Guest guest Posted April 10, 2003 Report Share Posted April 10, 2003 Hi , Perhaps you should have cavetted the below with 'in a perfect world'..........smile............ I suspect we all have stories that have bits and pieces missing from problems with travelling long journeys, time constraints, unforeseen circumstances etc........... I didn't get to see my anaesthestist until the night before and initially he seemed more keen on trying to tell me I shouldn't be having the surgery scheduled due to my history of osteomylitis than getting on with his job.........which set up an interesting senario...... He did however look after me quite well when he applied his mind to his part of the job and after the operation seemed somewhat excited about what he had witnessed....... my op required the femur chipped out before a Resurface could start........... My brotherinlaw is an anaesthestist so yes I am aware of all the years of study and how varied and stressful their work actually is.......... My BIL actually get that awful decision of turning off life support....... He had told me when initially considering the op that most surgeons these days prefer a spinal block arrangement for any surgery below the waist...........apparently the risks are far less. i.e. we are now more aware of what full anaesthetics do to the brain and after about 20 of them I wasn't keen on any more anyway.......... Thankyou for your outline though - very helpful. Edith > Dear fellow hippys: > > There has been some recent confusion about different types of > surgical anesthesia. This is a summary of information which I hope > is helpful. > > Orthopedic and other surgeons generally work with an > anesthesiologist, a specialist in Perioperative Medicine. This is > care of a patient prior to, during and after surgery. This includes > evaluating and preparing a patient to undergo the rigors of surgery. > The anesthesiologist plans the anesthetic for the patient and then > cares for the patient during the surgical procedure. He/she monitors > the patient's blood pressure, heart rate, breathing, and level of > consciousness and analgesia. The anesthesiologist adjusts the > anesthetic plan, medications, fluids, and other parameters to > provide a safe, pain free surgical experience for the patient. > He/she will take care of your medical needs during the operation so > the surgeon can concentrate on the surgery. After the surgery, the > anesthesiologist continues to provide the care necessary to ensure a > smooth emergence from the anesthetic and pain control after your > surgery. > Anesthesiologists are specialists in control of both acute > and chronic pain. They also are involved in the care of critically > ill patients. > To become an Anesthesiologist requires four years in > college to earn an undergraduate degree, four years of medical > school to earn a Doctor of Medicine degree. He/she must then > complete another four years of training in an accredited Anesthesia > Residency Program. The physician may then complete another one or > two years in a subspecialty of anesthesia such as Obstetrical > Anesthesia, Cardiac Anesthesia, Pediatric Anesthesia, or Pain > Management. > After completing the above training, he or she must then > pass a rigorous written and oral exam. To become a " Diplomate of the > American Board of Anesthesiology " . > Some anesthesiologists complete similar requirements to > become certified in their subspecialty as well, such as Pain > Management Certification. > .In some cases a certified Nurse anaesthetist may perform much of > the monitoring and some other parts of the procedure, under > supervision of the anaesthesiologist. Regulations vary somewhat > from state to state. > > Types of anesthesia: > > An-esthesia : lack of sensation > 1. Local: An injection in the skin and subcutaneous tissue. > This might be used for a superficial biopsy. > > 2. Nerve Block : Injection into a nerve sheath to affect an entire > area served by the nerve. This is a common technique used by > dentists for example. An injection of the dental (mental) nerve > will result in numbness of the entire mandible (jawbone) on that > side FOR HIP SURGERY, A FEMORAL NERVE BLOCK IS GIVEN. THIS > RESULTS IN DEEP LOSS OF SENSATION IN THAT LEG > > SPINAL ANESTHESIA - TWO TYPES > 3A EPI-DURAL ANESTHESIA - This is reserved for a more limited > area > where only a few of the exiting spinal nerve roots will be > affected. A very tiny needle or small plastic catheter is injected > into the space just outside of the main covering over the spinal > nerve roots and cord. > > 3B " Spinal " Sub-Dural Anesthesia - Allows for deeper and > more > extensive area of pain control and paralysis. Prevents uncontrolled > muscle movement (so you don't kick the surgeon in the head).and > has > other advantages. > > Sometimes, special needles and catheters are used to combine both > types of spinal anesthesia. > > GENERAL ANAESTHESIA: > This usually refers to the use of an endo-tracheal tube, Anesthetic > gases and is reserved as back up for other techniques, use in people > with respiratory, cardiac and certain other high risk situations. > > SEDATION: > > This refers to a variety of techniques using various intravenous > medications. > > Conscious sedation refers to a common technique which may be used > for a variety of diagnostic and therapeutic procedures such as > colonoscopy and gastroscopy. The advantage is that the patient is > able to cooperate and follow instructions while controlling > anxiety. Often, the patient may be given medication so that there > is no memory of the procedure. > > For Hip surgery, on otherwise healthy patients, the best combination > may be a Femoral nerve block, spinal anesthesia and with intravenous > sedation. NOTE: The level of intravenous sedation can be varied at > will throughout the procedure. This will not affect the level of > pain control. > > This is why a number of surface hippies have reported " waking > up " > (light sedation) during their surgery. This is under the control of > the anesthesiologist and doesn't indicate a mistake. > > When you go for pre-anaesthesia assessment, ask questions and be > sure to answer fully and honestly so that the best procedure can be > planned . > > > Best to all, > > in NC > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2003 Report Share Posted April 10, 2003 , Great summary, there is indeed confusion on this, especially between a " spinal " and an " epidural " . If you don't mind, I will put a copy in the files section. Something I'd like to see comment on are the use of additives in the mix, like something that causes the patient to lose short-term memory (I believe its called Versed) and the anti-nausea medications. When people have nausea is it due to the anesthesia or the pain killer (e.g., morphine PCA) given afterward? - > > > Date: 2003/04/09 Wed PM 08:05:42 EDT > To: surfacehippy > Subject: Types of anesthesia > > > Dear fellow hippys: > > There has been some recent confusion about different types of > surgical anesthesia. This is a summary of information which I hope > is helpful. > > Orthopedic and other surgeons generally work with an > anesthesiologist, a specialist in Perioperative Medicine. This is > care of a patient prior to, during and after surgery. This includes > evaluating and preparing a patient to undergo the rigors of surgery. > The anesthesiologist plans the anesthetic for the patient and then > cares for the patient during the surgical procedure. He/she monitors > the patient's blood pressure, heart rate, breathing, and level of > consciousness and analgesia. The anesthesiologist adjusts the > anesthetic plan, medications, fluids, and other parameters to > provide a safe, pain free surgical experience for the patient. > He/she will take care of your medical needs during the operation so > the surgeon can concentrate on the surgery. After the surgery, the > anesthesiologist continues to provide the care necessary to ensure a > smooth emergence from the anesthetic and pain control after your > surgery. > Anesthesiologists are specialists in control of both acute > and chronic pain. They also are involved in the care of critically > ill patients. > To become an Anesthesiologist requires four years in > college to earn an undergraduate degree, four years of medical > school to earn a Doctor of Medicine degree. He/she must then > complete another four years of training in an accredited Anesthesia > Residency Program. The physician may then complete another one or > two years in a subspecialty of anesthesia such as Obstetrical > Anesthesia, Cardiac Anesthesia, Pediatric Anesthesia, or Pain > Management. > After completing the above training, he or she must then > pass a rigorous written and oral exam. To become a " Diplomate of the > American Board of Anesthesiology " . > Some anesthesiologists complete similar requirements to > become certified in their subspecialty as well, such as Pain > Management Certification. > .In some cases a certified Nurse anaesthetist may perform much of > the monitoring and some other parts of the procedure, under > supervision of the anaesthesiologist. Regulations vary somewhat > from state to state. > > Types of anesthesia: > > An-esthesia : lack of sensation > 1. Local: An injection in the skin and subcutaneous tissue. > This might be used for a superficial biopsy. > > 2. Nerve Block : Injection into a nerve sheath to affect an entire > area served by the nerve. This is a common technique used by > dentists for example. An injection of the dental (mental) nerve > will result in numbness of the entire mandible (jawbone) on that > side FOR HIP SURGERY, A FEMORAL NERVE BLOCK IS GIVEN. THIS > RESULTS IN DEEP LOSS OF SENSATION IN THAT LEG > > SPINAL ANESTHESIA & #8211; TWO TYPES > 3A EPI-DURAL ANESTHESIA & #8211; This is reserved for a more limited > area > where only a few of the exiting spinal nerve roots will be > affected. A very tiny needle or small plastic catheter is injected > into the space just outside of the main covering over the spinal > nerve roots and cord. > > 3B " Spinal " Sub-Dural Anesthesia & #8211; Allows for deeper and > more > extensive area of pain control and paralysis. Prevents uncontrolled > muscle movement (so you don't kick the surgeon in the head).and > has > other advantages. > > Sometimes, special needles and catheters are used to combine both > types of spinal anesthesia. > > GENERAL ANAESTHESIA: > This usually refers to the use of an endo-tracheal tube, Anesthetic > gases and is reserved as back up for other techniques, use in people > with respiratory, cardiac and certain other high risk situations. > > SEDATION: > > This refers to a variety of techniques using various intravenous > medications. > > Conscious sedation refers to a common technique which may be used > for a variety of diagnostic and therapeutic procedures such as > colonoscopy and gastroscopy. The advantage is that the patient is > able to cooperate and follow instructions while controlling > anxiety. Often, the patient may be given medication so that there > is no memory of the procedure. > > For Hip surgery, on otherwise healthy patients, the best combination > may be a Femoral nerve block, spinal anesthesia and with intravenous > sedation. NOTE: The level of intravenous sedation can be varied at > will throughout the procedure. This will not affect the level of > pain control. > > This is why a number of surface hippies have reported " waking > up " > (light sedation) during their surgery. This is under the control of > the anesthesiologist and doesn't indicate a mistake. > > When you go for pre-anaesthesia assessment, ask questions and be > sure to answer fully and honestly so that the best procedure can be > planned . > > > Best to all, > > in NC > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2003 Report Share Posted April 10, 2003 : Quick question here. When I had my surgery 2 weeks ago, I had made up my mind after some research and talking to get an epidural. Right before my surgery, when I met the anesthesiologist I told him of my choice....epidural and medium " sleep " . He said he did not recommend an epidural for hip replacement because I would be on my side and the epidural could therefore 'pool'. I was taken aback because I had never heard of this before. He was insistent. He suggested a spinal or a general. Since I was caught off guard and it was the 11th hour, I went with the general. Had you heard of this with a epidural before? I had an epidural when I had a c-section 13 years ago, but then I was positioned on my back. Thoughts? Lois C+ 3/27/03 Dr. Mont Types of anesthesia Dear fellow hippys: There has been some recent confusion about different types of surgical anesthesia. This is a summary of information which I hope is helpful. Orthopedic and other surgeons generally work with an anesthesiologist, a specialist in Perioperative Medicine. This is care of a patient prior to, during and after surgery. This includes evaluating and preparing a patient to undergo the rigors of surgery. The anesthesiologist plans the anesthetic for the patient and then cares for the patient during the surgical procedure. He/she monitors the patient's blood pressure, heart rate, breathing, and level of consciousness and analgesia. The anesthesiologist adjusts the anesthetic plan, medications, fluids, and other parameters to provide a safe, pain free surgical experience for the patient. He/she will take care of your medical needs during the operation so the surgeon can concentrate on the surgery. After the surgery, the anesthesiologist continues to provide the care necessary to ensure a smooth emergence from the anesthetic and pain control after your surgery. Anesthesiologists are specialists in control of both acute and chronic pain. They also are involved in the care of critically ill patients. To become an Anesthesiologist requires four years in college to earn an undergraduate degree, four years of medical school to earn a Doctor of Medicine degree. He/she must then complete another four years of training in an accredited Anesthesia Residency Program. The physician may then complete another one or two years in a subspecialty of anesthesia such as Obstetrical Anesthesia, Cardiac Anesthesia, Pediatric Anesthesia, or Pain Management. After completing the above training, he or she must then pass a rigorous written and oral exam. To become a " Diplomate of the American Board of Anesthesiology " . Some anesthesiologists complete similar requirements to become certified in their subspecialty as well, such as Pain Management Certification. ..In some cases a certified Nurse anaesthetist may perform much of the monitoring and some other parts of the procedure, under supervision of the anaesthesiologist. Regulations vary somewhat from state to state. Types of anesthesia: An-esthesia : lack of sensation 1. Local: An injection in the skin and subcutaneous tissue. This might be used for a superficial biopsy. 2. Nerve Block : Injection into a nerve sheath to affect an entire area served by the nerve. This is a common technique used by dentists for example. An injection of the dental (mental) nerve will result in numbness of the entire mandible (jawbone) on that side FOR HIP SURGERY, A FEMORAL NERVE BLOCK IS GIVEN. THIS RESULTS IN DEEP LOSS OF SENSATION IN THAT LEG SPINAL ANESTHESIA – TWO TYPES 3A EPI-DURAL ANESTHESIA – This is reserved for a more limited area where only a few of the exiting spinal nerve roots will be affected. A very tiny needle or small plastic catheter is injected into the space just outside of the main covering over the spinal nerve roots and cord. 3B " Spinal " Sub-Dural Anesthesia – Allows for deeper and more extensive area of pain control and paralysis. Prevents uncontrolled muscle movement (so you don't kick the surgeon in the head).and has other advantages. Sometimes, special needles and catheters are used to combine both types of spinal anesthesia. GENERAL ANAESTHESIA: This usually refers to the use of an endo-tracheal tube, Anesthetic gases and is reserved as back up for other techniques, use in people with respiratory, cardiac and certain other high risk situations. SEDATION: This refers to a variety of techniques using various intravenous medications. Conscious sedation refers to a common technique which may be used for a variety of diagnostic and therapeutic procedures such as colonoscopy and gastroscopy. The advantage is that the patient is able to cooperate and follow instructions while controlling anxiety. Often, the patient may be given medication so that there is no memory of the procedure. For Hip surgery, on otherwise healthy patients, the best combination may be a Femoral nerve block, spinal anesthesia and with intravenous sedation. NOTE: The level of intravenous sedation can be varied at will throughout the procedure. This will not affect the level of pain control. This is why a number of surface hippies have reported " waking up " (light sedation) during their surgery. This is under the control of the anesthesiologist and doesn't indicate a mistake. When you go for pre-anaesthesia assessment, ask questions and be sure to answer fully and honestly so that the best procedure can be planned . Best to all, in NC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2003 Report Share Posted April 10, 2003 At 09:11 PM 4/9/2003 -0400, you wrote: >When people have nausea is it due to the anesthesia or the pain killer >(e.g., morphine PCA) given afterward? I'm sure it varies widely, but for my mom's first THR, she was so sick immediately post-op that they wouldn't give her any pain meds. So she was sick and hurt like hell. Funny that she doesn't remember it now, but her experience made me perfectly happy to have a spinal. C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2003 Report Share Posted April 10, 2003 Hi Lois: The anesthesiologist was of course correct. That is why " spinal " anaesthesia, where the needle completely passes through the Dura (the thick sac surrounding the spinal cord and nerves) is used. The anesthesiologist can feel when the needle has reached the right place. In addition, a small amount of exquisitely clear fluid will come out of the needle hub (CSF - cerbrospinal fluid). The medicine is injected so that it completely mixes with the CSF and bathes all of the nerve roots going to the lower body. By the way, the spinal " cord " ends at the Lumbar 1 level which is well above where the " needle " or catheter goes in. There is no cord, but only the collection of nerve roots, " cauda equina " , latin for " Horse's tail " . This is a technique which I, as a diagnostic radiologist, utilize to perform " Myelograms " . The anesthesiologists use a much smaller needle, 26 or 27 guage which reduces the likelyhood of a post procedure headache. When they are initially positioning you, they will elevate your head and caution you not to cough to limit the extent of anesthesia toward your head. Remember, this procedure is very easy for them, they have years of training and do this on a daily basis. EPI-dural anaesthesia requires positioning the needle/catheter in the epidural space. This has a very slight " negative " pressure. A drop of saline (salt water) or anaesthetic which is placed in the hub of the needle will be " sucked in " slighlty as the needle reaches the right spot. This technique is used when a much more limited level of anesthesia is desired. I hope all went well with you. As I mentioned in the previous post, most surface hippies will be offered the combination of local femoral nerve block, spinal anesthesia and intravenous sedation which can be easily be controlled by the anesthesiologist. Trust the anesthesiologist to handle his/ her specialty. Your Orthopedist does. Let the OS handle the surgery. I was very pleased with my experience. in NC (L) C+ 3/31/03, Dr. Vail In surfacehippy , " Lois G. " <lgers@n...> wrote: > > : > > Quick question here. When I had my surgery 2 weeks ago, I had made up my > mind after some research and talking to get an epidural. Right before my > surgery, when I met the anesthesiologist I told him of my choice....epidural > and medium " sleep " . He said he did not recommend an epidural for hip > replacement because I would be on my side and the epidural could therefore > 'pool'. I was taken aback because I had never heard of this before. He > was insistent. He suggested a spinal or a general. Since I was caught > off guard and it was the 11th hour, I went with the general. Had you heard > of this with a epidural before? I had an epidural when I had a c-section > 13 years ago, but then I was positioned on my back. Thoughts? > > Lois C+ 3/27/03 Dr. Mont > > > > Types of anesthesia > > > > Dear fellow hippys: > > There has been some recent confusion about different types of > surgical anesthesia. This is a summary of information which I hope > is helpful. > > Orthopedic and other surgeons generally work with an > anesthesiologist, a specialist in Perioperative Medicine. This is > care of a patient prior to, during and after surgery. This includes > evaluating and preparing a patient to undergo the rigors of surgery. > The anesthesiologist plans the anesthetic for the patient and then > cares for the patient during the surgical procedure. He/she monitors > the patient's blood pressure, heart rate, breathing, and level of > consciousness and analgesia. The anesthesiologist adjusts the > anesthetic plan, medications, fluids, and other parameters to > provide a safe, pain free surgical experience for the patient. > He/she will take care of your medical needs during the operation so > the surgeon can concentrate on the surgery. After the surgery, the > anesthesiologist continues to provide the care necessary to ensure a > smooth emergence from the anesthetic and pain control after your > surgery. > Anesthesiologists are specialists in control of both acute > and chronic pain. They also are involved in the care of critically > ill patients. > To become an Anesthesiologist requires four years in > college to earn an undergraduate degree, four years of medical > school to earn a Doctor of Medicine degree. He/she must then > complete another four years of training in an accredited Anesthesia > Residency Program. The physician may then complete another one or > two years in a subspecialty of anesthesia such as Obstetrical > Anesthesia, Cardiac Anesthesia, Pediatric Anesthesia, or Pain > Management. > After completing the above training, he or she must then > pass a rigorous written and oral exam. To become a " Diplomate of the > American Board of Anesthesiology " . > Some anesthesiologists complete similar requirements to > become certified in their subspecialty as well, such as Pain > Management Certification. > .In some cases a certified Nurse anaesthetist may perform much of > the monitoring and some other parts of the procedure, under > supervision of the anaesthesiologist. Regulations vary somewhat > from state to state. > > Types of anesthesia: > > An-esthesia : lack of sensation > 1. Local: An injection in the skin and subcutaneous tissue. > This might be used for a superficial biopsy. > > 2. Nerve Block : Injection into a nerve sheath to affect an entire > area served by the nerve. This is a common technique used by > dentists for example. An injection of the dental (mental) nerve > will result in numbness of the entire mandible (jawbone) on that > side FOR HIP SURGERY, A FEMORAL NERVE BLOCK IS GIVEN. THIS > RESULTS IN DEEP LOSS OF SENSATION IN THAT LEG > > SPINAL ANESTHESIA – TWO TYPES > 3A EPI-DURAL ANESTHESIA – This is reserved for a more limited > area > where only a few of the exiting spinal nerve roots will be > affected. A very tiny needle or small plastic catheter is injected > into the space just outside of the main covering over the spinal > nerve roots and cord. > > 3B " Spinal " Sub-Dural Anesthesia – Allows for deeper and > more > extensive area of pain control and paralysis. Prevents uncontrolled > muscle movement (so you don't kick the surgeon in the head).and > has > other advantages. > > Sometimes, special needles and catheters are used to combine both > types of spinal anesthesia. > > GENERAL ANAESTHESIA: > This usually refers to the use of an endo-tracheal tube, Anesthetic > gases and is reserved as back up for other techniques, use in people > with respiratory, cardiac and certain other high risk situations. > > SEDATION: > > This refers to a variety of techniques using various intravenous > medications. > > Conscious sedation refers to a common technique which may be used > for a variety of diagnostic and therapeutic procedures such as > colonoscopy and gastroscopy. The advantage is that the patient is > able to cooperate and follow instructions while controlling > anxiety. Often, the patient may be given medication so that there > is no memory of the procedure. > > For Hip surgery, on otherwise healthy patients, the best combination > may be a Femoral nerve block, spinal anesthesia and with intravenous > sedation. NOTE: The level of intravenous sedation can be varied at > will throughout the procedure. This will not affect the level of > pain control. > > This is why a number of surface hippies have reported " waking > up " > (light sedation) during their surgery. This is under the control of > the anesthesiologist and doesn't indicate a mistake. > > When you go for pre-anaesthesia assessment, ask questions and be > sure to answer fully and honestly so that the best procedure can be > planned . > > > Best to all, > > in NC > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2003 Report Share Posted April 10, 2003 At 04:47 AM 4/10/2003 +0000, you wrote: > When they are initially positioning you, they >will elevate your head and caution you not to cough to limit the >extent of anesthesia toward your head. On the other hand, if you are not numb high enough up, they will tilt the table a bit so that some will run towards your head. I found that low-tech solution hysterically funny (although without the versed, I may have only been slightly amused ;-). C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2003 Report Share Posted April 10, 2003 Ok Edith, I'll bite.... " apparently the risks are far less. i.e. we are now more aware of what full anaesthetics do to the brain " ...what does it do to the brain? 2/19/03 BHR DeSmet > Hi , > > Perhaps you should have cavetted the below with 'in a perfect > world'..........smile............ > > I suspect we all have stories that have bits and pieces missing from > problems with travelling long journeys, time constraints, unforeseen > circumstances etc........... I didn't get to see my anaesthestist until the > night before and initially he seemed more keen on trying to tell me I > shouldn't be having the surgery scheduled due to my history of osteomylitis > than getting on with his job.........which set up an interesting > senario...... He did however look after me quite well when he applied his > mind to his part of the job and after the operation seemed somewhat excited > about what he had witnessed....... my op required the femur chipped out > before a Resurface could start........... > > My brotherinlaw is an anaesthestist so yes I am aware of all the years of > study and how varied and stressful their work actually is.......... My BIL > actually get that awful decision of turning off life support....... He had > told me when initially considering the op that most surgeons these days > prefer a spinal block arrangement for any surgery below the > waist...........apparently the risks are far less. i.e. we are now more > aware of what full anaesthetics do to the brain and after about 20 of them I > wasn't keen on any more anyway.......... > > Thankyou for your outline though - very helpful. > > Edith Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2003 Report Share Posted April 11, 2003 ........I am planning on traveling to Belgium in July and inquired about a femoral nerve block plus a spinal for my resurface and Dr DeSmet suggested I consider general anesthesia because he felt it gave a much deeper muscle relaxation compared to a femoral nerve block and spinal. Could you comment please. Types of anesthesia > > > > Dear fellow hippys: > > There has been some recent confusion about different types of > surgical anesthesia. This is a summary of information which I hope > is helpful. > > Orthopedic and other surgeons generally work with an > anesthesiologist, a specialist in Perioperative Medicine. This is > care of a patient prior to, during and after surgery. This includes > evaluating and preparing a patient to undergo the rigors of surgery. > The anesthesiologist plans the anesthetic for the patient and then > cares for the patient during the surgical procedure. He/she monitors > the patient's blood pressure, heart rate, breathing, and level of > consciousness and analgesia. The anesthesiologist adjusts the > anesthetic plan, medications, fluids, and other parameters to > provide a safe, pain free surgical experience for the patient. > He/she will take care of your medical needs during the operation so > the surgeon can concentrate on the surgery. After the surgery, the > anesthesiologist continues to provide the care necessary to ensure a > smooth emergence from the anesthetic and pain control after your > surgery. > Anesthesiologists are specialists in control of both acute > and chronic pain. They also are involved in the care of critically > ill patients. > To become an Anesthesiologist requires four years in > college to earn an undergraduate degree, four years of medical > school to earn a Doctor of Medicine degree. He/she must then > complete another four years of training in an accredited Anesthesia > Residency Program. The physician may then complete another one or > two years in a subspecialty of anesthesia such as Obstetrical > Anesthesia, Cardiac Anesthesia, Pediatric Anesthesia, or Pain > Management. > After completing the above training, he or she must then > pass a rigorous written and oral exam. To become a " Diplomate of the > American Board of Anesthesiology " . > Some anesthesiologists complete similar requirements to > become certified in their subspecialty as well, such as Pain > Management Certification. > .In some cases a certified Nurse anaesthetist may perform much of > the monitoring and some other parts of the procedure, under > supervision of the anaesthesiologist. Regulations vary somewhat > from state to state. > > Types of anesthesia: > > An-esthesia : lack of sensation > 1. Local: An injection in the skin and subcutaneous tissue. > This might be used for a superficial biopsy. > > 2. Nerve Block : Injection into a nerve sheath to affect an entire > area served by the nerve. This is a common technique used by > dentists for example. An injection of the dental (mental) nerve > will result in numbness of the entire mandible (jawbone) on that > side FOR HIP SURGERY, A FEMORAL NERVE BLOCK IS GIVEN. THIS > RESULTS IN DEEP LOSS OF SENSATION IN THAT LEG > > SPINAL ANESTHESIA - TWO TYPES > 3A EPI-DURAL ANESTHESIA - This is reserved for a more limited > area > where only a few of the exiting spinal nerve roots will be > affected. A very tiny needle or small plastic catheter is injected > into the space just outside of the main covering over the spinal > nerve roots and cord. > > 3B " Spinal " Sub-Dural Anesthesia - Allows for deeper and > more > extensive area of pain control and paralysis. Prevents uncontrolled > muscle movement (so you don't kick the surgeon in the head).and > has > other advantages. > > Sometimes, special needles and catheters are used to combine both > types of spinal anesthesia. > > GENERAL ANAESTHESIA: > This usually refers to the use of an endo-tracheal tube, Anesthetic > gases and is reserved as back up for other techniques, use in people > with respiratory, cardiac and certain other high risk situations. > > SEDATION: > > This refers to a variety of techniques using various intravenous > medications. > > Conscious sedation refers to a common technique which may be used > for a variety of diagnostic and therapeutic procedures such as > colonoscopy and gastroscopy. The advantage is that the patient is > able to cooperate and follow instructions while controlling > anxiety. Often, the patient may be given medication so that there > is no memory of the procedure. > > For Hip surgery, on otherwise healthy patients, the best combination > may be a Femoral nerve block, spinal anesthesia and with intravenous > sedation. NOTE: The level of intravenous sedation can be varied at > will throughout the procedure. This will not affect the level of > pain control. > > This is why a number of surface hippies have reported " waking > up " > (light sedation) during their surgery. This is under the control of > the anesthesiologist and doesn't indicate a mistake. > > When you go for pre-anaesthesia assessment, ask questions and be > sure to answer fully and honestly so that the best procedure can be > planned . > > > Best to all, > > in NC > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2003 Report Share Posted April 11, 2003 Hi, Oh #$@ wish you hadn't.......... smile......... Actually I am but an amature and caught myself here........ When considering the hip operation my brotherinlaw who is an anaesthestist discussed it with me and it the general things were said rather than specific results of surveys over time etc......... and maybe I can plead having had 20 of them my brain doesn't remember details too well............smile...........or maybe that is just old age.............. From what I can remember and understand it is that a percentage of people simply don't react too well to being plunged into that level of unconsciousness and/or that some bodies react badly to whatever the contents of the drug used........... this can lead to hassles which affect all organs of the body, not only the brain and the percentage chance of that is higher than the damages that result from rendering the body numb via the spine............as there are risks there too with nerve damage. I probably have failed to explain any of it satisfactorily here.......... and will try hard not to be too general in the future and get myself into trouble....... Edith > > I'll bite.... " apparently the risks are far less. i.e. we are now more > aware of what full anaesthetics do to the brain " ...what does it do to > the brain? 2/19/03 BHR DeSmet > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2003 Report Share Posted April 11, 2003 Hi: I can not make any specific recommendations for anyone. European physicians may have different relationships with their anaesthesia arrangements. I don't know if he uses an anaesthesiologist or the equivalent of a nurse anaesthetist in the US. In any case,you must trust the judgement of the OS you have chosen for the procedure. My original post was to try to explain the differences in terminology for educational purposes of surface hippies. Good luck with your surgery. in NC (L) C+, 3/31/03, DR. Vail > > > > : > > > > Quick question here. When I had my surgery 2 weeks ago, I had > made up my > > mind after some research and talking to get an epidural. Right > before my > > surgery, when I met the anesthesiologist I told him of my > choice....epidural > > and medium " sleep " . He said he did not recommend an epidural > for hip > > replacement because I would be on my side and the epidural could > therefore > > 'pool'. I was taken aback because I had never heard of this > before. He > > was insistent. He suggested a spinal or a general. Since I > was caught > > off guard and it was the 11th hour, I went with the general. Had > you heard > > of this with a epidural before? I had an epidural when I had a > c-section > > 13 years ago, but then I was positioned on my back. Thoughts? > > > > Lois C+ 3/27/03 Dr. Mont > > > > > > > > Types of anesthesia > > > > > > > > Dear fellow hippys: > > > > There has been some recent confusion about different types of > > surgical anesthesia. This is a summary of information which I hope > > is helpful. > > > > Orthopedic and other surgeons generally work with an > > anesthesiologist, a specialist in Perioperative Medicine. This is > > care of a patient prior to, during and after surgery. This includes > > evaluating and preparing a patient to undergo the rigors of > surgery. > > The anesthesiologist plans the anesthetic for the patient and then > > cares for the patient during the surgical procedure. He/she > monitors > > the patient's blood pressure, heart rate, breathing, and level of > > consciousness and analgesia. The anesthesiologist adjusts the > > anesthetic plan, medications, fluids, and other parameters to > > provide a safe, pain free surgical experience for the patient. > > He/she will take care of your medical needs during the operation so > > the surgeon can concentrate on the surgery. After the surgery, the > > anesthesiologist continues to provide the care necessary to ensure > a > > smooth emergence from the anesthetic and pain control after your > > surgery. > > Anesthesiologists are specialists in control of both > acute > > and chronic pain. They also are involved in the care of critically > > ill patients. > > To become an Anesthesiologist requires four years in > > college to earn an undergraduate degree, four years of medical > > school to earn a Doctor of Medicine degree. He/she must then > > complete another four years of training in an accredited Anesthesia > > Residency Program. The physician may then complete another one or > > two years in a subspecialty of anesthesia such as Obstetrical > > Anesthesia, Cardiac Anesthesia, Pediatric Anesthesia, or Pain > > Management. > > After completing the above training, he or she must then > > pass a rigorous written and oral exam. To become a " Diplomate of > the > > American Board of Anesthesiology " . > > Some anesthesiologists complete similar requirements to > > become certified in their subspecialty as well, such as Pain > > Management Certification. > > .In some cases a certified Nurse anaesthetist may perform much of > > the monitoring and some other parts of the procedure, under > > supervision of the anaesthesiologist. Regulations vary somewhat > > from state to state. > > > > Types of anesthesia: > > > > An-esthesia : lack of sensation > > 1. Local: An injection in the skin and subcutaneous tissue. > > This might be used for a superficial biopsy. > > > > 2. Nerve Block : Injection into a nerve sheath to affect an > entire > > area served by the nerve. This is a common technique used by > > dentists for example. An injection of the dental (mental) nerve > > will result in numbness of the entire mandible (jawbone) on that > > side FOR HIP SURGERY, A FEMORAL NERVE BLOCK IS GIVEN. THIS > > RESULTS IN DEEP LOSS OF SENSATION IN THAT LEG > > > > SPINAL ANESTHESIA - TWO TYPES > > 3A EPI-DURAL ANESTHESIA - This is reserved for a more limited > > area > > where only a few of the exiting spinal nerve roots will be > > affected. A very tiny needle or small plastic catheter is injected > > into the space just outside of the main covering over the spinal > > nerve roots and cord. > > > > 3B " Spinal " Sub-Dural Anesthesia - Allows for deeper and > > more > > extensive area of pain control and paralysis. Prevents > uncontrolled > > muscle movement (so you don't kick the surgeon in the head).and > > has > > other advantages. > > > > Sometimes, special needles and catheters are used to combine both > > types of spinal anesthesia. > > > > GENERAL ANAESTHESIA: > > This usually refers to the use of an endo-tracheal tube, Anesthetic > > gases and is reserved as back up for other techniques, use in > people > > with respiratory, cardiac and certain other high risk situations. > > > > SEDATION: > > > > This refers to a variety of techniques using various intravenous > > medications. > > > > Conscious sedation refers to a common technique which may be used > > for a variety of diagnostic and therapeutic procedures such as > > colonoscopy and gastroscopy. The advantage is that the patient is > > able to cooperate and follow instructions while controlling > > anxiety. Often, the patient may be given medication so that there > > is no memory of the procedure. > > > > For Hip surgery, on otherwise healthy patients, the best > combination > > may be a Femoral nerve block, spinal anesthesia and with > intravenous > > sedation. NOTE: The level of intravenous sedation can be varied at > > will throughout the procedure. This will not affect the level of > > pain control. > > > > This is why a number of surface hippies have reported " waking > > up " > > (light sedation) during their surgery. This is under the control > of > > the anesthesiologist and doesn't indicate a mistake. > > > > When you go for pre-anaesthesia assessment, ask questions and be > > sure to answer fully and honestly so that the best procedure can be > > planned . > > > > > > Best to all, > > > > in NC > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 2003 Report Share Posted April 12, 2003 In regards to anti-nausea medications... My doctor ( Kennedy) wrote me a script for a medication called Kytril. It is a medication prescribed to chemo patients to prevent nausea and vomiting. It was one pill I took on the morning of surgery. I have had general anesthesia in the past and have always been severly sick, but this time I felt great. I highly recommend this to anyone who knows there having general anesthesia and who knows they get sick from it. It was not cheap, (about $20 with my prescription plan) but it was money well spent. Diane Dr.Kennedy, 1/23/03, Cormet > Something I'd like to see comment on are the use of additives in the mix, like something that causes the patient to lose short-term memory (I believe its called Versed) and the anti-nausea medications. When people have nausea is it due to the anesthesia or the pain killer (e.g., morphine PCA) given afterward? > > - > Quote Link to comment Share on other sites More sharing options...
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