From the Book

Foreword

“I don’t want to know anything; I don’t want to feel anything.” I have heard this so many times, and I understand it completely. While I do this every day, surgery is a completely foreign experience to you. You’re anxious, and you didn’t sleep well last night. You woke up at 5:00 a.m., and you skipped breakfast. On top of that, you’re wearing a tacky gown in an uncomfortable bed, waiting to turn your body and mind over to a guy you just met. It doesn’t seem like the best way to start your day.

I always appreciate when patients share these concerns, and it often happens. It is a constant reminder of how frightening the surgical process can be, and how much trust you place in me. You may be one of several patients I’ll see today, which is just another day in my regular week. But this may be your first surgery. And even if it’s not, you’re still nervous. Beyond that, you’re important. You’re somebody’s one mother. Somebody’s one father. Somebody’s big sister. Somebody’s little brother. Somebody’s sweetie. It’s a privilege taking care of you, and I promise I’ll care for you like you were in my family. I know surgery and anesthesia can be scary, but part of that fear comes from lack of information. So, I have written this text hoping that you will learn some new information that will put you more at ease.

The surgical process can be much less frightening and much more pleasant if you are prepared from a knowledge and mental attitude standpoint. That is the purpose of this book. This text contains important information that should make your surgery a more positive experience.

Approach to the Book

If you’re preparing for surgery, you probably don’t want to read a long book, particularly if much of the material is unrelated to what you’re having done. So, I encourage you to read about the Types of Anesthesia, Drugs, Lines (because you may get one), and What to Expect. Then, just read the information specific to your surgery. I want you to be informed but not overwhelmed.

If you’re interested, I have added more information generally about being a doctor and specifically about the medical professionals who administer anesthesia. If you wish, read about all of the different types of surgeries. Read a little. Read a lot. I just want you to get comfortable with what to expect. Make it your book.

Always ask a qualified physician before taking medications or relying upon any provision of this book on a specific basis. This book is intended to provide information that you can use to better understand and participate in your surgical care decisions. It is not intended as a substitute for your physicians or their team members. It does not constitute an informed consent. Please do not take any action, medication, or make any decision based solely upon this book. Please confer with your physicians before taking any action or making any decisions with respect to your health care or the health care of anyone else.

What is anesthesia?

Simply put, anesthesia is the lack of sensation. But anesthesia is a spectrum, and it can mean anything from numbing the skin to complete unresponsiveness in surgery. It is a balance of “sleepiness” against the degree of surgical stimulation. Ideally, the “depth” of anesthesia should counterbalance the stimulation of the procedure. That is, the more something hurts, the more anesthesia you need to cover it.

Rendering an anesthetic requires us to manipulate and manage your physiology. In fact, we maintain the physiology while the surgeon rearranges the anatomy! We use monitors and drugs to provide the right amount of anesthesia, while minimizing side effects. We find that perfect balance, the right amount of medication, under these circumstances, at this time, for this patient: you.

Top 10 Questions People Ask Before Their Surgery

  1. Will someone be with me during my entire surgery?

    Good question. In fact, several patients have asked whether we just administer a shot and then leave the room. I suppose many people think that. After all, they’re asleep, so how would they know otherwise?!
    The answer is yes. Someone trained in anesthesia will constantly be with you. You will not be left alone in the operating room. As you will read later in the book, anesthesiologists work with two types of mid-level providers: anesthesiologist assistants (AA’s) and nurse anesthetists (CRNA’s). This is just like your surgeon who may have a physician assistant (PA) or a nurse practitioner (ARNP).


    In some hospitals, there are only anesthesiologists. There, the anesthesiologist stays in the room the entire time. Elsewhere, anesthesiologists work as a team with these mid-level providers. In such a case, the anesthesiologist is involved in putting the patient to sleep, and the AA or CNRA stays with the patient during the case. Understand that, like flying a plane, the planning of an anesthetic is the greatest challenge. Once the surgery is underway, a mid-level provider is capable of continuing the anesthetic. The anesthesiologist is always available for any questions or issues that may develop. Notice in the photo that everyone’s attention is focused on the patient. That’s the way it is and how it should be.

Anesthetics for Certain Procedures

Appendix

The appendix is near the junction of the small intestine and the large intestine (colon). We typically leave it alone unless it becomes inflamed, a condition called appendicitis. This oftentimes presents as pain in the right lower area of your belly, and you can see the small, worm-shaped appendix in the lower left side of the drawing. The image is drawn as if you were looking at someone else, which is why it is on the left side of the picture.


Usually, it is treated as an emergency. The most common surgical approach is laparoscopic (using cameras). Surgery to remove it is called an appendectomy (pronounced APP-en-DECK-to-me). Several small holes are made, and they usually close nicely. Most patients go home the next day. The alternative approach is to open the abdomen. Some patients will need this because they have had multiple abdominal surgeries or perhaps because the laparoscopic attempt is too difficult. The open approach is rare.

For the surgery, plan to have a general anesthetic. Other considerations during abdominal surgery are a function of your underlying medical problems. For example, a patient who has been vomiting for two days will likely have an electrolyte imbalance and dehydration, which will require an additional large IV. A very sick patient may need an arterial line to monitor changes in blood pressure. Your anesthesiologist will discuss this with you. There are several possibilities, and the ones just mentioned are common considerations.

Nausea is possible after abdominal surgery. If you have a history of motion sickness or nausea during a previous surgery, please let your anesthesiologist know. He can provide several medications to minimize this risk.

Table of Contents

  • Foreword
  • Approach to the Book
  • What is anesthesia?
  • Top 10 Questions People Ask Before Their Surgery
  • What are the types of anesthesia?
    • Local anesthesia
    • Regional anesthesia
    • Monitored Anesthesia Care (MAC)
    • General anesthesia
  • Drugs
    • Opiates (narcotics)
    • Sedatives
    • Propofol
    • Ketamine
    • Gas
    • Muscle Relaxants (paralytics)
  • Invasive “Lines”
    • Central Line
    • Arterial Line
  • What should you expect on your day of surgery?
  • Anesthetics for Certain Procedures
    • Appendix
    • Arm and Forearm
    • Back
    • Birth, Labor Epidural
    • Birth, Cesarean section (C-section)
    • Bladder, cystoscopy (looking in with a camera)
    • Bladder, stimulator
    • Blood vessel (major vascular)
    • Brain
    • Breast
    • Children
    • Colonoscopy
    • CT (CAT) Scan and MRI
    • Ear
    • Endoscopy
    • Eye
    • Face
    • Foot (podiatry)
    • Gall bladder
    • Hand
    • Heart, angiogram/angioplasty/ablation
    • Heart, open heart
    • Hernias (inguinal, umbilical, and abdominal)
    • Hip pinning (for a fracture)
    • Hip replacement
    • Intestine (bowel)
    • Kidney
    • Kidney stone, shock
    • Knee arthroscopy
    • Knee replacement
    • Leg, lower
    • Leg, upper
    • Liver
    • Lung
    • Major trauma
    • Mouth
    • Neck, bones
    • Neck, carotid artery
    • Neck, everything else
    • Nose
    • Pain injections (by your chronic pain physician)
    • Prostate removal
    • Prostate seeding
    • Shoulder
    • Spleen
    • Uterus
    • Wrist
  • Special Considerations
    • Allergies
    • Awareness
    • Blood transfusions and Jehovah’s Witnesses
    • Chronic Pain
    • Difficult Airway
    • Difficult IV Stick
    • DNR (Do Not Resuscitate), Living Will, and POA
    • Heart valve problems
    • Language challenges
    • Malignant Hyperthermia
    • Nausea
    • Post-op ventilation
    • Pseudocholinesterase Deficiency
  • An Anesthesiologist Is a Medical Doctor
  • About Other People Who Administer Anesthesia
  • Conclusion