Honest and open communication between you and your nurse anesthetist prior to surgery is essential in order to enhance your safety and build a spirit of teamwork. Before surgery, a preoperative interview with your nurse anesthetist provides valuable information that helps determine your care. It is equally important to communicate with your anesthesia provider after your surgery. The medications you have been given can remain in your body for 24 hours or more after they have been administered, and you won’t be “back to your old self” until the anesthetic has been totally eliminated.
Please feel free to ask your nurse anesthetist any questions you might have — before and after your anesthesia is administered.
During the procedure, anesthesia allows you to be free of pain. All anesthesia care is provided with the highest degree of professionalism, including constant monitoring of every important body function. As changes occur in your reactions to anesthesia, the nurse anesthetist responds with modifications of the anesthetic to ensure your safety and comfort.
In addition to their role in the procedure itself, nurse anesthetists make many preparations for you before surgery. You can — and should — take an active role in these preparations by communicating and cooperating with your nurse anesthetist and your surgeon.
There are several kinds of anesthesia.
The one chosen for you is based on factors such as your physical condition, the nature of the surgery and your reactions to medications. Frank and open discussion with your nurse anesthetist is key in the selection of the best anesthetic for you.
In particular, you must speak freely and follow instructions closely regarding your intake of medications, food or beverages before anesthesia. Such substances can react negatively with anesthetic drugs and chemicals.
The preoperative interview is essential to effective communication.
This confidential discussion with the nurse anesthetist prior to surgery provides information vital to your care. You may be given a questionnaire to fill out and bring along to the preoperative interview. Information supplied by the questionnaire assists your nurse anesthetist in doing the interview thoroughly and efficiently.
Different types of patients or procedures may require different types of anesthesia.
Speak frankly. Ask questions. Follow instructions. Provide your nurse anesthetist with a medical history. And, notify your nurse anesthetist or doctor immediately of any change in your physical condition prior to surgery. Communication and cooperation are essential to the anesthesia process.[/section] [section name=”Your Role After Surgery”]
Anesthesia means freedom from pain during surgery.
All anesthesia care is provided with the highest degree of professionalism. Sensitive equipment monitors every important function of your body. In response to your body’s reactions, the nurse anesthetist modifies your anesthetic as needed.
But anesthesia care is not confined just to surgery. The process also refers to activities that take place — before and after — an anesthetic is given. Before anesthesia, a preoperative interview with your nurse anesthetist supplies valuable information that helps determine your care. Open communication and cooperation are essential during the interview.
Communication and cooperation are necessary after surgery as well.
The medications that you have been given can remain in your body for up to 24 hours after their administration. You are not completely “back to your old self” until the anesthetic has been totally eliminated.
Also during this time, it is still possible for substances entering your body to interact with the anesthetic. Certain substances may cause negative reactions. Therefore, check with your care provider about what medications you can take. Continue to cooperate with your nurse anesthetist and physician after surgery. Don’t hesitate to ask questions.
After receiving anesthesia during a surgical procedure, you can play an active role in your recovery by heeding the straightforward list of do’s and don’ts that follows:
Communication and cooperation are essential to the anesthesia process. Active participation in your care helps ensure your safety and comfort.
“Do’s and Don’ts” After Anesthesia: A Quick Guide
Conscious sedation induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives. Patients who receive conscious sedation usually are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider.
Conscious sedation provides a safe, effective option for patients undergoing minor surgeries or diagnostic procedures. The number and type of procedures that can be performed using conscious sedation have increased significantly as a result of new technology and state-of-the-art drugs.
Conscious sedation allows patients to recover quickly and resume normal daily activities in a short period of time. A brief period of amnesia may erase any memory of the procedure.
Conscious sedation is administered in hospitals and outpatient facilities (for example, ambulatory surgery centers and doctors’ offices) to facilitate procedures such as the following:
Conscious sedation is extremely safe when administered by qualified providers: Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, other physicians, dentists and oral surgeons. Specifically trained registered nurses may assist in the administration of conscious sedation.
Because patients can slip into a deep sleep, proper monitoring of conscious sedation is necessary. Healthcare providers monitor the patient’s heart rate, blood pressure, breathing, oxygen level and alertness throughout and after the procedure. It is important that the provider who monitors the patient receiving conscious sedation has no other responsibilities during the procedure and remains with the patient at all times during the procedure.
A qualified provider monitors the patient immediately following the procedure. Written postoperative care instructions should be given to the patient to take home. Patients should not drive a vehicle, operate dangerous equipment or make any important decisions for at least 24 hours after receiving conscious sedation. A follow-up phone call usually is made by the healthcare provider to check on the patient’s condition and answer any remaining questions.
A brief period of amnesia after the procedure may follow the administration of conscious sedation. Occasional side effects may include headache, hangover, nausea and vomiting or unpleasant memories of the surgical experience.
Following is a list of questions patients should ask prior to the surgical or diagnostic procedure:
Every woman experiences childbirth in her own unique way. In preparing for labor and delivery, some women are quite certain they will want pain relief. Some are unsure of their pain relief options and how they will affect their labor and delivery. Others would prefer to give birth without any pain relief.
No matter which category you fall into, it is important for you to know how anesthesia and pain relief are used in labor and delivery. Even if you fall into the latter category, you should know your options. Every woman should be prepared for the possibility of needing an anesthetic should an emergency arise.
This information will attempt to answer many of the questions you may have about the use of anesthesia in labor and delivery and give you a general overview of the various types of anesthetics available today. After reading this material, you may also want to meet with your obstetrical provider (obstetrician, family practitioner, nurse midwife) or an anesthetist to discuss the best pain relief and anesthesia options for you and your baby.
Obstetrical anesthesia is different from any other type of anesthesia in that there are two patients involved — you and your baby. It is important that you take both individuals into account when considering your anesthesia choices.
Another factor to be considered is that labor is unpredictable. It can range anywhere from relatively quick and easy to painful and exhausting. An important point to remember is that everyone experiences pain differently. Only you will know the level of pain you’re experiencing, so you should never feel guilty about asking for pain relief.
The ideal anesthetic should:
The ideal anesthetic should not:
There are several different forms of anesthesia administered for childbirth. They may be used independently or in conjunction with one another. Some of the most commonly administered anesthetics include:
Local infiltration – This series of local injections can make you more comfortable for delivery and for the placement of sutures if you need them.
Narcotics or tranquilizers – Administered as an injection or intravenously, narcotics or tranquilizers can help reduce the pain of labor but will not eliminate the pain entirely. They are also used to ease the anxiety that sometimes accompanies the delivery process.
Pudendal block – Administered as injections of local anesthetics to numb your vaginal area in preparation for delivery.
An epidural is a local anesthetic delivered through a tiny tube called a catheter placed in the small of the back, just outside the spinal canal. An advantage of the epidural is that it allows most women to fully participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. In most cases, the anesthetist will start the epidural when cervical dilation is 4 to 5 centimeters. Under certain circumstances, it may be desirable to place the epidural earlier.
This anesthetic is similar to an epidural, but because it is administered with a needle into the spinal canal, its effects are felt much faster. You may feel numb and need assistance in moving during the delivery. Spinal anesthetics are sometimes used for delivery by cesarean section or when forceps use is indicated.
Epidurals or spinals cannot be used if the patient:
General anesthesia is administered by giving anesthetic drugs intravenously and having the patient breathe anesthetic gases. A general anesthetic may be necessary if complications arise during delivery. Because general anesthetics can be administered quickly, they’re considered the best choice when time is of the essence. Also, general anesthesia enables the uterus to relax if your obstetrical provider finds it necessary.
What Your Anesthetist Should Know
In order for your anesthetist to determine which type of anesthesia is best for you and your baby, it is important that you inform your anesthetist about:
If you are a woman with any of these conditions, it is especially important that you meet with an anesthetist prior to going into labor.
Here are some of the questions frequently asked by pregnant women about the use of anesthesia in labor and delivery:
Because no two women experience pain or react to drugs in quite the same way, and because different anesthetic techniques have different effects, the answers to these questions will vary. There is no ideal anesthesia for everyone. This makes it very important for you to be informed — and discuss your options with your obstetrical provider and anesthetist. The purpose of anesthesia during labor and childbirth is to help you have the most positive birth experience possible. Anesthesia should not hinder you from enjoying your baby as soon as possible after delivery. You should be able to bond with and breast feed your baby, if you so desire. The better prepared you are before labor and delivery, the more rewarding the entire birth experience will be for you.
Acknowledgment: We gratefully acknowledge the assistance provided by Divina J. Santos, MD, and Carolyn J. Nicholson, CRNA, BSEd, Department of Obstetrical Anesthesiology, University of Cincinnati, Cincinnati, OH, and their videotape, “What Anesthesia Is Best for Me and My Baby?”[/section] [section name=”Anesthesia for Children”]
Surgery can be an emotional time. Surgery that is to be performed on your child can be especially stressful. There are things you can do to reduce the chance that your fears and anxieties, as a parent, will be transferred to your child. Children who are less anxious and less fearful have an easier time before and after surgery.
Remember your emotions and anxiety level influence your child. Keep calm and in control of your emotions to help your child do the same. Follow the recommendations listed to accomplish this goal. For more information, talk with your child’s physician, surgeon and nurse as well as staff at the hospital or surgicenter.
To Help You and Your Child Before Surgery and Anesthesia:
Ask your child’s doctor and nurse what you can do to care for your child after surgery and anesthesia.[/section]