Anesthesia Associates of Southern Connecticut

General FAQ's

What training is required to become an Anesthesiologist?

An anesthesiologist is a medical doctor who has completed four years of undergraduate training, four years of medical school, and four years of residency training. Highly advanced subspecialty training, also referred to as a fellowship, may follow. Upon completion of residency, the anesthesiologist becomes eligible for the rigorous examination process leading to board certification by the American Board of Anesthesiology. All of our anesthesiologists are either board-certified or in the examination process.

Some anesthesia practices, including AASC, use certified registered nurse anesthetists (CRNA) who work under the supervision of an anesthesiologist. A CRNA is a registered nurse who has completed 24 months of additional anesthesia training under the direction of anesthesiologists.

When do I meet my anesthesiologist?

If you are having ambulatory surgery, you will meet your anesthesiologist on the day of surgery. He or she will review your record, and ask you questions pertinent to your anesthetic care.

If you have a complicated case or history you may be asked to come to our ambulatory surgery center several days before surgery for an interview. At that time the anesthesiologist will determine if any additional evaluation or testing needs to be done. This is not necessarily the anesthesiologist who will care for you during your surgery. If you are an inpatient or have come for surgery the night before surgery, an anesthesiologist will interview you in your hospital room.

Why can't I eat or drink before surgery?

Your safety is our most important consideration. Normally, protective airway reflexes ("gag reflex") prevent food or liquids from going down the "wrong pipe" (the trachea or windpipe) into your lungs. Everybody is familiar with the body's violent reaction when food goes down "the wrong pipe."

The protective airway reflexes are impaired under anesthesia, and are completely absent in general anesthesia. Food or liquid in the stomach can make its way into the throat (even without vomiting) and then down into the lungs. This is called aspiration and can cause a particularly virulent form of pneumonia. This is why patients are required to be "NPO" before surgery. ("NPO" is the medical term for fasting).

We follow the American Society of Anesthesiologists' NPO Guidelines American Society of Anesthesiologists
Summary of Fasting Recommendations to Reduce
the Risk of Pulmonary Aspiration
Clear Liquids
Breast Milk
Infant Formula
Non-human Formula
Light Meal
Regular Meal
2 hours
4 hours
6 hours
6 hours
6 hours
8 hours
These recommendations apply to healthy patients who are undergoing elective surgery. They are not intended for women in labor. Following the guidelines does not guarantee a complete gastric emptying has occurred. The fasting periods above apply to all ages.

Examples of clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. Since non-human milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period.

A light meal typically consists of toast and clear liquids. Meals that include fried or fatty foods or meat may prolong gastric emptying time. Both the amount and type of foods ingested must be considered when determining an appropriate fasting period.
regarding food and liquids before elective surgery. If these guidelines are not followed, your surgery might be delayed or even cancelled. For emergency surgery, special techniques are used to minimize the risk of aspiration. This usually involves the use of a breathing tube inserted immediately after the patient is asleep.

Is an IV necessary for every case?

Almost every patient receiving an anesthetic, regardless of type, needs an IV. The IV is usually started in the preoperative area, although in our surgicenters the IV is often started in the operating room. Antibiotics, fluids, blood, emergency drugs, pain medicine, anxiety medicine, and anesthetics are all administered through the IV.

The only exception to this rule is ear tubes in children, which are extremely short cases requiring only a brief inhaled anesthetic. Children undergoing longer cases (tonsillectomy, endoscopy) will often be anesthetized with a parent present using only a mask. The IV is then started as soon as the child is asleep.

Do I need to quit smoking before surgery?

Tobacco smoking reduces the oxygen carrying capacity of the blood. This effect can be reversed by quitting smoking for 6 – 8 weeks. However, quitting for even 24 hours before surgery can help, by reducing the carbon monoxide levels in the blood, which improves the ability of the blood to carry oxygen to the tissues.

We recommend that you quit smoking for as long as you can before surgery. Use of a nicotine patch is perfectly acceptable.

Can herbal medications interfere with my anesthetic?

Herbal medications can have significant effects on your anesthetic. The ASA has published a small pamphlet briefly describing the more common herbal medications and their effects.

ASA Brochure on Herbal Medications - requires Adobe Acrobat Reader. It is a little difficult to read. Click on the "+" button (next to the 100% sign) above the text to zoom in a bit.

What are the complications of anesthesia?

The vast majority of complications from anesthesia are minor and temporary. These include sore throat, hoarseness, nausea/vomiting, bruised or cut lips.

A more serious, but not major complication following spinal or epidural is spinal headache, which occurs in less than one in a hundred cases.

The major complications include aspiration pneumonia, heart attacks, stroke, nerve damage, anaphylactic shock, and rarely death. Fortunately, the incidence of these major complications is extraordinarily low. The incidence of anesthesia-related death is approximately 1:200,000 in healthy patients.

Your risk for complications will vary with your medical condition, the procedure you are having, and if you are having emergency surgery. Some of the medical conditions that may increase your risk are poorly controlled high blood pressure, coronary artery disease, abnormal heart rhythm, strokes, smoking history, asthma, obesity or diabetes. Well-controlled, uncomplicated high blood pressure does not increase risk. Allergic reactions, drug interactions, and rare hereditary disorders such as malignant hyperthermia, may also contribute to anesthetic risk.

What is malignant hyperthermia?

Malignant Hyperthermia (MH) is a rare, lifethreatening disorder, developing during or after general anesthesia. It is a genetic disorder (autosomal dominant). Both a genetic predisposition, and one or more triggering agents are necessary to evoke MH. Triggering agents include all inhaled anesthetics and one muscle relaxant (succinylcholine). In classical MH a hypermetabolic state develops, caused primarily by muscles of the skeletal system. Elevated heart rate, breathing rate, and temperature (to 110 degrees) develop. Untreated, muscle breakdown occurs with release of massive amounts of potassium, and resultant death.

Fortunately, with early recognition, MH can be treated effectively with Dantrolene, and the mortality reduced to about 10%. Better yet, if a patient is known to have a history of MH, or a family history, steps can be taken to avoid all triggering agents and prevent MH altogether. This is why you will be asked about any family history of MH. The anesthesia department of AASC has a dedicated MH cart with all necessary drugs and protocols for the treatment of MH. Every anesthesiologist and CRNA is expected to be familiar with this cart.

MHAUS (Malignant Hyperthermia Association of the United States) has been in the forefront of MH education and treatment. They maintain an excellent website with a good Patient Info Section.

What is a spinal headache?

A spinal headache may occur after either a spinal or an epidural anesthetic. It usually begins at least 24 hours after the procedure and is classically a throbbing headache, made much worse by sitting and standing, and dramatically relieved by lying flat. If you have symptoms like these after a spinal or epidural anesthetic, contact our department for an evaluation.

When a spinal anesthetic is done, a fine needle punctures the membrane (dura) which holds the spinal fluid. Medication is then injected into the spinal fluid and a spinal anesthetic develops. In 1 out of every 100 patients, continued leakage of spinal fluid from the small puncture causes a severe headache. Similarly, when a diagnostic spinal tap is done by a neurologist or other physician, a spinal headache can also occur. In fact, most of the spinal headaches we treat are referred by other physicians after diagnostic spinal taps.

When an epidural anesthetic is done, a larger needle is placed but the dura is not punctured. If the dura is accidentally punctured, a spinal headache will develop in at least half of cases. Fortunately, the incidence of accidental dural puncture among experienced anesthesiologists is less than 1 in 100. At AASC, only anesthesiologists do our epidural anesthetics. We do not have residents. The incidence of spinal headaches among our obstetric patients is far lower than the national average of 1 in a 100.

If a spinal headache develops, the initial treatment is bedrest flat on your back, lots of fluids, and caffeine. If that is ineffective, then an epidural blood patch may be done. An anesthesiologist will place an epidural needle in your back. Once the epidural space is encountered, about 20cc of your blood will be drawn out of your arm and injected into the epidural needle. This blood acts to seal the puncture in the dura and prevents the continued leakage of spinal fluid. The success rate is over 90%, and the results are usually felt within minutes.

What has been done to improve the safety of anesthesia?

Over the last twenty years anesthesia has become far safer. The American Society of Anesthesiologists has developed practice guidelines, establishing monitoring standards, and is now recognized as a leader in the field of medicine in managing risk and improving patient outcomes. More rigorous anesthesiology training with development of subspecialty expertise, advances in monitoring technology, and onging clinical research have all contributed to this trend.

Today, anesthesiologists are trained in the use of advanced monitoring technology. The minimum ASA standard for monitoring on every case includes EKG, blood pressure measurement, pulse oximetry for patient oxygen saturation, inspired oxygen concentration, and exhaled carbon dioxide. For more complex cases, more advanced monitoring is available, including direct arterial blood pressure measurement, Swan-Ganz pulmonary artery catheter, EEG (brain wave monitoring) and TEE (transesophageal echocardiography).

In spite of the incredible advances in technology and the great improvements in safety brought by them, the key to a safe anesthetic is still an alert, vigilant anesthesiologist who understands your medical condition and understands the advantages and the limitations of the technology he or she is using. In order to insure vigilance and alertness, our anesthesiologists do not work on the day after call.

Ultimately, the most important aspect of your anesthetic is the trained response provided by your anesthesiologist. The risk of death from anesthesia today is estimated at 1:200,000 anesthetics. This number was about 1:10,000 in the 1970's.

What type of anesthetic will I get?

There is usually more than one option for anesthesia. Your anesthesiologist will review with you the different techniques available and which ones are the safest for you. The decision on type of anesthesia is a joint decision between you and your anesthesiologist. Often, especially in healthy patients, there are several safe choices, and it is a matter of deciding which one you prefer. Use the menu above to learn about the different types of anesthesia.

Often you will get a combination of techniques. It is very common to combine local or regional anesthesia with sedation. It is also very common to receive a general anesthetic for the operation and a long acting nerve block for post-operative pain relief.

How will I wake up from anesthesia?

With the extraordinarily rapid clearance of modern anesthetic drugs, most patients awaken from general anesthesia within minutes of the conclusion of surgery. This usually occurs in the operating room. You are then transported to the Post-Anesthesia Care Unit (PACU), also called the recovery room. This unit is staffed by RN's who specialize in the care of patients recovering from surgery. The PACU is equipped to handle any type of emergency situation.

If you had a general anesthetic, you may be somewhat drowsy in PACU. We give medications during surgery to prevent nausea and pain, but occasionally you will have one or both of these. These symptoms are treated immediately with intravenous medications in the PACU. Your recovery from anesthesia will take a variable amount of time depending on the anesthetic technique used, the medications used, the type and duration of surgery, and your individual metabolism. Most of our patients are ready for discharge form the PACU within one hour. At the end of your PACU stay, you will go to your hospital bed if you are staying overnight, or you will return to the ambulatory surgery area where you will be given a light snack and beverage and discharged to home when you have met the criteria for discharge to home. This process is used to promote safety during your recovery period.

On rare occasions, usually in extremely complex cases or emergency cases, patients are kept asleep after surgery until they are stable. In these cases, the patient is transported to the intensive-care unit (ICU) where he or she recovers from anesthesia.

What if I need a blood transfusion?

Transfusion is much less common now than in the past. The decision to transfuse is based on your blood count (hematocrit). Normal hematocrit is 35-45%. In the past, transfusion was done frequently when the hematocrit dropped below 30. In the last few decades, It has become clear that healthy patients can tolerate hematocrits far lower than this, and it is safe for healthy patients to go home with a hematocrit in the low 20's, or in rare cases, in the high teens.

Transfusion becomes necessary when, in the judgment of the surgeon and anesthesiologist, the blood count has dropped to the point that the blood is no longer capable of carrying adequate oxygen to the tissues. In patients with heart disease or lung disease, the decision to transfuse will occur earlier than in healthy patients. Patients with coronary artery disease tolerate severe anemia very poorly.

Transfusion of certain blood components other than the oxygen-carrying red cells may be necessary. For this reason, donated blood in the blood bank is usually separated into red cells, plasma, and platelets. Your anesthesiologist makes the decision to transfer one or more of these components based on your needs. If you need oxygen-carrying capacity, you need red cells, if you are clotting blood poorly, you may need plasma or platelets.

What can be done to lessen the chance for transfusion: If an operation is expected to produce significant blood loss, several options are available to the anesthesiologist.

  • The patient may pre-donate blood before surgery to be given back during surgery.
  • The blood lost during surgery can be collected, washed and treated for transfusion back into the patient. This is referred to as a "cell-saver" technique.
  • Some of the patient's blood can be removed immediately before surgery and replaced with either saline or a "colloid" solution. The patient tolerates this blood removal easily. The blood is then transfused when it is needed during surgery. This is called "normovolemic hemodilution" and is commonly used in large cases such as abdominal aortic aneurysm repair.
  • Colloid solutions may be used in place of saline solutions to replace lost blood volume.
  • In the future, artificial blood that had oxygen-carrying capabilities will be available and will further reduce the need for transfusion.

In spite of maximum utilization of these techniques, it is sometimes necessary to transfuse blood. A sample of the patient's blood is sent to the blood bank (usually before surgery), where it is used to "type and cross-match" one or more units (pints) of blood. The type and crossmatch is a rigorous process to insure that the chances of a transfusion reaction is reduced to a minimum. In our laboratory, if the patient has never had a type and crossmatch, a second specimen from the patient is sent and the process repeated. This is to insure that no lab errors or collection errors have occurred.

Risks of blood transfusion: A transfusion may occur may occur from incompatible blood; these are usually minor allergic-type reactions. The risk of major transfusion reactions is extremely small due to the safety procedures described above. The risk of a fatal transfusion reaction is about 1:300,000 to 1:700,000.

The blood is screened for all organisms known to infect blood. The risk of HIV (AIDS) is estimted to be between 1:450,000 and 1:600,000. The risk of hepatitis B is 1:63,000 and hepatitis C is 1:103,000 per unit of blood.

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