| Anesthesia and You Until faced with
the possibility of having surgery, few people are familiar with the
highly trained, caring professionals who will provide their
anesthesia services. In fact, most people think only of their
anesthesia provider as “the doctor behind the mask” who helps them
sleep through surgery. At Anesthesiologists of Greater Orlando, most
operations are performed using an “Anesthesia Care Team” approach.
This team is comprised of an anesthesiologist and a nurse
anesthetist. Let’s lift their masks and take a closer look at these
professionals.
Most people understand that anesthesiologists are the doctors who
administer the medications which keep them from feeling pain and
sensations during surgery. However, few people realize that today’s
anesthesiologists are involved in the patient’s care in a much more
critical and comprehensive manner. Anesthesiologists make the
medical judgments necessary to protect and regulate critical life
functions such as breathing, heart rhythm, blood pressure, brain and
kidney function that are affected by the surgery being performed.
They are also the specialists who treat any medical
problems that may arise during surgery or in the recovery period.
They possess a wide range of knowledge in a variety of areas:
medicine, surgery, pharmacology, human physiology and how the body
reacts to the stresses of surgery. This knowledge is used to provide
the safest care of the patient and also address the needs of the
surgeon.
In addition to your anesthesiologist, most cases will include a
certified nurse anesthetist (CRNA) in the patient’s care. These
professionals are advanced practice registered nurses who have
completed specialty training from an accredited school of nurse
anesthesia and have passed a rigorous certification examination.
Prior to surgery, your anesthesiologist will formulate a
personalized anesthetic plan taking into consideration your medical
history and current condition. The anesthesiologist and the CRNA
will initiate your anesthetic together. The CRNA will remain with
you throughout the procedure while the anesthesiologist checks on
your status at regular intervals and remains readily available at
all times.
During surgery, the Anesthesia Care Team utilizes the latest
technology to monitor your body’s functions. They constantly
interpret these sophisticated monitors to diagnose, regulate and
treat the body’s organ systems using a delicate balance of
anesthetic agents and medications. At the conclusion of your
surgery, they manage the patient’s return to consciousness.
During the immediate post-operative period, it is the
anesthesiologist who manages the patient’s care, including pan
relief, in the PACU (Post Anesthesia Care Unit).
For more information on this subject here is a link to American
Society of Anesthesiologists
http://www.asahq.org/patientEducation/anesandyou.htm
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Anesthesia for Ambulatory Surgery
http://www.asahq.org/patientEducation/ambulatoryAnes.pdf
Pain Relief During Labor and Delivery
http://www.asahq.org/patientEducation/labordelivery.pdf
When Your Child Needs Anesthesia
The anesthesiologist will want to make sure
that your child is in the best possible physical condition before
surgery. You will be asked important questions about your child's
general health, including whether he or she has allergies or asthma,
whether there has been any family history of difficulties with
anesthesia and what your child's experiences have been with previous
anesthetics. During this evaluation, the anesthesiologist will
explain the planned anesthetic procedures. The discussion may
include whether or not your child will receive anything for sedation
before surgery, how the anesthetic will be initiated and maintained,
and other pertinent anesthetic details. This is the best time for
you and your child to ask questions and express any concerns to the
anesthesiologist.
Sometimes minor illnesses such as sniffles and
colds may cause problems during some types of surgery and
anesthesia. For this reason, the anesthesiologist may feel it is
best to postpone surgery. Remember, the anesthesiologist has your
child's safety in mind.
What if my child has outpatient surgery?
Outpatient surgery for certain operations has
become very common and can be performed without a hospital
admission. This means that information about your child needed by
the anesthesiologist will be obtained the day of surgery or at some
meeting arranged before the day of surgery. Although outpatient or
same-day surgery is usually performed for "small" operations, the
anesthesia is never "small." It is just as important to follow
preoperative directions for outpatient surgery as for operations
when your child is brought into the hospital overnight. For example,
it is very important for your child's safety to follow closely the
anesthesiologist's instructions concerning food and liquid intake.
Will my child receive any medication
before surgery?
In the past, virtually every child received an
injected sedative before being taken to the operating room. We now
realize that many children need less sedation when calm, assured and
confident parents help them through the stress of a procedure or
hospitalization. In spite of parents' reassurances, however, some
children still may require medicine to calm them before surgery.
This medication may be given by mouth, injection or rectal
suppository. The time before surgery that such premedication is
given will vary. The type of medicine used, if any, will be
determined by the anesthesiologist during the preoperative visit.
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How will my child be given anesthesia?
Anesthetic agents can be started in several
ways. Most commonly in adults, anesthesia is started by an
intravenous injection so the patient becomes unconscious rapidly.
This is also a method that can be used for children. Another method
of beginning anesthesia is to let your child breathe anesthetic
agents until losing consciousness. This is called a mask or
inhalational induction. With this approach, your child will be asked
to breathe through a "space mask" quietly, and no needlesticks will
be performed until after your child is sound asleep. The choice of
which method to begin anesthesia will be made by the
anesthesiologist based on many factors. Although anesthetics can
provide complete pain relief and loss of consciousness during an
operation, they do occasionally have side effects. They tend to
decrease breathing, heart action and blood pressure. The
anesthesiologist is specially trained to ensure that these
anesthetic effects are minimized. Different children may awaken from
anesthesia at differing rates. Some children may be fully alert upon
arriving in the recovery room. Others may be groggy for hours after
surgery. If you have any concerns about your child's recovery, you
should feel free to ask your anesthesiologist. Although operations
are much safer these days, they still produce stress on the body and
may cause your child to have a "sick" feeling. Nausea and vomiting
are occasional side effects after surgery and anesthesia.
What about regional anesthesia for my
child?
In recent years, it has become possible to
provide pain relief to specific areas of the body rather than give
general anesthesia that causes unconsciousness. For example, if your
child is having foot surgery, it is possible to eliminate the
feeling of pain in only the foot, either with a local injection of
an anesthetic or by regional anesthesia. The most common type of
regional anesthesia used in children is called epidural anesthesia.
This is very similar to the anesthesia used for childbirth when
local anesthesia is injected into the back or tailbone region.
Intravenous sedation or inhaled anesthetic agents may be combined
with a regional anesthetic. This combination may allow the
anesthesiologist to give less general anesthesia. Another advantage
is that regional anesthesia is often used to provide pain relief
after surgery. Your anesthesiologist can discuss the advantages and
disadvantages of regional anesthesia with you.
How is pain controlled after surgery?
The anesthesiologist may be consulted to help
manage your child's pain following the surgery. Although
"painkilling" injections are still commonly used, other forms of
pain management may also be chosen to provide comfort. For instance,
patient-controlled analgesia (PCA) allows a child to self-administer
a controlled dose of pain-relieving medicine when needed. A small,
computerized pump is programmed by the anesthesiologist, and
children 8 years old or older may be instructed on PCA use.
Another approach is the insertion of a tiny
epidural catheter in your child's back through which a small dose of
medication for pain relief can be given. This allows the child to be
more awake and lessens the chance for complications from the use of
other pain medications. Sometimes, the epidural pain relief can be
continued for several days after the operation.
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How Can I Help as a Parent?
The anesthesiologist and the surgeon will do
their best to make your child's visit to the hospital as pleasant as
possible; however, you also have a key role to play in your child's
care. It is important that you begin preparing your child for the
operation as soon as a decision is made to perform surgery. Children
tolerate surgery and anesthesia better when they are well-prepared.
As with all of us, children have natural fears of the unknown.
Anything you can do to relieve these anxieties and to inform your
child about the coming events in the hospital and the operating room
will greatly improve your child's experience.
Before you explain to your child what to
expect, you also must learn what to expect. It is very important to
learn about your child's anesthetic experience beforehand by
discussing it with the anesthesiologist in the preanesthetic
interview.
Once you learn what will happen, you will gain
confidence and be better able to talk calmly and honestly to your
child. Honesty is a key word. Your child should be told that he or
she will be in unfamiliar surroundings but will meet many friendly
doctors and nurses. Children need to know that they will have an
operation and that there may be some discomfort afterward. Let them
know that you may not be with them every minute but will be waiting
nearby.
Your composure as a parent is essential.
Nothing calms a child more than a confident parent. Although it is
natural for parents to have anxiety when their children are having
surgery, it is best not to convey this to your child. Talk to your
child about what to expect in the hospital such as corridors,
hospital beds and the presence of other children. Reassure your
child that everything done during the hospital stay will be
explained beforehand.
http://www.asahq.org/patientEducation/childanes.htm
Other related topics on anesthesia can be found at
http://www.asahq.org/patientEducation.htm
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