RE: General versus Spinal plus question

[Guest guest]

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

Note: the needles used are actually quite small in diameter!!!

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,

(MD) in NC

L C+ 3/31/03 Dr. Vail

> Hi Ken,

> At the Vancouver General where I was surfed last month, they favor

spinals. I

> was assured I would not be awake, as some strong sedatives are

included in

> the brew. The anesthesiologist (a friend... I requested him,

thinking I'd like to

> see a familiar face on the way in and out... then had second

thoughts about

> whether I wanted my friend looking at my sorry butt for an hour...

oh well) told

> me spinals are preferred because they can get a jump start on pain

control that

> way. They use the same tap to dose you with morphine before

closing you up,

> and I suspect it's a whopping dose because I was quite comfortable

but really

> woozy for a few days and didn't even need to use the self-

administering pump

> at all. The reassuring thing is: I was totally out of it on the

table. Didn't see/hear

> anything. I imagine my friend could have given me less sedative if

I wanted to

> be more conscious. They do have tons of control in that regard.

Important thing

> is to discuss all this pre-op, of course. Then relax and just roll

over.

>

[Guest guest]

The anesthesiologist (a friend... I requested him, thinking I'd like to see a

familiar face on the way in and out... then had second thoughts about whether I

wanted my friend looking at my sorry butt for an hour... oh well)

a,

After you are asleep, they put up a drape so the only thing your friend would

have seen is your sweet sleeping face.

Cindy

C+ 5/25/01 and 6/28/01

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