Common Questions About Ambulatory Anesthesia*

What is ambulatory anesthesia? The majority of patients today who undergo surgery do not need to stay overnight in the hospital. Ambulatory anesthesia is designed to meet the needs of ambulatory surgery so you can go home soon after your surgery. Short-acting anesthetic drugs and specialized anesthetic techniques are used to make your experience safe and pleasant. After your early recovery from anesthesia, you usually will return directly home. Appropriate pain management will be included as part of your discharge planning.

What types of anesthesia are available? The choice of the anesthetic technique depends on several factors, including the surgical procedure, your medical history, and your preferences. The four anesthetic options are:

General anesthesia - This anesthetic choice produces unconsciousness so that you will not feel, see or hear anything during the surgical procedure. The anesthetic medications are given to you through an intravenous line or through an anesthesia mask.

Regional anesthesia - This technique produces numbness with the injection of local anesthesia around nerves in a region of the body corresponding to the surgical procedure. Epidural or spinal blocks anesthetize the abdomen and both lower extremities. Other nerve blocks may be done to anesthetize individual extremities. With regional anesthesia, medications can be given that will make you comfortable, drowsy and blur your memory.

Monitored anesthesia care - With this technique, you usually receive pain medication and sedatives through your intravenous line from your anesthesiologist. The surgeon also will inject local anesthesia into the skin, which will provide additional pain control during and after the procedure. While you are sedated, your anesthesiologist will monitor your vital body functions.

Local anesthesia - The surgeon will inject local anesthetic to provide numbness at the surgical site. In this case , there may be no anesthesia team member with you.

Before receiving any sedatives or anesthetics, you will meet your anesthesiologist to discuss the most appropriate anesthetic plan. Your anesthesiologist will discuss the risks and benefits associated with the different anesthetic options. Occasionally it is impossible to keep you comfortable with regional, monitored or local anesthesia, and general anesthesia may be needed.

What may I eat or drink before my anesthesia? As a general rule, you should not eat or drink anything after midnight before your surgery. Under some circumstances, you may be given permission by your anesthesiologist to drink clear liquids up to two hours before your anesthesia.

Will I need someone to take me home? Yes, you must make arrangements for a responsible adult to take you home after your anesthetic or sedation. You will not be allowed to leave alone or drive yourself home. It is strongly advised that you have someone stay with you during the first 24 hours.

If you have local anesthesia only, with no sedation, it may be possible to go home without someone to accompany you. Check with your surgeon first.

Should I take my usual medications before surgery? Some medications should be taken and others should not. Discuss this with your anesthesiologist and surgeon. Do not interrupt medications unless your anesthesiologist or surgeon recommends it.

What will happen on the day of surgery? You will meet you anesthesiologist on the day of your surgery. Your anesthesiologist will review your medical and anesthesia history and the results of any laboratory tests and will answer any questions you may have. Nurses will record your vital signs. Intravenous fluids will be started and any needed preoperative medications will be given. In the operating room, monitoring devices will be attached to monitor your blood pressure, electrocardiogram and the oxygen level in your blood. At this point, you will be ready for anesthesia.

During surgery, your anesthesiologist is responsible for your comfort and well- being. Your anesthesiologist leads the anesthesia care team, and is also responsible for managing medical problems that may arise related to surgery as well as chronic medical conditions you may have, such as asthma, diabetes, high blood pressure or heart problems. A member of your anesthesia team will be with you throughout your procedure.

After surgery, you will be taken to the post-anesthesia care unit. Your anesthesiologist will direct the monitoring and medications needed for your safe recovery. For about the first thirty minutes, you will be watch closely by specially trained nurses. During this period, you may receive extra oxygen, and your breathing and heart functions will be observed closely. You will then be moved to another area where you will continue to recover, and family or friends will be allowed with you. You will be offered something to drink, and you will be assisted in getting up.

What side effects will I have? The amount of discomfort you experience will depend on a number of factors, especially the type of surgery. Your doctors and nurses can relieve pain after your surgery with medicines given by mouth, injection or by numbing the area around the incision. Your discomfort should be tolerable, but do not expect to be totally pain-free. Nausea or vomiting may be related to anesthesia, the type of surgical procedure or postoperative pain medications. These side effects occur in some patients, but are less of a problem today because of improved anesthetic agents and techniques. Medications to minimize postoperative pain, nausea and vomiting are often given by your anesthesiologist during the surgical procedure and in recovery.

What can I expect after I go home? Most patients are ready to go home between one to four hours after surgery. Patients often experience drowsiness and minor after-effects following ambulatory anesthesia, including muscle aches, sore throat and occasional dizziness or headaches. Nausea may be present, but vomiting is less common. These side effects usually decrease rapidly in the hours following surgery, but it may take several days before they are gone completely. The majority of patients usually feel general tiredness or surgical discomfort the next day. Plan to take it easy for a few days until you feel back to normal. For the first twenty-four hours after your anesthesia, do not drink alcoholic beverages, do not drive a car or operate dangerous machinery, and do not make important decisions.

What medications are available for managing pain? A wide variety of medications and treatments are available for acute, chronic and cancer pain.

Non-aspirin pain relievers such as acetaminophen (Tylenol) can relieve headaches and minor pain but do not reduce swelling. They are sometimes used in combination with other drugs to provide greater pain relief.

Anti- inflammatory drugs such as aspirin (Anacin, Bayer), coated or buffered aspirin (Ascripton, Bufferin) and aspirin and acetaminophen (Excedrine) may be used to reduce swelling and irritation as well as to relieve pain. There are also non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and nproxen (Aleve). Anti-inflammatory drugs are used to relieve pain, inflammation and fever. There also are steroidal drugs (like cortisol and prednisone), available only by prescription, that are used to treat more serious inflammatory conditions such as chronic arthritis.

Opioid pain medications such as morphine-like drugs are prescribed to treat acute pain or cancer pain. They are occasionally used for chronic, non-cancer pain.

Anti-depressant medications were originally used only to treat depression, but they also can relieve certain types of pain.

Anti-seizure medications are used to relieve "shooting" pain by decreasing abnormal painful sensations caused by damaged nerves.

What treatments other than medications are available for managing pain? For some patients certain therapies may be used in addition to pain medicines, or may eventually replace the need for taking any pain medicines.

Injection treatments - Local anesthetics (lidocaine, bupivacaine,etc.) with or without cortisone-like medicines, can be injected around nerve roots and into muscles or joints. These medicines reduce swelling, irritation, muscle spasms and abnormal nerve activity that can cause pain

Nerve blocks- A group of nerves, called a plexus or ganglion, that causes pain to a specific organ or body region can be blocked with local anesthetics. If successful, another solution that numbs the nerves can then be injected.

Physical and aquatic therapy- A physiatrist or physical therapist may suggest an exercise program tailored to decrease pain and increase daily functioning. Other treatments may include whirlpool therapy, ultrasound and deep-muscle massage.

Electrical stimulation- Transcutaneous electrical nerve stimulation (TENS) is the most common form of electrical stimulation used in pain management. It is not painful and does not require needles or medicine. TENS consists of a small battery-operated device that can diminish pain by stimulating nerve fibers through the skin.

Acupuncture- Practitioners of acupuncture use very thin needles at specific points on the skin to treat pain. These techniques may be offered for certain painful conditions.

Psychological support- The emotional effects of suffering often accompany the physical aspects of pain. Feelings of anger, sadness, hopelessness or despair may be present. Pain can alter personality, disrupt sleep, interfere with work and relationships and often have a profound effect on family members. Support and counseling from a psychiatrist or psychologist may be combined with a comprehensive pain treatment program. These professionals can teach self-help therapies such as relaxation training or biofeedback to relieve pain, lessen muscle spasms and reduce stress.

Surgery- In rare instances when severe pain has not responded to other treatments and procedures, surgery on certain nerves can be done to provide some relief of pain and allow resumption of near-normal activities. Usually all other avenues of treatment are tried before surgery is considered.