, and the anesthesiologists at DMH are all highly-skilled board certified physicians. Naturally they will need to be fully informed of any medical disorders that you may have or problems with anesthesia in the past. It is especially important that if you have any heart problems your regular physician send copies of old EKGs and information about any other tests that you may have had.

What you should know before surgery

• After your surgery is scheduled, you will meet an important medical specialist: The anesthesiologist. Your anesthesiologist, a vital member of your surgical team, has critical responsibility for your welfare.
• You will also meet your nurse anesthetist (CRNA), who is a member of the anesthesia team, and also has critical responsibility for your welfare.
• What will happen before the operation?
• If you have recently had an anesthetic at DMH, you should notify your nurse when you are admitted so that your records can be reviewed. Your anesthesiologist can discover a great deal about your individual response to anesthesia by reviewing these records. Your pre surgical visit to the Out patient care center is an important time.
• If you are admitted to the hospital prior to your surgery, you will usually be seen by your anesthesiologist in your hospital room. He or she will assess your medical condition and type of surgery to determine the type of anesthesia treatment to be used.
• In some cases, you may be evaluated when you are brought to the surgery area. Many patients are admitted to DMH's Same Day Surgery Unit. Our anesthesiologists assess these patients shortly before surgery.

How Can I Help?

1. Bring a list of all medications that your are currently taking.
2. Consult your physician for special instructions if you are taking routine medications, insulin or blood thinners.
3. Do not eat or drink anything for eight hours before your scheduled surgery. Do not chew gum or tobacco. For infants and children instructions will be given to the parents or guardian regarding "NPO" (no eating or drinking) requirements.
4. Do not bring valuables, earrings, piercing, hair ornaments, watches, etc., to the operating room.
5. Do not wear nail polish or make-up. Make-up and nail polish make it difficult to determine if your body is receiving enough oxygen.
6. You should take out any removable teeth prior to surgery.
7. Do not wear glasses or contact lenses to the operating room.
8. If you are a Same Day Surgery patient, you must have made an arrangement for a responsible adult to drive you home and to provide care for at least 24 hours.
9. If you are a woman, and you know or suspect that you may be pregnant, you must inform the anesthesiologist. Some types of anesthetics may be unsafe during pregnancy.

Who selects my anesthetic?

• Your anesthesiologist will develop a plan based on the proposed surgery, your surgeon’s preference and your medical condition.

Who administers my anesthesia?

• At DMH, we use a care team approach to provide anesthesia for our patients.
• Your anesthesiologist (Doctor) works with a trained nurse anesthetist in administering your anesthesia. More than one anesthesiologist or anesthetist (CRNA) may be involved in your care. Anesthesiologists are medical doctors who attend college, four years of medical school and four years residency in anesthesia to qualify as experts in anesthesia. Certified Registered Nurse Anesthetists (CRNA) are registered nurses with backgrounds in intensive care nursing who have completed additional graduate level education in the field of nurse anesthesia. In Illinois a CRNA is identified also as an APN-Advanced Practice Nurse.
• Anesthesia personnel remain with you during the operation. Your anesthesiologist prescribes the anesthesia plan and is present during the beginning of the anesthetic to observe for unexpected reactions. A CRNA will remain with you. Your anesthesiologist is available to*Participate in the most demanding procedures of the anesthetic; *Follow the course of anesthesia administration at frequent intervals; *Diagnose and treat unexpected conditions; *Provide indicated care during your recovery period.

What type of anesthesia is administered?

• The type of anesthesia used for minimally invasive surgery will most likely be a general anesthetic. General anesthesia causes loss of consciousness during the operation. Anesthetics enter the bloodstream and are transported to the brain where they act on nerve centers to cancel pain impulses in the nervous system and provide amnesia for the procedure. Vital signs are monitored for blood pressure, heart rate, respiratory rate, pulse oximetry and additional monitors specific the type of surgical procedure being performed. These anesthetics can reach the bloodstream by being inhaled into the lungs or by injection through an intravenous tube (IV).

Will I remember going to the operating room?

• In most cases, yes. Some years ago, the beginning of general anesthesia could be difficult, and it was common to give a heavy sedative before surgery. Today, modern anesthetic drugs provide a very pleasant and smooth beginning for anesthesia, so that heavy sedation before surgery is no longer necessary. Heavy sedation tends to prolong the recovery period and has other disadvantages. You will probably receive a very light sedation medication before surgery, if any.

What will happen to me in the surgery area?

• Most anesthetics require that an intravenous (IV) line be started. This will be started either in the surgery preoperative area (Pre-op) or in the operating room and may involve some minor discomfort. Medications may be administered through the IV.
• The anesthesia care team carefully monitors your body systems, such as heart rate and blood pressure, using electronic devices and minicomputers. After you are moved onto the padded operating room table, some of these monitors will be applied.
• Occasionally, additional monitors are needed which may require the placement of catheters or "lines" in blood vessels. These monitoring procedures usually involve minor discomfort, similar to the placement of the IV.
• Special monitoring techniques help anesthesia personnel recognize unusual problems associated with a specific patient’s condition or a particular surgical procedure. The decision to use these specialized monitors is usually make by your anesthesiologist with the surgeon's agreement.
• The application of your anesthetic will begin when the surgery team is fully prepared, your surgeon is ready and all the essential monitors have been placed.
• What happens during surgery?
• Anesthesia personnel remain with you throughout your operation to:
• Carefully monitor your body functions during the operation
• Control the level of the anesthetic you receive
• Attend to the anesthesia equipment
• Maintain balance in your body functions
• Keep records of the procedure
• Give blood and/or medications to keep your vital signs stable
• What happens after the operation?
• At the end of surgery, you will probably be taken to the Post-Anesthesia Care Unit (PACU) where you will be observed until you no longer require intensive monitoring. PACU is actually a special type of intensive care unit. The anesthetist reports the detail of your medical condition, surgery and anesthesia to a recovery nurse who is specially trained to work in this area. Your anesthesiologist is available to diagnose problems and direct therapy during your stay in this unit and evaluate your condition before releasing you to your room.

What are the side effects of anesthesia?

• Nausea and vomiting: Modern anesthetics are much less likely to cause you nausea and vomiting than those used years ago. However, some operations and some post-operative medications for pain may cause nausea no matter what anesthesia is used.
• Inflammation of the veins: The placement of the IV may require more than one attempt. Some swelling and bruising is not unusual at the IV site. Sometimes injecting medications into a particularly sensitive vein may result in inflammation which may take some time to heal.
• Impaired coordination or judgment: The sedatives you were given may impair your coordination and judgment for more than 24 hours. For this reason, you should not drive or perform other tasks requiring full physical skills or mental alertness for at least 24 hours after anesthesia care. This effect may be prolonged in you take narcotic pain-relievers after surgery.
• Airway injury: During general anesthesia, your condition resembles deep sleep. Most individuals relax to such a degree that there is some obstruction-like severe snoring-to normal breathing. The anesthetist help relieve the obstruction by holding your jaw up or by putting an airway device into your mouth or nose. Some situations require temporarily placing a tube into the trachea or windpipe. You may experience a sore throat and mild hoarseness following anesthesia. This is very common and should not be a cause for alarm.

Are there any risks involved?

• Every anesthetic involves some risk, but the overwhelming majority of patients do not experience major anesthesia complications. Emergency surgery has an increased risk because the emergency patient may not have an empty stomach. Under general anesthesia, the patient’s normal reflexes are impaired and there is a potential for vomiting. If it enters the lungs it can result in breathing problems and other difficulties. Fortunately, our modern techniques reduce the incidence of this problem and many emergency anesthetics are given each day without complications. There is a small incidence of nerve injury related to anesthesia. In regional anesthesia, this risk involves the area of surgery itself; in general anesthesia nerve injury most commonly results for the positioning needed for the surgery. Often such nerve injury is temporary, but once in a great while it is permanent.
• If you would like a more detailed explanation of risk, please ask your anesthesiologist.

If you have other questions or comments, The DMH Anesthesia staff is here for you.
If you have questions regarding your anesthesia treatment, please call 876-2575.