Total care before, during and after surgery
Anesthesiology is the specialty of medicine that deals with total care of a patient before, during and after surgery. As an integral part of your surgical care team, anesthesiologists are responsible for closely monitoring and managing changes which are altered by anesthesia medications and surgery, such as heart rate, breathing and blood pressure. Their primary role is to be your advocate in the operating room and make informed medical decisions to keep you safe.
Preoperative care
Several days, or even weeks prior to your procedure, you will meet with a nurse in pre-anesthesia testing (PAT). In PAT, there will be a thorough evaluation of your medical background. On the day of surgery, your anesthesiologist will meet with you to go through your background once again. Based on the review of your background and clinical assessment, an anesthesia care plan will be devised that anesthesiologist determines is the safest. All benefits and risks will be discussed with you during this time as well. Your anesthesiologist may provide direct physician care or lead an anesthesia care team, which includes a dedicated nurse anesthetist.
Intraoperative care
Main Line Health anesthesiologists provide services at our hospitals and health centers located throughout the Philadelphia suburbs, offering all types of anesthesia care to meet your needs, including:
- General anesthesia – This type of anesthesia is used for major operations, such as gallbladder surgery or spine surgery for example. Under general anesthesia, you are completely unaware. You are started either with medications that go through an intravenous line or by breathing it in through a face mask.
- Regional anesthesia – With regional anesthesia, local anesthetics will be injected around major nerves which results in numbing a large part of the body.
- Spinal anesthesia: With spinal anesthesia, numbing medication is injected around fluid surrounding spinal nerves in the lower back. This injection is done below the level of the spinal cord itself. The medication injected will block transmission of pain reception and cause numbness from the waist done. The block is rapid onset and safe. Spinal anesthesia is effective for procedures involving lower abdomen and lower extremities.
- Epidural anesthesia – Epidural anesthesia is similar to spinal anesthesia. The difference lies in where the medication is injected. In epidural anesthesia, the numbing medicine is given in the space surrounding the sac containing the spinal fluid and the spinal cord. A catheter can be threaded into this space therefore allowing your anesthesiologists to give additional numbing medication or start a continuous infusion. Epidural are not as rapid onset as a spinal and usually takes about 15–30 minutes for adequate effect.
- Peripheral nerve block – A peripheral nerve block is the injection of local anesthesia around the nerves that supply sensation to area of surgery. Peripheral nerve blocks are reserved for surgeries of the arms, legs and abdomen. These nerve blocks last several hours, and therefore will give the patient an extra measure of pain control during surgery and recovery.
- Monitored anesthesia care (MAC) or intravenous (IV) sedation – Certain types of procedures can be performed under monitored anesthesia care (MAC) or intravenous (IV) sedation. In this type of anesthesia, medications will be given through an intravenous line resulting in sleepiness, analgesia and relaxation. This type of anesthesia is commonly referred to as “twilight” anesthesia. Depending on the surgery, the level of sedation may range from minimal, in which you may be sleepy but able to talk, or deep, in which you may not remember the procedure. MAC anesthesia is usually combined with local anesthesia, which involves numbing a small portion of the patient’s body or regional anesthesia, as described above.
Postoperative care
Following the surgical procedure, you will be transferred to the recovery room or the Post Anesthesia Care Unit (PACU). This area is staffed by specialized nurses and a consulting anesthesiologist who continue to monitor your vital signs. The supervising anesthesiologists is readily available should any questions or concerns arise during a patients recovery.
