General Anesthesia is defined as the maintenance of unconscious state even when a painful stimulus is applied. In real world terms, this means you are deeply unconscious while an airway device is placed. Anesthesic gases are then delivered to maintain you unconscious state.
General anesthesia usually begins with an IV induction agent (IV drug) that brings you to an initial state of unconsciousness. Once completely asleep, an airway device is placed to maintain your breathing. This airway device can come in two forms: an endotracheal tube or a laryngeal mask airway (LMA). An endotracheal tube is insert through the vocal cords into your trachea. This allows the airway to be secured while delivering oxygen and anesthetic gas to maintain your asleep state. The LMA is a soft pliable device that seats in the back of your mouth. This device maintains an open airway, allowing you to breathe on your own while it maintains your asleep state with an anesthesic gas. Additional medications may also be given through your IV to help maintain your unconscious state. All of your vital signs will be monitored closely throughout the operation.
Once the surgery is done, the anesthesic gas will be turned off and you will begin to slowly wake up. Once awake, you will then be transferred to the Recovery Room.
The most common side effect of general anesthesia is nausea or vomiting. Medications will be given to help to prevent this, but in some instances, it is not 100% avoidable. Additional medications can be administered, if needed. A sore throat is also a common side effect, usually lasting only for 1-2 days before resolving on it's own. Throat lozenges and sprays usually help to alleviate this type of discomfort. There is also a possibility of dental/lip injury when we place the breathing device, but it's is extremely rare.
Upon arrival to the recovery room, most patients are awake and responsive, however, most do not remember their arrival there. Their first recollection usually occurs within the next 10-20 minutes. Upon meeting our discharge criteria, you will either be brought to the surgical floor or prepared for discharge home.
Total Intravenous Anesthesia
Total Intravenous Anesthesia (TIVA) is a common technique in which all of the anesthesia is administered through your IV (vs. anesthetic gas). This type of anesthetic is used for less painful surgeries and require less sedation.
Although you are unconscious, this technique allows you to breath on your own with supplemental oxygen either with nasal cannula or a clear face mask. Sedation is maintained through a continuous infusion of medicine through your IV.
Benefits of TIVA include a faster recovery time and many fewer side effects than for general anesthesia. TIVA is tolerated very well by most patients. Patients with severe obstructive sleep apnea may not be offered this type of anesthesia depending on the type of procedure.
Montiored Anesthesia Care
Monitored Anesthesia Care (MAC) is a type of anesthesia in which a very light sedation is given. Although all patients remain conscious through the procedure, some might not remember their operation secondary to the amnestic effects of the sedation medicines.
This type of anesthesia is usually used in operations that require the patient to be somewhat responsive at certain points of the surgery (eg. cataracts, etc..).
The recovery from this form of anesthesia is rapid and the side effects associated with MAC are usually negligible.
Regional anesthesia is accomplished by carefully inserting, usually under ultrasound guidance, a needle near a selected nerve and injecting local anesthesia to numb that nerve. The result is numbness and loss of muscle control in the affected area, usually lasting several hours and up to 3 days if a catheter is inserted. This can often produce excellent pain relief for the patient.
There are numerous different types depending on the surgical procedure. Common blocks include: Axillary, Popliteal Fossa, Femoral, Sciatic, Intrascalene, and many others.
These blocks are contraindicated for certain patient populations and do have risks associated with them. Each patient is very different and must be evaluated by an anesthesiologist on a case by case basis. Risks of the different blocks will be thoroughly disscussed by your attending anesthesiologist.
In addition to the regional block, we usually administer some sort of sedation: either MAC or TIVA to render the patient comfortable and calm, often unconscious. Certain patients benefit from a deeper sedation. Lighter anesthesia usually quickens wakeup and recovery from anesthesia and causes fewer side effects like nausea and vomiting.
Childbirth is one of the most exciting experiences in life, however, natural labor is well known to be painful. Reston Anesthesia Associates is committed to providing safe alternatives to provide pain relief for both vaginal deliveries and cesarian sections.
Epiduals analgesia, also known as an epidural block is used to alleviate much of the pain from labor and childbirth. Approximately 95% of our patients decide to go this route for the sake of comfort. This technique allows the anesthesiologist to partially numb the lower portion of the body, yet still allow the mother to move her legs and push for a vaginal delivery. While many patients are apprehensive about the pain involved in placing an epidural, most patients later report that it is less painful than having an intravenous (IV) catheter placed.
All types of medical procedures have risk involved. As anesthesiologists, we worry most about serious complications which are extremely rare, including: infection and bleeding in the back, nerve injury, and seizures. The most common issues are spinal headaches, partial blocks, and catheter misplacement usually corrected by placement of another epidural.
We maintain a visible presence in the labor ward and are available 24 hours a day for the comfort and safety of our laboring patients.
Planned Cesarian Section: Our most common type of analgesia for cesarian section is the combined spinal/epidural technique which is no more invasive than an epidural alone. We use the spinal analgesia for the operation and later us the epidural for post operative pain. Most of our patients are very happy with this technique. Some patients prefer to discontinue the epidural early so they can get on their feet sooner. We can offer intravenous pain medications if this is the case.
Unplanned Cesarian Section: Unfortunately, many patients end up requiring a cesarian section for the safe delivery of their child for a variety of reasons. If the patient has an epidural in place already, we can usually use this successfully for the procedure. In truly emergent conditions, however, we may need to utilize a general anesthetic, where the mother is unconscious for the delivery. We prefer to use the epidural whenever the urgency of the situation allows it.
Epidural and Spinal Analgesia is a reasonable and safe choice for most of our patients, however, there are certain contraindications for the placement these regional techniques. Certain bleeding disorders, recent use of anticoagulants, certain past surgeries, and some congenital disorders might make the risk of the regional anesthesia unsafe. Each patient will have a thorough discussion of their individual risks with an anesthesiologist prior to using any regional technique. Systemic (intravenous) medications are available for laboring patients and general anesthesia is available for cesarian sections.
If you have questions or concerns about your epidural or upcoming cesarian section, please feel free to contact us to schedule an appointment consultation at (703) 689-9087. Monday — Friday, 8AM to 4PM.
For a preoperative consultation for an upcoming surgery, please call 1 (844) 204-1474 Monday — Friday, 8AM to 7PM