About Anesthesia
Hospital Based Anesthesia
Sedation Analgesia
Regional Anesthesia
General Anesthesia
Anesthesia for Labor and Delivery
Inpatient Pain Management
Out Patient Pain Management
Ankle Nerve Block
Axillary Brachial Plexus Block
Epidural for Childbirth
Femoral Nerve Block
Interscalene Brachial Plexus Block
Patient-Controlled Epidural Analgesia (PCEA)
Popliteal Fossa Block

Hospital Based Anesthesia

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Sedation Analgesia

Sedation analgesia can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests. It involves using medications for many types of procedures without using general anesthesia, which causes complete unconsciousness.
Sedation analgesia is usually administered through an intravenous catheter, or “I.V.,” to relax you and to minimize any discomfort that you might experience. This is often used in combination with an injection of a local anesthetic, or “numbing medicine,” at the site of surgery. Oftentimes, sedation analgesia can have fewer side effects than may occur with general anesthesia. Frequently, there is less nausea from sedation techniques, and patients generally recover faster after the procedures.
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Regional Anesthesia

In regional anesthesia, your anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. There are several kinds of regional anesthesia. Two of the most frequently used are spinal anesthesia and epidural anesthesia, which are produced by injections made with great exactness in the appropriate areas of the back. They are frequently preferred for childbirth and prostate surgery. Another common type of regional anesthesia is a peripheral nerve block, which is produced by injections made with great exactness near a cluster of nerves to numb the appropriate area of your body extremity (arm, leg, head) that requires surgery. Two of the most frequently used are femoral nerve block, which is produced by injection in the leg region, and brachial plexus block, which is produced by injection in the arm and shoulder region. These blocks are frequently performed for surgery in the knee, shoulder, or arm.
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General Anesthesia

What is general anesthesia?
General anesthesia refers to a state of unconsciousness (like a deep sleep) that enables you to comfortably undergo surgery.

How is general anesthesia administered?
Usually, general anesthesia is started by inducing sleep with medication (such as propofol) injected into the intravenous (IV) line. A wide array of medications may be administered through your IV or as a gas through a breathing tube (endotracheal tubes & laryngeal mask airways) or face mask to keep you asleep and maintain general anesthesia.
Endotracheal tubes (ET tubes) & Laryngeal Mask Airways (LMA’s) are usually placed after you are completely asleep and removed before you are aware of its presence. The ET tube is placed through your mouth or nose and into your ‘windpipe’ (trachea). It helps protect your lungs during surgery. The LMA is a different type of tube with a small air-filled mask on the end that rests in the back of your throat above your windpipe. The ET tube and LMA allow you to breathe oxygen and anesthetic gas during surgery. During general anesthesia, your vital signs are measured continuously and you are closely monitored throughout the surgery.

What happens after receiving general anesthesia?
After surgery, you will be taken to the recovery room or postanesthesia care unit (PACU) where you can rest and recover from the effects of anesthesia and surgery under the watchful eyes of skilled nursing personnel with anesthesiologist consultation immediately available. The duration of your recovery stay may range from one to three hours after which you will either be transferred to your room in the medical facility or be allowed to go home following outpatient surgery. Even though you may feel fairly alert, because your mental faculties are blunted, you should refrain from making any important decisions or driving a car for at least 24 hours.

Medications used during general anesthesia and surgery can potentially cause severe, but fortunately very rare, side effects which may adversely affect the kidneys, liver, heart, and central nervous system. Your anesthesia team closely monitors you for any signs of such adverse reactions and is prepared to treat any problems if they arise.

Aspiration of fluid or food into the lungs (aspiration pneumonitis) is a serious complication that necessitates having an empty stomach when undergoing anesthesia. (Please refer to fasting guidelines).

Other major complications include heart attack (myocardial infarction), stroke and death. A given patient’s risk for complications can depend largely on his or her medical condition as well as the type of surgery. The most feared complication of general anesthesia is death which is said to occur at rates of less than 1 in 10,000 but this figure incorporates both elective and high risk emergency surgeries for patients with all types of medical conditions. The risk of death is significantly lower for healthy patients undergoing elective surgeries.

Obstructive Sleep Apnea often manifests in the postanesthesia recovery period. Apnea refers to the cessation of breathing that can result in dangerously low oxygen levels. Patients using a CPAP machine at home should bring it to the hospital with them.

Minor complications occur at predictable rates even in previously healthy patients. Nausea is fairly common for a few hours after surgery. Other possible complications include: sore throat, hoarseness, damage to the mouth or teeth, shivering, lingering tiredness, delayed return to normal mental functioning.

Which medications should I take or skip prior to having general anesthesia?
There are several medications and classes of medications that warrant special attention prior to undergoing general anesthesia.

Blood Pressure Medications
Beta Blockers. If you are taking a beta blocker for high blood pressure, it is important for you to continue taking this medication up to the morning of your surgery and throughout your hospital stay. Abruptly stopping this type of medication can cause dangerous increases in your blood pressure and heart rate that can result in a heart attack. Beta Blockers include

  • Betapace (sotalol)

  • Lopressor (metoprolol)

  • Toprol (metoprolol)

  • Corgard (nadolol)

  • Normodyne (labetalol)

  • Trandate (labetalol)

  • Inderal (propranolol)

  • Tenormin (atenolol)

  • Zebeta (bisoprolol)

Aspirin & Non-steroidal Anti-inflammatory Drug (NSAIDs)
Aspirin & NSAIDs are usually avoided to avoid increased surgical bleeding. Please consult with your surgeon to confirm how long you should stop taking these medications. Examples of some commonly used NSAIDs include

  • Advil (ibuprofen)

  • Indocin (indomethacin)

  • Nuprin

  • Aleve (naproxen)

  • Mobic

  • Relafen

  • Daypro (oxaprozin)

  • Motrin (ibuprofen)

  • Voltaren (diclofenac)

  • Feldene (piroxicam)

  • Naprosyn (naproxen)

Chronic Pain Medications
Narcotic analgesics for chronic pain should be continued and taken on the morning of surgery in order to avoid worsening of the chronic pain.

Monoamine Oxidase (MAO) Inhibitors
MAO inhibitors can interact with certain medications and result in a hypertensive crisis (a sharp increase in blood pressure) that can lead to stroke, heart attack or death. When possible, they should be discontinued at least 2 weeks undergoing general anesthesia. MAO inhibitors include

  • Marplan (isocarboxazid)

  • Matulane (procarbazine)

  • Nardil (phenelzine)

  • Pargyline

  • Parnate (tranylcypromine)

Herbal Remedies
The American Society of Anesthesiologists recently issued a warning about the potential side effects and interactions of herbal remedies with medications used before, during and after surgery. Some of the observed risks include but are not limited to

  • increases in heart rate & blood pressure (increasing the risk of heart attack and stroke)

  • bleeding

  • increased sedative effect and duration of anesthesia.

The group recommends that a person stop taking all herbs at least two weeks prior to surgery.

If you have any questions or concerns regarding your medications, please don’t hesitate to contact us or your surgeon.
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Anesthesia for Labor and Delivery

The skilled physicians of AAA on available 24 hours each day and will work with your obstetrical team to provide you with a positive and comfortable labor and delivery experience. Depending on your particular circumstance, several options for pain relief during labor and delivery or cesarean section are available to you.

Systemic Analgesics
Systemic analgesics are often given as injections into a muscle or vein. They lessen pain but will not cause you to lose consciousness. They act on the whole nervous system rather than a specific area. Sometimes other drugs are given with analgesics to relieve the tension or nausea that may be caused by these types of pain relief. Like other types of drugs, this pain medicine can have side effects. Most are minor, such as nausea, feeling drowsy or having trouble concentrating. Systemic analgesics are not given right before delivery because they may slow the baby’s reflexes and breathing at birth.

Local Anesthesia
Local anesthesia provides numbness or loss of sensation in a small area. It does not, however, lessen the pain of contractions. A procedure called an episiotomy may be done by your doctor before delivery. Local anesthesia is helpful when an episiotomy needs to be done or when any vaginal
tears that happened during birth are repaired. Local anesthesia rarely affects the baby. There usually
are no side effects after the local anesthetic has worn off.

Regional Analgesia
Regional analgesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural analgesia, spinal blocks and combined spinal–epidural blocks are all types of
regional analgesia that are used to decrease labor pain.

Epidural Analgesia
Epidural analgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. An epidural block with more or stronger medications (anesthetics, not analgesics) can be used for a cesarean delivery or if vaginal birth requires the help of forceps or vacuum extraction. Your doctors will work with you to determine the proper time to give the epidural. An epidural block is given in the lower back into a small area (the epidural space) below the spinal cord. You will be asked to sit or lie on your side with your back curved outward and to stay this way until the procedure is completed. You can move when it’s done, but you may not be allowed to walk around. Before the block is performed, your skin will be cleaned and local anesthesia will be used to numb an area of your lower back. After the epidural needle is placed, a small tube (catheter) is usually inserted through it, and the needle is withdrawn. Small doses of the medication can then be given through the tube to reduce the discomfort of labor. The medication also can be given continuously without another injection. Low doses are used because they are less likely to cause side effects for you and the baby. In some cases, the catheter may touch a nerve. This may cause a brief tingling sensation down one leg. Because the medication needs to be absorbed into several nerves, it may take a short while for it to take effect. Pain relief will begin within 10–20 minutes after the medication has been injected. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel your doctor’s exams as labor progresses. Your anesthesiologist will adjust the degree of numbness for your comfort and to assist labor and delivery. You might notice a bit of temporary numbness, heaviness or weakness in your legs. Although rare, complications or side effects, such as decreased blood pressure or headaches, can occur. To help prevent a decrease in blood pressure, fluids will be given through a vein by a tube in the arm. This may increase the risk of shivering. However, a woman may shiver during labor and delivery even if an epidural is not given. Keeping a woman warm often helps to stop the shivering. Some women (less than 1 out of 100) may get a headache after the procedure. A woman can help decrease the risk of a headache by holding as still as possible while the needle is placed. If a headache does occur, it often subsides within a few days. If the headache does not stop or if it becomes severe, a simple treatment may be needed to help the headache go away. The veins located in the epidural space become swollen during pregnancy. Because of this, there is a risk that the anesthetic medication could be injected into one of them. If this occurs, you may notice dizziness, rapid heartbeat, a funny taste or numbness around the mouth when the epidural is placed. If this happens, let your doctor know right away.

Spinal Block
A spinal block—like an epidural block—is an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings good relief from pain and starts working fast, but it lasts only an hour or two. A spinal block can be given using a much thinner needle in the same place on the back where an epidural block is placed. The spinal block uses a much smaller dose of the drug, and it is injected into the sac of spinal fluid below the level of the spinal cord. Once this drug is injected, pain relief occurs right away. A spinal block is most often used for a cesarean delivery. It also can be used in a vaginal birth if the baby needs to be helped out of the birth canal with forceps or by vacuum extraction. Spinal block can cause the same side effects as epidural block, and these side effects are treated in the same way.

General Anesthesia
General anesthetics are medications that put you to sleep (make you lose consciousness). If you have general anesthesia, you are not awake and you feel no pain. General anesthesia often is used when a regional block anesthetic is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness. Therefore, it is often used when an urgent cesarean delivery is needed. A major risk during general anesthesia is caused by food or liquids in the woman’s stomach. Labor usually causes undigested food to stay in the stomach. During unconsciousness, this food could come back into the mouth and go into the lungs where it can cause damage. To avoid this, you may be told not to eat or drink once labor has started. If you need general anesthesia, your anesthesiologist will place a breathing tube into your mouth and windpipe after you are asleep. If you are having a cesarean delivery, you also will be given an antacid to reduce stomach acid. In some cases, ice chips or small sips of water are allowed during labor. Talk to your doctor about what is best for you.
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Inpatient Pain Management

Specialists who have completed advanced training in managing acute, chronic and cancer pain, along with the Clinical Nurse Specialist certified in pain management, work with patients and their medical team to provide ongoing pain management. Referrals for pain management may be through the Anesthesia Department by any Primary Care Physician or Specialist. Ongoing assessments and education are provided by the Clinical Nurse Specialist. Consultation includes a complete pain assessment and recommendation for a pain management program. The program may include the latest interventional pain management techniques, biotechnology as well as medication management.
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Out Patient Pain Management

Consultation, injections and operative pain procedures.

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