Frequently Asked Questions

Anesthesia is typically very safe, with an estimated rate of mortality of less than one in a million. (Read below, if you want a citation and further information).

This is based on the study done by Gouhua Li and other authors.

(Guohua Li, M.D., Dr.P.H.; Margaret Warner, Ph.D.; Barbara H. Lang, B.S.; Lin Huang, M.S.; Lena S. Sun, M.D.

Anesthesiology April 2009, Vol. 110, 759–765.

https://doi.org/10.1097/ALN.0b013e31819b5bdc)

"The anesthesia-related death rate was 1.1 per million population per year,

 with the rate for males almost twice the rate for females (1.45 vs.  0.77).

 The death rate varied with age (fig. 2). For both sexes,

 the lowest rate was found in children aged 5–14 yr,

 and the highest rate was found in those aged 85 yr or older. 

Males had higher death rates than females throughout the life span,

 and the gap between sexes was especially pronounced in young and middle-age adults."

Dr. Li further points out that:

"In the advent of new anesthesia techniques, drugs, and enhanced training, 

anesthesia mortality risk has declined from approximately 1 death in 1000 anesthesia procedures in the 1940s to 1 in 10,000 in the 1970s and to 1 in 100,000 in the 1990s and early 2000s.

The results of our study suggest that the United States has experienced a 97% decrease in anesthesia-related death rates since the late 1940s."

The point of all this is that office surgery is very safe. 

In short, one of the benefits of outpatient anesthesia is the avoidance of the hospital (where most of the anesthesia related deaths do occur). 

Outpatient candidates are generally healthier and undergoing smaller procedures (think colonscopy vs. liver transplant), where doses of anesthesia given are typically much lower.

And preoperative visits to the primary physician (or a screening H & P) are usually very good at detecting potential hazards to undergoing anesthesia.

If you have any medical problems (heart attacks, lung problems, a history of strokes, severe allergies, high blood pressure, liver or kidney problems), you may need to see a primary physician prior to your procedure to ensure you are in optimal condition for surgery.

In rare circumstances, your procedure may need to be scheduled at the hospital.

The main reason for not being able to eat prior to anesthesia is the risk for vomiting while under anesthesia.

The body naturally protects the airway when vomiting occurs (while fully awake).

However, this reflex is lost (or blunted) while under anesthesia.

If vomiting were to occur while under anesthesia, there is a danger of the vomitus entering the lungs.

This can produce a condition known as "aspiration pneumonitis" and can end in death or a prolonged ICU stay.

For this reason, we typically ask a patient to avoid eating for eight hours prior to surgery.

The literature has shown that there is no additional risk for taking medications with small sips of water, especially blood pressure meds.

In some cases it may be permissible to have clear liquids four hours before surgery, but this should be cleared through your surgeon or anesthesiologist!

The safest thing to do is to avoid food for eight hours prior to surgery.

The anesthesia provider will (once a IV is started) rehydrate you and check a sugar level (in the case of diabetes).

If your blood sugar is low, sugar will be given to you through the IV.

Given the modern techniques and drugs and anesthesia, many surgeries can be performed on an outpatient or in the office basis.

The notable exceptions to this include surgeries that involve working inside the abdomen, the chest or the neck.

It is likely that your surgeon has already given a good amount of consideration to whether or surgery can be performed in the office.

Benefits of having it at the office include: 

• avoidance of contact with other patients,
• improved wake-up times, 
• decrease costs 
• and availability of equipment that the surgeon would otherwise need.

If you have severe medical problems, especially those related to your heart, lung, liver or kidneys, please alert your surgeon or anesthesiologist.

Having these conditions does not mean that your surgery can not be done and the office or on an outpatient basis; but it may mean that special accommodations have to be made. 

If a medical condition is severe, then it may have to be done at the hospital, for safety reasons.

The drugs used for an anesthetic and vary depending on 

• the type of surgery, 
• the patient,
• the presence of medical problems, 
• and patient requests.

At Lakeshore Anesthesia we attempt to tailor our anesthetic to meet your needs.

Some of the drugs that are commonly used in anesthesia include the inhalational agents (the gases you breathe while under).

These are commonly use of the hospital, and can cause nausea and vomiting. We generally try to avoid these.

One drug that we find very beneficial is propofol, as it provides excellent anesthesia, and usually minimizes the chances of nausea and vomiting.

Fentanyl is a drug similar to morphine, and is used to help control pain postoperatively. 

We try to use this in small amounts, as Fentanyl (and all opiates) can cause nausea and vomiting in large doses.

Versed is a drug that helps patients relax and creates amnesia (the inability to remember). This is a very beneficial effect when used in reasonable doses.

Other drugs that might be used include:

• Anti-emetics which help in preventing nausea and vomiting.
• Local anesthesia, which blocks the transmission of nerve impulses and will be injected by the surgeon or the anesthesiologist (generally after you are asleep).
• Medications to control heart rate and blood pressure can be used when the need arises.
• Antibiotics are indicated for some surgeries.
• Steroids, or other anti-inflammatories, may be used to decrease swelling and postoperative pain.

Pain during the operation is generally controlled with the anesthetic itself and judicious use of opiates. This generally renders a patient unaware and pain-free during surgery. This essentially is the entire purpose behind anesthesia.

However, there has to be some consideration given to pain control as a patient wakes up from the surgery, too.

Post operative pain is controlled 

• with the use of local anesthesia (typically injected at the site), 
• through the  an injection of opiates (examples of which include morphine, fentanyl or Demerol (among others))
• and administeration of anti-inflammatories (steroids, NSAIDs).

In specific cases a specialized block can be performed, which will render the area numb for several hours.

If there is still pain postoperatively, small doses of IV and oral medication can be given in the recovery room.

The answer to this question is a qualified 'yes'.

Many procedures can be done under local anesthesia, and, of course, depend upon a given patient's ability to tolerate discomfort. However, most surgeons and anesthesiologists have considered the potential operation, and know what a patient is likely to be able to tolerate.

Generally, we try to run an anesthetic at a level that makes a patient comfortable and unaware, without putting them "too deep". This falls in line with the "tailoring of the anesthetic".

If you are being offered an anesthetic, it is because the surgeon and anesthesiologist know that it's very difficult to perform without anesthesia.

One of the side benefits of anesthesia is that it generally makes the patient very still and saves the surgeon from having to work on a "moving target".

If you are truly concerned and wish to avoid anesthesia, you should talk to your anesthesiologist (no charge of fee for just talking about it). 

It also may be possible to minimize the anesthesia ("some, but not a lot"), but this often requires a degree of pain tolerance and the consent of the surgeon.

Certainly there is no harm in requesting minimal to no anesthesia, and at Lakeshore Anesthesia we try to be as accommodating as possible.

The short answer is "probably not".

The IV is the method by which we administer anesthesia.

Even if you were going without anesthesia for the procedure, it would still be wise to have an IV. 

The IV is there to provide medications in case of an emergency or if there was a need to convert to a full anesthetic.

At Lakeshore Anesthesia, we try to do things to minimize the trauma of the needlestick, especially for patients who are "needle phobic".

• We typically use a very small gauge IV (24 gauge).
• Also, we use a device, called a "Vein-lite" for patients who have poor veins. This generally helps us achieve IV access on the first 'stick'.

In short, the pain of a single IV stick is well worth it to avoid and minimize any pain during and after the procedure.

At Lakeshore Anesthesia, we realize that many people are "needle phobic".

We do our best to minimize this trauma in starting an IV.

24 gauge are about the smallest needle we can use. We 24 gauge IVs use this routinely. 

Our providers start IVs regularly and we are usually very adept at getting it on the first stick.

For patients who typically have difficulty with IV starts, we have a device called a Vein Lite. 

This device lights up and maps the veins. It usually makes it much easier to get an IV on the first try. We will try everything to make the IV start as pain-free as possible.

Awareness under anesthesia is a uncommon situation in which patients are aware while under anesthesia. This is a fairly rare phenomenon. It is estimated that 'awareness' occurs once in every 3000 surgeries. 

At Lakeshore Anesthesia, we have proprietary techniques, which we believe we make this much more rare. I know of no incident in which one of my patients has been aware while under anesthesia.

With that explanation, the chances are never zero. 

We strive hard to make them as close to zero as possible.

Many cases of awareness involved no pain, but only hearing conversations in the OR.

With reasonable doses of Versed and Fentanyl, most cases of awareness are generally of conversations only. Therefore, at Lakeshore Anesthesia, we try to give adequate doses of Fentanyl and Versed.

We also monitor blood pressure and heart rate closely which may be early signs of potential awareness. We also do not use muscle relaxants, which make awareness more likely. Avoidance of muscle relaxants is a key factor.

If you are particularly worried about awareness under anesthesia, please tell your anesthesiologist. There are things that can be done to make this go from a rare event to a vanishingly rare event.