News

11/18/2008

Chugach Anesthesia is a Premera Blue Cross in-network provider.

Frequently Asked Questions

 

Q Are there different kinds of anesthesia?
A There are three main categories of anesthesia: local, regional, and general. Each has many forms and uses.

In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery, for example, on the hand or foot. In regional anesthesia, your anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake, or you may be given a sedative. You do not see or feel the actual surgery take place. There are several kinds of regional anesthesia. The most frequent types used at the Alaska Surgery Center are peripheral nerve blocks, which are produced by injections made with great exactness in the appropriate around the nerves supplying the surgical site. 

In general anesthesia, you are unconscious and have no awareness or other sensations. There are a number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein. During anesthesia, you are carefully monitored, controlled and treated by your anesthesiologist, who uses sophisticated equipment to track all your major bodily functions. A breathing tube may be inserted through your mouth and frequently into the windpipe to maintain proper breathing during this period. The length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesiologist will reverse the process and you will regain awareness in the recovery room.

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Q Who Administers Anesthesia?
A Anesthesia can be administered by an Anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA). Both anesthesia providers are highly skilled in administering anesthesia, and all of Chugach’s anesthesia providers have many years of experience in providing safe and comfortable anesthesia. 

On the day of your surgery, you will meet your anesthesia provider who will ask you questions about your medical history and answer any questions you may have about the anesthesia for your procedure. This information is important to help your anesthesia provider understand your medical condition in order to provide you with safe and comfortable anesthesia.

 

Q What are the risks of anesthesia?
A All operations and all anesthesia have some risks, and they are dependent upon many factors including the type of surgery and the medical condition of the patient. Fortunately, adverse events are very rare. Your anesthesiologist takes precautions to prevent an accident from occurring just as you do when driving a car or crossing the street.

The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your anesthesia.

 

Q What about eating or drinking before my anesthesia?
A As a general rule, you should not eat or drink anything after midnight before your surgery. Under some circumstances, you may be given permission by your anesthesiologist to drink clear liquids up to a few hours before your anesthesia. This is essential in preventing vomiting during and after anesthesia. If you were to violate these guidelines, your surgery may be postponed or even cancelled.

 

Q What are some of the problems patients experience coming out of general anesthesia?
A After general anesthesia, the most common complication is nausea. This occurs more frequently in those who have experienced nausea with previous anesthetics, and those who are susceptible to motion sickness. Those with diabetes and obesity, are also more prone to getting sick. This problem can be prevented or treated if it occurs. Minor complications such as sore throat, headache, hoarseness, drowsiness, muscle aches, and fatigue are common for the first several days following surgery. Most patients do not experience these problems, but should these problems occur, your anesthesiologist can try to prevent a recurrence of the problem. At the end of the operation you may feel pain in the operated area. Anesthesiologists have developed their treatment so that it is possible to avoid severe pain in most circumstances, particularly after surgery.

 

Q What is regional anesthesia?
A Regional Anesthesia is the technique of rendering a portion of a patients' body insensate to surgical stimuli. A patient may be having surgery on a part of the body such as the hand, foot or shoulder and not even realize that the operation is occurring! This is accomplished by placing a local anesthetic medication (the "-caine" drugs) near the nerves which go to that portion of the body. Examples of regional blocks include spinals, epidurals or peripheral nerve blocks.

There are many advantages of regional anesthesia compared to general anesthesia. Regional anesthetics have been associated with less post-operative pain and less nausea. More importantly, a lower incidence of blood clots, less blood loss, and less of a stress response by the body have also been reported. Finally, many patients who have experienced both general and regional anesthetics often prefer the "regional" experience. Regional anesthesia is particularly appealing to patients undergoing orthopedic procedures. These procedures often involve the limbs and are associated with a significant amount of post-operative pain. For this reason, anesthesiologists at the Alaska Surgery Center have dedicated themselves to perfecting the art and science of regional anesthesia.

Of course there is more to regional anesthesia than placing a local anesthetic near a nerve. Some patients prefer to be awake during the surgery and some prefer to be asleep. Either is possible with regional anesthesia. The patient's preferences can be discussed with the anesthesiologist prior to surgery.

As with general anesthesia, patients can react differently to regional anesthetics. Therefore, from the moment the patient enters the operating room until the time the patient is comfortable in the recovery room, the anesthesiologist is with the patient for the entire time. This is done to ensure the anesthetic is working perfectly and the patient is calm, comfortable and stable.

As with any anesthetic, there are risks associated with the benefits of regional anesthetics. Fortunately; serious complications associated with regional blocks are exceedingly rare. Prior to performing a regional block the anesthesiologist will discuss common and uncommon risks associated with regional anesthesia at your request.

The Department of Anesthesiology at Hospital for Special Surgery performs over 25 thousand regional anesthetics each year. This experience translates into a safe and efficient anesthetic experience for patients presenting for orthopedic surgery at Hospital for Special Surgery.

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Q When will I be able to see my family after surgery? What happens after my surgery is over?
A After your surgery is over, your anesthesiologist and your surgeon (or surgeon's assistant) will take you to the Post-Anesthesia Care Unit (PACU). If the operation is a simple one you may already be wide-awake, or if your surgery is more complex you could still be sleeping. In the PACU a nurse is assigned to your care and will continue to assess your well-being by checking vital signs such as blood pressure and heart rate, your level of wakefulness, and your pain control requirements.  Your family will be able to visit shortly after these parameters have been stabilized.

 

Q I have sleep apnea syndrome. Is there anything special I need to know?
A Sleep apnea is a relatively common disorder seen in our patients undergoing surgery. Although many patients with sleep apnea are admitted with the diagnosis, some patients are only diagnosed in the operating room by the anesthesiologist from the pattern of their breathing.

If you know that you have sleep apnea, please alert your surgeon, anesthesiologist, and the hospital staff. Special home equipment for sleep apnea such as nasal CPAP should be brought to the surgery center the day of surgery. As a precautionary measure, patients with sleep apnea are usually observed in the recovery room for a greater time after surgery to make sure that opiates (narcotics) or other pain killers prescribed to control pain after surgery do not interfere with respiration. The recovery room allows for constant monitoring of your breathing.

 

Q I have a lot of allergies. Is that a problem for anesthesia?
A Many people who come for surgery have allergies and it is extremely important that you inform your anesthesiologist of these. Your anesthesiologist (and the other doctors involved in your care) need to know not only what you might be allergic to, but also what type of reaction you had to that substance. Patients can be allergic to a variety of substances such as environmental particles, drugs (including anesthetics, antibiotics, pain medicines, etc.), latex, and foods or food components (eggs/milk, fruits, etc.). It is important to note all of these on your preoperative form and to inform your health care team.  You will even be given a wristband that indicates what drugs or substances you are allergic to.

Since not all reactions to medicines or other substances are true allergic reactions, it is important to specify exactly what happened as a result of a previous exposure. If you do not know what the reaction was, it is ok, still include that substance as a possible cause of allergy.

Some people have allergies specifically to anesthetic agents. These can range from typical allergic reactions that cause skin rashes, hives, breathing problems and/or anaphylaxis to a very rare condition called malignant hyperthermia. It is especially important that your anesthesiologist know of any history of these types of reactions. Your anesthesiologist can find safe, alternative ways of giving you anesthesia without using those substances that have caused problems in the past. For your safety, your anesthesiologist may even recommend preoperative testing by an allergist to confirm true drug allergies.

If you do have an allergic reaction in the hospital, it can be treated. However, the safest way to avoid these types of problems is by avoiding exposure. This is why your reporting of previous allergic reactions is so important.

 

Q I've heard I can get blood clots after surgery. What is the risk, and what can be done to reduce the risk?
A A blood clot will form within a blood vessel when there is damage to the blood vessel wall. This occurs when the rate of blood flow is diminished, or when these is an increased clotting tendency (hypercoagulability). The rate of blood clot formation varies greatly, depending on the type of surgery. Total hip and knee replacements have some of the highest rates of deep venous thrombosis of the leg, generally felt to be 30-50%. While most of these blood clots do not cause symptoms, about 1 in 100 patients having a joint replacement will have a clot break off and travel through the heart to the lungs (a pulmonary embolus) which can profoundly affect circulation and respiration. 

Smoking, obesity, and estrogen all increase the risk of blood clot formation. You may want to discuss modifying these risk factors with your doctor prior to surgery. Be sure to tell your doctor if you've had a pervious blood clot.

Postoperatively, you can promote blood flow and reduce your risk of blood clots by doing exercises that will be prescribed, and walking with assistance as soon as possible. You may be given a medication to make the blood less coagulable and/or given a device that intermittently squeezes your calves or feet to promote blood flow.

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Q Will I experience a lot of pain after surgery?
A Postoperative pain control is an important focus for us at the Alaska Surgery Center. Your anesthesiologist plays an essential role in planning and maintaining your comfort during and after your surgery. Surgery in general and orthopedic surgery specifically results in postoperative pain. To eliminate pain totally after surgery would require complete anesthesia, and the resulting motor weakness and lack of tactile sensations would hinder the recovery and rehabilitation process. Furthermore, pain medications can have side effects such as sedation, nausea, vomiting, or disorientation. The goal of postoperative pain management, therefore, is to control the pain and reduce it to a level that does not distract you from your daily activity and enables you to function and participate with physical therapy. Initially after surgery, pain is managed by various modalities, including epidural infusions, local anesthetic infusions near peripheral nerves, or intravenous/patient controlled infusions of opiates (PCA). As pain gradually lessens in the days following surgery, you will be switched to oral medications. Usually, before going home your surgeon will write you a prescription for medication for pain control to be taken after you leave the hospital.

 

Q I'm afraid I'm going to wake up during my surgery. Is this going to happen?
A If you are concerned about this issue, please discuss it with your anesthesiologist before surgery. During general anesthesia, it is extremely rare to experience what is referred to as "recall". However, this is dependent on the anesthetic technique and the amount and type of drugs that are administered by your anesthesiologist. During regional anesthesia (i.e. spinal, epidural, or nerve block) you may be choose to be anywhere from wide-awake to fully asleep. Many of the sedatives used have memory-blanking properties, and although you may be awake and conversant during the procedure you may have no recollection of these events later, (this is known as conscious sedation or "twilight sleep"). Your level of consciousness is very much under the control of your anesthesiologist. In many cases, your anesthetic can be "customized" to meet your expectations.

 

Q Should I take my usual medicines?
A Some medications should be taken and others should not. It is important to discuss this with your anesthesiologists. Do not interrupt medications unless your anesthesiologist or surgeon recommends it.

 

Q Could herbal medicines and other dietary supplements affect my anesthesia if I need surgery?
A Anesthesiologists are conducting research to determine exactly how certain herbs and dietary supplements interact with certain anesthetics. They are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists anticipating a possible reaction is better than reacting to an unexpected condition. So it is very important to tell your doctor about everything you take before surgery.

 

Q Should I stop smoking before my surgery?
A The bottom line is - quit smoking now! Your surgery represents a golden opportunity to do so. There is evidence that smokers who quit at or before surgery experience fewer symptoms of nicotine withdrawal and are more likely to succeed in their attempt to stop smoking long term.

You can find the materials that the ASA has developed to help you stop smoking at http://www.asahq.org/patientEducation/smoking_cessation.htm.
It's hard to do it on your own entirely, and the use of nicotine replacement therapy (NRT) - that is the nicotine patch or gum - can definitely help keep you off the cigarettes.

 

Q Do you take my insurance? What about Medicare?
A Like charges from your surgeon, your anesthesiologist's fees are not included in your hospital bill.  Many insurance plans cover our charges in full but some do not.  While all of our physicians participate with Medicare and Medicaid, we may not participate with your specific insurance plan.  To obtain information about your particular insurance plan, we recommend that you contact your insurer.

Regardless of your insurance coverage, you will receive a bill for anesthesia services.  Our billing company (ABC Medical Billing Services Inc.) will also file this claim directly with your carrier.  In many cases you may be required to intervene with your insurance company to ensure that they cover all the charges they should.  ABC will assist you in this process.  If you have an outstanding balance after your insurance payment you will be responsible for that amount. In the case of financial hardship or other extenuating circumstances, you must contact ABC to resolve the matter.

If you have further questions about our billing practices, please feel free to contact ABC toll-free at 1-800-477-2094

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