Monday, 23 June 2014

"Why do I have to starve before surgery?"


Safety, as with most things in surgery, is the reason patients are required to eat nothing for several hours prior to surgery. There is some debate over the ideal duration of preop fasting - some patients require longer fasting periods (e.g. patients with diabetes) and some shorter (e.g. small children). However,  rest assured your providers have a very good reason for making you hungry.

On induction of anesthesia (i.e. when you are 'put to sleep'), the reflexes protecting your airway (i.e. your lungs) stop working. Consequently, it would be possible for the contents of your stomach to travel into your lungs (- his is called 'aspiration'. Aspiration can require a prolonged stay in the intensive care unit, and is sometimes fatal.

Clear liquids (i.e. water, black coffee) are safer than other substances because they travel through the stomach quickly and produce less damage if they do end up in the lungs.

You may be told to take your daily medication on the morning of surgery with a sip of water. This is to ensure that your normal medication regimen is maintained, with minimal risk of aspiration during your surgery.

We all understand that going without food and water for 12 hours or more is unpleasant. It is, however, far preferable than risking an aspiration event.

Sunday, 15 June 2014

"Last time they put me to sleep in the preop area"

General anesthesia is never induced in the preoperative area. This is for safety. All of our necessary tools (intubation equipment, ventilator, monitors, medications etc.) are in the operating room, and it would be unnecessarily dangerous to transport a newly-anesthetized patient from the preop area to the operating room.
It is, however, common to be given sedating medication in the preoperative area (to soothe anxiety). Many of these medications have memory-inhibiting properties. Consequently, many patients do not remember leaving the preoperative area. Frequently I have conversations with patients on the way to the operating room that they subsequently deny.

Friday, 13 June 2014

"How long will it take me to wake up after surgery?"

Although the recovery room is the first place most people remember after surgery, patients usually awaken from anesthesia in the operating room. The reason most people do not remember the operating room is that they still have enough anesthesia in their system to blur those memories.
The type of surgery, the type of anesthesia, and the age and health of the patient all affect how long before they are fully awake. Generally most people will spend about an hour in the recovery room and then be transferred to an inpatient ward or an outpatient area prior to discharge.

Wednesday, 11 June 2014

"Will you be there the whole time?"

An anesthesia provider will be with you the entire time that you are under a general anesthetic. We do not leave you without someone else taking over.
In academic medical centers (teaching hospitals) there are often two people taking care of your anesthetic - an attending anesthesiologist and a trainee (i.e. an anesthesiology resident or nurse anesthetist student). In that situation one or other of the providers will take a break (lunch / bathroom etc) while the other stays in the operating room with you.
In a smaller hospital or private practice setting, there may be available personnel who will provide coverage for a break.
Otherwise, your anesthesia provider does not leave you and will wait until your case is finished to take a break. 

Monday, 9 June 2014

"What's the difference between 'anesthesia' and 'sedation'?"

Anesthesia is defined as "Insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations." Basically it means that we use medications to prevent pain during medical procedures. There are many different types of medications that we use - e.g.  local anesthetics to numb up a particular area; inhaled anesthetic gases that put a patient all the way 'to sleep'.

Sedation, on the other hand, is defined as "The administering of a sedative drug to produce a state of calm or sleep". That is, we use medications to relax you. Note that this can be with or without anesthesia. For example, if a patient has a spinal anesthetic for a procedure, we may sedate them so that they can comfortable lie on a hard operating table for 3 hours or so. Conversely, we might sedate a very anxious patient so that they could have an MRI scan without moving.