Patient Guide to the Anesthetic Experience

The anesthesiologist is your advocate in the operating room.

As physician specialists and members of the surgical team, we are responsible for your welfare when you undergo anesthesia. Our job is to ensure your comfort and safety during surgery and to make informed medical judgments to protect you, such as treating and regulating changes in breathing, heart rate, blood pressure as they are affected by the surgery being performed. Your anesthesiologist immediately diagnoses and treats any medical problems that might arise during your surgery or recovery period. We also to manage any chronic medical conditions that may need special attention during your procedure and immediately afterward.

Preparing for Anesthesia

Regardless of the type of surgery or anesthesia you will be having, it is important to follow presurgical guidelines.

• There is no eating and drinking before any kind of procedure.
• You must not eat or drink anything after midnight the night before your surgery.
• You may take necessary medications with sips of water.
• If your child is to undergo anesthesia for any kind of procedure, please refer to the section on pediatric anesthesia for more specific guidelines.

Failure to adhere to these guidelines may result in delay or even cancellation of your surgery!

Before you come in for surgery, you should discuss all of your prescription and over-the-counter medications with your doctor or the person designated by your anesthesiologist to call you before surgery. Most of the time, you should continue to take all of your medication as usual.

During a preoperative visit, an anesthesiologist will carefully evaluate you and your medical history and will inquire about your prescription and over-the-counter medications, allergies, and prior experiences with anesthesia. This physician will also inform you about the procedures associated with your surgery and discuss the anesthetic choices including their risks and benefits. In some cases, you may not meet your anesthesiologist until you arrive in the operating room, but you will always have the opportunity to talk with him or her before you receive any sedation. You are encouraged to ask any questions and express any concerns you may have about your anesthesia. The type of anesthesia used for any given operation will depend on many factors which your anesthesiologist will discuss with you and your surgeon.

During your Surgery

Your anesthesiologist is responsible for your comfort and well-being. He/she leads the anesthesia care team to monitor as well as manage your vital body functions during your surgery. Your anesthesiologist is also responsible for managing medical problems that might arise related to surgery as well as any chronic medical conditions you may have, such as high blood pressure, heart problems, asthma, and diabetes. A member of your anesthesia team will be with you throughout the procedure.

After your Surgery

After surgery, you will be taken to the postanesthesia care unit (PACU) – often called the recovery room – where you will begin to recover from the effects of anesthesia used during your surgery.

Your anesthesiologist continues to be responsible for your care in the recovery room. Here, the anesthesiologist directs specially trained nursing staff who monitor your condition and vital signs as the effects of the anesthesia wear off. As you continue to recover you will receive a nutritional snack and a beverage, and you will be assisted in getting up. An anesthesiologist will determine when you are able to leave the recovery room.

Post-operative Pain Control

If you will be staying in the hospital after your surgery, our Inpatient Pain Medicine Division may be consulted for the treatment of your postoperative pain. This group of highly specialized anesthesiologists focuses on making sure you are as comfortable as possible after your surgery by using any number of pain treatment modalities, including patient-controlled analgesia (PCA) and patient-controlled epidural anesthesia (PCEA). It is very important to inform the pain specialist of all medications you take and any medical problems that you may so that we can best determine the options are appropriate for you.

Ambulatory Surgery

The majority of patients who undergo surgery or diagnostic tests at NewYork-Presbyterian/Weill Cornell do not need to stay overnight in the hospital. Ambulatory (or outpatient) anesthesia and surgical care has proven to be safe, convenient, and cost-effective. Short-acting anesthetic drugs, and specialized anesthetic techniques and care specifically focused on the needs of the ambulatory patient are used to make your experience safe and pleasant. Because each patient is unique, your anesthesiologist and your surgeon will carefully evaluate you, your health status, and the extent of your surgical procedure to determine if you should undergo ambulatory anesthesia.

Before Ambulatory Surgery

Ambulatory surgery patients will receive a telephone call from a hospital staff member on the day before surgery. During the call you will be told what time to come into the hospital and where to go. You will also be reminded to adhere to the fasting guidelines, as mentioned above.

After Ambulatory Surgery

After your early recovery from anesthesia, you usually will return directly home. Appropriate pain management will be included as part of your discharge planning. In most cases, family and friends can provide all the needed assistance. If you do not have family members or others to help at home, please let your surgeon know before scheduling an outpatient procedure; you may require additional help.

Side Effects

The amount of discomfort you experience will depend on a number of factors, especially the type of surgery. Your doctors and nurses can relieve pain after your surgery with medicines given by mouth, injection or by numbing the area around the incision. Your discomfort should be tolerable, but do not expect to be totally pain-free.

Nausea or vomiting may be related to anesthesia, the type of surgical procedure, or postoperative pain medications. Although less of a problem today because of improved anesthetic agents and techniques, these side effects continue to occur for some patients.

Rest assured that every effort will be made by your anesthesiologist, your surgeon, and the nurses taking care of you in recovery to minimize postoperative pain, nausea, and vomiting.

Going Home

Most patients are ready to go home between one and four hours after surgery. Before you are discharged, you will be given written discharge instructions that the nurse will review with you and your family. Any other special instructions will also be discussed. You will be given prescriptions if needed. You are encouraged to ask questions! Be sure you understand how to take care of yourself at home before you leave the hospital.

You must make arrangements for a responsible adult to take you home after your anesthetic or sedation. Your surgery will be cancelled if you have not arranged an escort. In addition, it is strongly suggested that you have someone stay with you during the first 24 hours after your surgery. If you have local anesthesia only, with no sedation, it may be possible to go home without someone to accompany you. Check with your doctor first.

Recovery at Home

Be prepared finish your recovery at home. Patients often experience drowsiness and minor after-effects following ambulatory anesthesia, including muscle aches, a sore throat, and occasional dizziness or headaches. Nausea may also be present, but vomiting is less common. These side effects usually decline rapidly in the hours following surgery, but it may take several days before they are gone completely. In general, for 24 hours after your anesthesia:

• Do not drink alcohol
• Do not take any medications not authorized by your surgeon
• Do not drive a car or operate dangerous machinery
• Do not make important decisions
• Do not travel alone on public transportation
• Do not care for a dependent person

Most patients do not feel up to their typical activities the next day, usually due to general tiredness or surgical discomfort. Plan to take it easy for a few days until you feel back to normal. Know that a period of recovery at home is common and to be expected.

Remember to ask questions! Your experience will be easier if you know what usually happens and what you should expect. Remember, the focus of ambulatory anesthesia is on you, the patient.