Anesthesia is administered before and during your surgical procedure so you do not feel pain. Some anesthetics induce sleep, while others cause drowsiness and/or numbness.
The following is a description of the anesthetic techniques that are used at the Raleigh Orthopaedic Surgery Center:
Some minor surgical procedures at the Raleigh Orthopedic Surgery Center only require the use of numbing medications and do not require the placement of an intravenous line or use of any sedating medications. If this is an option for your surgical procedure, your surgeon will discuss this with you during your preoperative visit. For this type of anesthetic, your surgeon will administer the local anesthetic in the operating room immediately before your surgery.
General Anesthesia is an anesthetic technique in which the anesthesia care team gives you medications to keep the you from feeling surgical pain and completely unconscious and unaware of your surroundings. It may be used as the only anesthetic or in combination with a regional anesthetic based on the surgeon or the patient’s preference.
On arrival to the pre-op area of the Raleigh Orthopedic Surgery Center, in addition to meeting the nurses of the center, you will also meet the members of the anesthesia care team – the physician anesthesiologist and a certified registered nurse anesthetist (CRNA). The risks and benefits of the anesthesia will be discussed with you before you sign your consent.
Once the surgeon, operating room (OR) and OR team are ready, the OR nurse and CRNA will take you to the operating room. You will often receive some sedation through your intravenous prior to your transfer to the OR, which will help you relax prior to arriving in the OR. Once in the OR, you will be asked to move onto the operating room table. Next, standard monitors will be attached to measure your vital signs while you are asleep. These include a blood pressure cuff placed on your arm, a sensor to measure your blood oxygen level attached to your finger, and EKG leads that are placed on your chest.
Once the monitors are applied, a member of the anesthesia care team will ask you to breathe some oxygen and then inject some medication in the intravenous that will quickly start the general anesthetic. As this medication enters your vein, it may have a brief warm or slight burning sensation at the intravenous site – this is normal. (Children less than the ages of 10 may not have an intravenous started before the OR and will instead go to sleep by breathing anesthetic gases through a mask). Once you are completely asleep, a member of the anesthesia team may insert a breathing device into your mouth to enable the team to easily assist your breathing while you are asleep. The general anesthesia will then be continued with either anesthetic gases you breathe into your lungs or intravenous medications. A member of the anesthesia team will continually monitor your vital signs throughout the anesthetic to assure your safety.
Once the surgery is done, the breathing device will be removed and the anesthetic gases shut off.
The OR and anesthesia team will then transport you to the Post -Anesthesia Care Unit (PACU) where you will be cared for by PACU nurses as you continue to wake up from the general anesthetic. What patients remember of the experience can vary. Some patients may remember waking up in the OR at the end of the surgery, others won’t remember anything until the PACU or even later because of the tendency of general anesthetics to produce temporary amnesia.
Any anesthetic has some potential risk. Serious complications are rare, and your anesthesia team and PACU nurses are vigilant and ready to address and treat any potential complications that may arise.
Regional Anesthesia With Sedation
A Regional Anesthetic is a form of anesthesia in which a part of the body is made numb using a local anesthetic (numbing medicine). This technique is often called a “nerve block”. Because our orthopedic surgeons often operate on part of the patient’s arm or leg, nerve blocks are frequently a recommended type of anesthetic for surgery at the Raleigh Orthopedic Surgery Center (ROSC). A significant advantage of nerve blocks for outpatient orthopedic surgery is that they provide the patient with excellent pain relief for many hours after the surgery. Nerve blocks may also reduce the amount of traditional narcotic pain medications that a patient may need to have during or after surgery. Because narcotics can sometimes cause nausea and excessive drowsiness, using nerve block techniques can sometimes help reduce the chance that patients will experience these symptoms. Compared to those patients who have had a general anesthetic without a nerve block, patients who have had a nerve block will often feel more awake immediately after surgery and will be able to go home sooner from the surgery center. Many of the ROSC surgeons will discuss regional anesthesia options with you during your pre-op visit.
If regional anesthesia is an option for your surgical procedure, the anesthesiologist will discuss this technique with you on the day of surgery. On the basis of your medical history, the anesthesiologist will decide if you are an appropriate candidate to undergo a nerve block procedure. He / she will discuss the expected benefits and possible risks of regional anesthesia (nerve blocks), and the alternative forms of anesthesia. You will have the opportunity to discuss concerns and ask questions about the proposed nerve block with your anesthesiologist before signing your consent for anesthesia.
If you are to have a nerve block for your surgery, your preoperative team (nurse and anesthesiologist) will perform this block in the ROSC prep area prior to you going to the operating room. You will receive intravenous sedating medications (see Intravenous Sedation) before the block, and you will be monitored with an EKG monitor on your chest, blood pressure cuff on your arm, and an oxygen saturation sensor on your finger during the procedure. Although you are not completely asleep, you will be relaxed and very comfortable for this short nerve block procedure.
Once you go back to the operating room for your surgery, members of the anesthesia care team will typically combine your nerve block anesthetic with intravenous sedation (see MAC anesthesia below) or a light general anesthetic to make sure that you are completely relaxed and comfortable during your surgical procedure.
Other than cases that use local anesthesia only (see Local Anesthesia), a part of all other anesthetics is the use of sedating medications. The purpose of using these medications is to provide the patient with a pleasant, comfortable, and anxiety free experience.
Sedation before surgery
For the patient undergoing a nerve block (see Regional Anesthesia), intravenous sedatives will be given to the patient before the block to alleviate the minor discomfort of a block procedure and to relieve any anxiety about having the procedure.
Sedation during Surgery
Many surgical procedures do not require a general anesthetic. One option for some minor orthopedic surgeries is for the anesthesia team to administer sedating medications through the intravenous line and then the surgeon injects local anesthetic under the skin to numb the surgical area. This is sometimes referred to a Monitored Anesthesia Care or “MAC” anesthetic technique.
Awareness during Sedation
Patients are often concerned about whether they will “remember” something during the surgery. When the anesthesia team uses sedation (rather than general anesthesia), what the patient may remember about their operation will vary from patient to patient. When a technique of light sedation is used, the patient may remember much of their operation and in the case of deep sedation they will likely remember very little. The goal is to keep the patient extremely comfortable, pain free, and anxiety free in all cases. Once patients realize this fact, they are often much less concerned about whether they will remember anything during the surgery.