What to Expect

Your anesthesiologist is a key member of your surgical team. He or she gives you anesthetics (medications to keep you comfortable and decrease your awareness of surgery) and monitors your condition to keep you safe during surgery. You will have 1 of 3 kinds of anesthesia during your surgery.

Monitored anesthesia care (MAC)

• Often used for surgery that is short or not too invasive.
• Sedatives (medications to relax you) are given through an IV (intravenous) line.
• The area around the surgical site is usually numbed with a local anesthetic.
• You may choose to remain awake or sleep lightly.

Regional anesthesia (sometimes called spinal epidural or bier block)

• Often used for surgery on the arms, legs, and abdomen. It is also used during childbirth.
• A specific region of your body is numbed by injecting anesthetic near nerves, near your spine, or near the operative site.
• You may also be given sedatives through an IV line to relax you.
• With regional anesthesia, you may choose to remain awake or sleep lightly.

General anesthesia

• Often used for extensive surgery, such as on the heart, brain, or abdominal operation.
• Also used when the patient wants to be totally asleep.
• May be given as a gas that you breathe and as medications that are injected through an IV line.
• Because you are asleep, you feel no pain and remember nothing of the surgery

The risks and complications of anesthesia depend on your overall health. If you are healthy, the risks are low. The risks are higher for patients with heart or lung problems. Your anesthesiologist or nurse anesthetist will discuss the risks with you.

You're due to have surgery. During surgery, you'll be given medication called anesthesia. This will keep you comfortable and pain-free. Your surgeon will use monitored anesthesia care (MAC). This sheet tells you more about this type of anesthesia.

What is monitored anesthesia care?

MAC keeps you very drowsy during surgery. You may be awake, but you will likely not remember much. And you wont feel pain. With MAC, medications are given through an IV line into a vein in your arm or hand. A local anesthetic will usually be injected into the skin and muscle around the surgical site to numb it. The anesthesia provider monitors you during the procedure. He or she checks your heart rate and rhythm, blood pressure, and blood oxygen level.

Anesthesia tools and medications that may be near you during your procedure

You will likely have:

• A pulse oximeter on the end of your finger. This measures your blood oxygen level.
• Electrocardiography leads (electrodes) on your chest. These record your heart rate and rhythm.
• Medications given through an IV. These relax you and prevent pain. You may be awake or sleep lightly. If you have local anesthetic, it is injected directly into your skin.
• A facemask to give you oxygen, if needed.

Risks and Possible Complications

MAC has some risks. These include:

• Breathing problems
• Nausea and vomiting
• Allergic reaction to the anesthetic

Anesthesia safety

• Follow all instructions you are given for how long not to eat or drink before your procedure.
• Be sure your doctor knows what medications you take, especially any anti-inflammatory medication or blood thinners. This includes aspirin and any other over-the-counter medications, herbs, and supplements.
• Have an adult family member or friend drive you home after the procedure.
• For the first 24 hours after your surgery:
  • Do not drive or use heavy equipment.
  • Do not make important decisions or sign documents.
  • Avoid alcohol.
  • Have someone stay with you, if possible. They can watch for problems and help keep you safe.

You're scheduled for surgery. During surgery, you'll receive medication called anesthesia to keep you comfortable and pain-free. Your surgeon has decided that youll receive regional anesthesia. This sheet tells you what to expect with this type of anesthesia.

What is regional anesthesia?

Regional anesthesia numbs one region of your body. The anesthesia may be given around nerves or into veins in your arms, neck, or legs (nerve block or Bier block). Or it may be sent into the spinal fluid (spinal anesthesia) or into the space just outside the spinal fluid (epidural anesthesia). You may also be given sedatives to help you relax.

Nerve block or Bier block

A small area of the body, such as an arm or leg, can be numbed using a nerve block or Bier block.

• Nerve block. During a nerve block, your skin is numbed. A needle is then inserted near nerves that serve the area to be numbed. Anesthetic is sent through the needle.
• IV regional or Bier block. For this type of block, an IV line is put into a vein. The blood flow to the area to be numbed is blocked for a short time. Anesthetic is sent through the IV.

Spinal anesthesia

Spinal anesthesia numbs your body from about the waist down.

• Anesthetic is injected into the spinal fluid. This is a substance that surrounds the spinal cord in your spinal column. The anesthetic blocks pain traveling from the body to the brain.
• To receive the anesthetic, your skin is numbed at the injection site on your back.
• A needle is then inserted into the spinal space. Anesthetic is sent into the spinal fluid through the needle.

Epidural anesthesia

Epidural anesthesia is most commonly used during childbirth and may also be used after surgical procedures of the chest, abdomen, and legs.

• Anesthetic is injected into the epidural space. This is just outside the dural sac which contains the spinal fluid.
• To receive the anesthetic, your skin is numbed at the injection site on your back.
• A needle is then inserted into the epidural space. Anesthetic is sent into the epidural space through the needle.
• A small flexible catheter may be attached to the needle and left in place. This allows for continuous injections or infusions of anesthetic.

Anesthesia tools and medications that might be near you during your procedure

• Local anesthetic. This medication is given through a needle numbs one region of your body.
• Electrocardiography leads (electrodes). These are used to record your heart rate and rhythm.
• Blood pressure cuff. A cuff is placed on your arm to keep track of your blood pressure.
• Pulse oximeter. This small clip is placed on the end of the finger. It measures your blood oxygen level.
• Sedatives. These medications may be given through an IV. They help to relax you and keep you comfortable. You may stay awake or sleep lightly.
• Oxygen. You may be given oxygen through a facemask.

Risks and possible complications

Regional anesthesia carries some risks. These include:

• Nausea and vomiting
• Headache
• Backache
• Decreased blood pressure
• Allergic reaction to the anesthetic
• Ongoing numbness (rare)
• Irregular heartbeat (rare)
• Cardiac arrest (rare)

You're due to have surgery. During surgery, you'll be given medication called anesthesia. (It is also called anesthetic.) This will keep you comfortable and pain-free. Your anesthesia provider will use general anesthesia.This sheet tells you more about it.

What is general anesthesia?

General anesthesia puts you into a state like deep sleep. It goes into the bloodstream (IV anesthetics), into the lungs(gas anesthetics), or both. You feel nothing during the procedure. You will not remember it. During the procedure, the anesthesia provider monitors you continuously. He or she checks your heart rate and rhythm, blood pressure, breathing, and blood oxygen.

• IV Anesthetics. IV anesthetics are given through an IV line in your arm. Theyre often given first. This is so you are asleep before a gas anesthetic is started. Some kinds of IV anesthetics relieve pain. Others relax you. Your doctor will decide which kind is best in your case.
• Gas Anesthetics. Gas anesthetics are breathed into the lungs. They are often used to keep you asleep. They can be given through a facemask or a tube placed in your larynx or trachea (breathing tube).
  • If you have a facemask, your anesthesia provider will most likely place it over your nose and mouth while youre still awake. Youll breathe oxygen through the mask as your IV anesthetic is started. Gas anesthetic may be added through the mask.
  • If you have a tube in the larynx or trachea, it will be inserted into your throat after youre asleep.

Anesthesia tools and medications

You will likely have:

• IV anesthetics. These are put into an IV line into your bloodstream.
• Gas anesthetics. You breathe these anesthetics into your lungs, where they pass into your bloodstream.
• Pulse oximeter. This is a small clip that is attached to the end of your finger. This measures your blood oxygen level.
• Electrocardiography leads (electrodes). These are small sticky pads that are placed on your chest. They record your heart rate and rhythm.
• Blood pressure cuff. This reads your blood pressure.

Risks and possible complications

General anesthesia has some risks. These include:

• Breathing problems
• Nausea and vomiting
• Sore throat or hoarseness (usually temporary)
• Allergic reaction to the anesthetic
• Irregular heartbeat (rare)
• Cardiac arrest (rare)

Anesthesia safety

• Follow all instructions you are given for how long not to eat or drink before your procedure.
• Be sure your doctor knows what medications and drugs you take. This includes over-the-counter medications, herbs, supplements, alcohol or other drugs. You will be asked when those were last taken.
• Have an adult family member or friend drive you home after the procedure.
• For the first 24 hours after your surgery:
  • Do not drive or use heavy equipment.
  • Have a trusted family member or spouse make important decisions or sign documents.
  • Avoid alcohol.
  • Have a responsible adult stay with you. He or she can watch for problems and help keep you safe.

Epidural is a kind of anesthesia. This is a medicine that blocks pain. It can be used for labor and delivery. It is also used for some kinds of surgery. For an epidural, anesthetic is injected into the lower spine. This is done by an anesthesiologist (a type of healthcare provider). Or it may be done by a nurse anesthetist (CRNA).

How pain is blocked

The spinal cord is the main pathway for pain signals. These signals travel from nerves in your body through the spinal cord to your brain. The brain registers them as pain. The epidural blocks the nerves that enter your lower spine.

Numbing your lower body

Anesthetic is injected through the skin of your back into the part of the spinal canal called the epidural space. The anesthetic blocks nerves below the point where it is injected. It either reduces pain or blocks most feeling. You are awake. And you still have feeling in your upper body.

During labor and delivery

An epidural can be used during labor and delivery. You may be asked to lie on your side. Or you may be asked to sit on the edge of your bed and lean over. First, your healthcare provider numbs a small part of your lower spine with a local anesthetic. Your healthcare provider or nurse anesthetist then puts a needle into the epidural space. A thin tube (catheter) is threaded through the needle. The needle is removed. The anesthetic then goes through the catheter. In some cases a pump is attached to the catheter. This gives you a constant dose of anesthetic as long as you need it.

Risks and possible complications

Risks and possible complications include:

• A sudden drop in blood pressure, which may cause the baby's heart rate to drop temporarily
• Severe headache after birth
• Soreness of the back for several days
• Dizziness, seizures, breathing problems, allergic reaction to the anesthetic, nerve damage, or paralysis (all very rare)

You are scheduled for surgery. You'll receive medication called anesthesia to keep you from feeling pain during the surgery. This sheet explains steps you may need to take to prepare for anesthesia.

Tests

Your doctor may send you to have certain tests before your procedure. These may include:

• Blood tests. These help show how anesthesia may affect you.
• Electrocardiography (ECG or EKG). This helps show how your heart is working.
• Chest X-ray. This image helps show the health of your heart and lungs.

Medications

In the weeks before your surgery:

• Tell your doctor and anesthesia provider what medications you take. This includes aspirin, other over-the-counter drugs, herbs, and vitamins. Be sure to mention if you take illegal drugs (this will be kept confidential). Giving this information helps ensure your safety.
• You may be told to change certain medications you take. Or you may be told to stop taking medications for a certain amount of time.
• Mention how much alcohol you drink and if you smoke. Also mention whether youre allergic to any medications.

Other Preparations

• You may be told to stop eating or drinking for a certain amount of time before the surgery. This is often 8 hours. Do not eat or drink anything, including water, during this time. (If you have been told to take any medications before the surgery, take them with small sips of water.)
• If you dont talk to your anesthesia provider before surgery, you will meet the day of the procedure. He or she will explain your anesthesia and answer your questions.
• Arrange for an adult family member or friend to drive you home after the surgery.

Be sure to follow all your doctors instructions. If you don't, your procedure may have to be rescheduled.

You've just had surgery. During surgery you were given medicine called anesthesia to keep you relaxed and free of pain. After surgery you may have some pain or nausea. This is common. Here are some tips for feeling better and getting well after surgery.

Going home

Your doctor or nurse will show you how to take care of yourself when you go home. He or she will also answer your questions. Have an adult family member or friend drive you home. For the first 24 hours after your surgery:

• Do not drive or use heavy equipment.
• Do not make important decisions or sign legal papers.
• Do not drink alcohol.
• Have someone stay with you, if needed. He or she can watch for problems and help keep you safe.

Be sure to go to all follow-up visits with your doctor. And rest after your surgery for as long as your doctor tells you to.

Coping with pain

If you have pain after surgery, pain medicine will help you feel better. Take it as told, before pain becomes severe. Also, ask your doctor or pharmacist about other ways to control pain. This might be with heat, ice, or relaxation. And follow any other instructions your surgeon or nurse gives you.

Tips for taking pain medicine

To get the best relief possible, remember these points:

• Pain medicines can upset your stomach. Taking them with a little food may help.
• Most pain relievers taken by mouth need at least 20 to 30 minutes to start to work.
• Taking medicine on a schedule can help you remember to take it. Try to time your medicine so that you can take it before starting an activity. This might be before you get dressed, go for a walk, or sit down for dinner.
• Constipation is a common side effect of pain medicines. Call your doctor before taking any medicines such as laxatives or stool softeners to help ease constipation. Also ask if you should skip any foods. Drinking lots of fluids and eating foods such as fruits and vegetables that are high in fiber can also help. Remember, do not take laxatives unless your surgeon has prescribed them.
• Drinking alcohol and taking pain medicine can cause dizziness and slow your breathing. It can even be deadly. Do not drink alcohol while taking pain medicine.
• Pain medicine can make you react more slowly to things. Do not drive or run machinery while taking pain medicine.

Your health care provider may tell you to take acetaminophen to help ease your pain. Ask him or her how much you are supposed to take each day. Acetaminophen or other pain relievers may interact with your prescription medicines or other over-the-counter (OTC) drugs. Some prescription medicines have acetaminophen and other ingredients. Using both prescription and OTC acetaminophen for pain can cause you to overdose. Read the labels on your OTC medicines with care. This will help you to clearly know the list of ingredients, how much to take, and any warnings. It may also help you not take too much acetaminophen. If you have questions or do not understand the information, ask your pharmacist or health care provider to explain it to you before you take the OTC medicine.

Managing nausea

Some people have an upset stomach after surgery. This is often because of anesthesia, pain, or pain medicine, or the stress of surgery. These tips will help you handle nausea and eat healthy foods as you get better. If you were on a special food plan before surgery, ask your doctor if you should follow it while you get better. These tips may help:

• Do not push yourself to eat. Your body will tell you when to eat and how much.
• Start off with clear liquids and soup. They are easier to digest.
• Next try semi-solid foods, such as mashed potatoes, applesauce, and gelatin, as you feel ready.
• Slowly move to solid foods. Dont eat fatty, rich, or spicy foods at first.
• Do not force yourself to have 3 large meals a day. Instead eat smaller amounts more often.
• Take pain medicines with a small amount of solid food, such as crackers or toast, to avoid nausea.

Call your surgeon if

• You still have pain an hour after taking medicine. The medicine may not be strong enough.
• You feel too sleepy, dizzy, or groggy. The medicine may be too strong.
• You have side effects like nausea, vomiting, or skin changes, such as rash, itching, or hives.

If you have obstructive sleep apnea

You were given anesthesia medicine during surgery to keep you comfortable and free of pain. After surgery, you may have more apnea spells because of this medicine and other medicines you were given. The spells may last longer than usual.

At home:

• Keep using the continuous positive airway pressure (CPAP) device when you sleep. Unless your health care provider tells you not to, use it when you sleep, day or night. CPAP is a common device used to treat obstructive sleep apnea.
• Talk with your provi

Procedural Sedation

Procedural sedation is medicine to ease discomfort, pain, and anxiety during a procedure. The medicine is often given through an intravenous (IV) line in your arm or hand. In some cases, the medicine may be taken by mouth or inhaled. While you are under sedation, you will likely be awake. But you may not remember anything afterward.

Why procedural sedation is used

Sedation is used for many types of procedures. The goal is to reduce pain, anxiety, and stressful memories of a procedure. It can also help your health care provider treat you. For example, having a broken bone fixed may be easier if you feel relaxed.

Procedural sedation is used only for short, basic procedures. It is not used for complex surgeries. Some procedures that use this type of sedation include:

• Dental surgery
• Breast biopsy, to take a sample of breast tissue
• Endoscopy, to look at gastrointestinal problems
• Bronchoscopy, to check for lung problems
• Bone or joint realignment, to fix a broken bone or dislocated joint
• Minor foot or skin surgery
• Electrical cardioversion, to restore a normal heart rhythm
• Lumbar puncture, to assess neurological disease

Risks of procedural sedation

Procedural sedation has some risks and possible side effects, such as:

• Headache
• Nausea and vomiting
• Unpleasant memory of the procedure
• Lowered rate of breathing
• Changes in heart rate and blood pressure (rare)
• Inhalation of stomach contents into your lungs (rare)

Side effects will likely go away shortly after the procedure. Your health care team will watch your heart rate and breathing during your sedation. This is to help prevent problems.

Your own risks may vary based on your age and your overall health. They also depend on the type of sedation you are given. Talk with your health care provider about the risks that apply most to you.

Getting ready for procedural sedation

Talk with your health care provider how to get ready for your procedure. Tell him or her about all the medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs, and other supplements. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin. If you smoke, you may need to stop. Talk with your health care provider if you need help to stop smoking.

Tell your health care provider if you:

• Have had any problems in the past with sedation or anesthesia
• Have had any recent changes in your health, such as an infection or fever
• Are pregnant or think you may be pregnant

Also, make sure to:

• Ask a family member or friend to take you home after the procedure. You cannot drive on the day you receive sedation.
• Not eat or drink after midnight the night before your procedure, if advised.
• Follow all other instructions from your health care provider.

During your procedural sedation

You may have your procedure in a hospital or a medical clinic. Sedation is done by a trained health care provider. In general, you can expect the following:

• You will be given medicine through an IV line in your arm or hand. Or you may receive a shot. The medicine may also be given by mouth. Or you may inhale it through a mask.
• If you receive medicine through an IV, you may feel the effects very quickly. You will start to feel relaxed and drowsy.
• During the procedure, your heart rate, breathing, and blood pressure will be closely watched. Your breathing and blood pressure may decrease a little. But you will likely not need help with your breathing. You may receive a little extra oxygen through a mask.
• You will probably be awake the entire time. If you do fall asleep, you should be easy to wake up, if needed. You should feel little or no pain.
• When your procedure is over, the sedative medicine will be stopped.

After your procedural sedation

You will begin to feel more awake and aware. But you will likely be drowsy for a while afterward. You will be closely watched as you become more alert. You may have a faint memory of the procedure. Or you may not remember it at all.

You should be able to return home within an hour or two after your procedure. Plan to have someone stay with you for a few hours. Side effects such as headache and nausea may go away quickly. Tell your health care provider if they continue.

Don't drive or make any important decisions for at least 24 hours. Be sure to follow all after-care instructions.

When to call your health care provider

Have someone call your health care provider right away if you have any of these:

• Drowsiness that gets worse
• Weakness or dizziness that gets worse
• Repeated vomiting
• You cant be awakened