Most people are nervous before a medical procedure. That is only natural. But don’t let jitters keep you from having a pre-operative conversation with your anesthesiologist. It is your chance to ask questions, share important medical information, and receive counseling about what to expect.
“It’s extremely beneficial to patients, in terms of preparing them, relieving their anxiety, decreasing their complications after surgery and improving their satisfaction with their care,” says Jill Zafar, MD, assistant professor of anesthesiology and director of pre-surgical evaluation at Yale Medicine.
At most hospitals, patients meet their anesthesiologist immediately before surgery. But Yale Medicine patients can speak to an anesthesiologist at any time before their procedure. Here is a guide to getting the most out of that conversation.
Three questions to ask
1. What kind of anesthesia will I get?
Many patients do not know that there are different types of anesthesia. “Everything is on a spectrum, from being fully awake to being completely unconscious,” Dr. Zafar says. These are the common types of anesthesia:
A block: For simple procedures, your doctor may be able to numb the affected body part without bringing in an anesthesiologist. This “local anesthesia,” which blocks the transmission of pain messages to your central nervous system, is delivered via an injection or infusion through a catheter (as in an epidural). It might block a small area, such as with a skin biopsy, or it might block feeling in your arm, leg or abdomen. It could even numb you from the waist down (as with childbirth).
Conscious sedation: Conscious sedation may be given by a surgeon or nurse, typically for procedures such as interventional radiology or endoscopies. “Although patients may not remember anything, they’re really awake and should be able to communicate,” Dr. Zafar says.
Moderate sedation: This is a type of anesthesia that puts the patient to sleep, though not so deeply that he or she cannot be awakened.
Deep sedation: This is the name used to describe anesthesia in which the patient is more profoundly sedated but will still respond to repeated or painful stimuli.
General anesthesia: Patients under general anesthesia are fully unconscious and cannot be awakened until the anesthesiologist makes a deliberate change in the medications being delivered. Sometimes a breathing tube is inserted to assist in ventilation.
2. How will I feel when I wake up?
Both your surgeon and anesthesiologist will discuss how much pain you can expect to experience after your surgery and during your recovery. Some procedures leave patients quite uncomfortable, while others barely require over-the-counter pain relief. “It’s very important to talk with your doctors about the plan for pain management after surgery,” says Dr. Zafar. Sometimes a block can be administered to keep you comfortable during recovery. “This could be better for a patient who wants to decrease other pain medications, perhaps because they get sick from them,” Dr. Zafar says.
Your anesthesiologist will monitor you and your level of pain during your time in the recovery room. The goal is to keep your pain at a manageable level. For example, you should be able to breathe comfortably (though it is not always easy after a surgery to your abdomen or chest). Once you leave the recovery room, the anesthesiologist transfers your pain management to your surgeon. He or she will be responsible for prescribing any needed oral or patch medications while you are in the hospital and after your discharge.
The pain-relieving or numbing effects of anesthesia should wear off within 24 hours. If you had a breathing tube in conjunction with general anesthesia, you may have a sore throat for a few days. However, you can expect the discomfort and other aftereffects of surgery, such as fatigue, to persist for weeks, depending on the level of surgical stress to your body.
3. What will you do to make sure I don’t wake up feeling queasy?
Nausea is a common side effect of anesthesia, one many patients fear. This is usually caused by “an inhalational anesthetic, which patients breathe in and out when they are sleeping,” says Dr. Zafar. Some people are at higher risk for this than others, including women, nonsmokers, young people and those who have had nausea as a side effect of a previous surgery. Dr. Zafar notes that almost all patients are now given medication (an anti-emetic) to prevent post-anesthesia nausea. She suggests asking your anesthesiologist, before your surgery, how your risk of nausea will be managed.
Three Things to Share
1. I had a bad experience (or a good one)
Let your anesthesiologist know if you have had problems with anesthesia in the past. Perhaps you had an allergic reaction mid-surgery or woke up feeling nauseated or miserably itchy (a common side effect of pain-relieving opioid medications). “I always encourage people to get their anesthesia records from past surgeries, if possible,” Dr. Zafar says. If you have had good experiences before, your doctors may be able to replicate the approach. Don’t worry if the notes in the record are incomprehensible to you—“your next anesthesiologist will be able to read it,” Dr. Zafar says.
2. This painkiller has worked well for me
Tell your doctor about specific pain medications that have helped you in the past. And let him or her know if other drugs were ineffective or caused intolerable side effects. “There are genetic differences that have not been fully discovered” that affect how patients react to anesthesia, Dr. Zafar says. What works for one patient could cause another to hallucinate. She advises sharing what you have learned about your response to painkillers, as this information can help your anesthesiologist manage your post-surgical pain.
3. I have a history of using opiates
This could have a profound effect on how opioid medications will work. If you have used opioids—heroin or prescription pills—for a prolonged period, it is likely that your response to these drugs will be affected now and in the future. Be open and up front about your past and current use of opioids, says Dr. Zafar. “That is going to help us determine what our anesthesia plan is going to be, so that you wake up comfortable.”
Dr. Zafar says people who are former or current users of opioid medications may also require a different post-operative approach. “You might have a much higher requirement for opioid pain medications after surgery,” she says, “or some pain medications just won’t work for you.” Another possibility is what she calls a “hyper-pain response” after surgery. For example, you might experience off-the-chart pain in response to what another patient might characterize as a 5 on a scale of 1 to 10. If this happens, your anesthesiologist can still help to manage your pain, usually with other kinds of medications such as ibuprofen or acetaminophen.
Three things not to worry about
1. Which drugs, specifically, will I be getting?
If you have already dealt with the questions and issues raised above, you do not need to learn all the details of your anesthesia plan; it is more complicated than you probably realize. “There are about 10 common anesthesia drugs that we give in different combinations,” Dr. Zafar says. Most patients do not need to know exactly which ones will be given and in which order—and, in any case, the plan could change on the fly. Discussions about specific drugs usually “only come into play when the patient has had problems with anesthesia in the past—like getting sick afterward—and they want to avoid that happening again,” she says.
2. Will I wake up?
Although it is natural to feel anxious, Dr. Zafar notes that anesthesia is safe. “Statistically, it’s much safer than driving your car to the hospital in the morning.” The overwhelming majority of patients come out of their surgery just fine.
Many people fear they will awaken during their surgery, but Dr. Zafar says the chance of that happening is very small. There are rare situations in which blood pressure may drop or specific life-saving measures are taken that put a patient at higher risk for wakefulness. But the anesthesiologist is acutely aware of the patient’s level of consciousness at all times. “Our anesthetic drugs will make sure you are unconscious and that you wake up when it’s all over,” Dr. Zafar says.
3. Will I become addicted?
You will not become addicted to anesthesia drugs during surgery. One reason for the rise in opioid addiction is that patients used to be sent home after an operation with strong pain medications for longer periods than were necessary. They might have received a 30-day prescription for pain pills, for example, when the drugs might be necessary only for a day or two after surgery. If a patient took all the pills—or if someone else found and used them for recreational purposes—addiction could result. Today, doctors are more careful about prescribing potentially addictive opioid medications.