Read this if the thought of anesthesia worries you
While most people welcome sedation during surgical procedures, others find the idea of it nerve-wracking. But, anesthesiology is such an advanced science today, patients can feel comfortable that they will have a good experience, said anesthesiologist Kevin Vilsaint, MD of Cape Cod Anesthesia Associates.
The first thing they do to allay any fears and make sure your care will be optimal is meet with you before the surgery to take a medical history and answer any questions, he said. An anesthesia provider – either an anesthesiologist or a certified nurse anesthetist – will stay with you throughout the procedure, monitoring your progress and vital signs, and will oversee your time in recovery.
Patients may be surprised to learn that each individual patient receives a different anesthesia mixture that is completely personalized for them, said Dr. Vilsaint, who practices at Cape Cod Hospital.
“We always say that anesthesia is a case-by-case basis,” he explained. “There is no recipe to do anesthesia for every patient. Whatever I did for one patient will never be done on another patient again.”
That’s because each patient has different characteristics to take into consideration like age, weight, health and medical conditions. Anesthesiology is a fine-tuned specialty of medicine that is always evolving to better meet the pain and physiological needs of patients.
One of the questions Dr. Vilsaint always asks patients before surgery is how they have reacted to anesthesia in the past. This is important for many reasons. For example, a common side effect is post-operative nausea and vomiting. New medications can prevent or ease those symptoms if you are prone to them.
“It’s just a matter of speaking to your anesthesiologist and being candid with them and let them know anything that happened in prior surgeries,” he said.
Prior to surgery, Dr. Vilsaint recommends following all instructions given to you by your surgeon and the medical professionals who do your pre-admission testing.
One of his biggest concerns as an anesthesiologist is patients who are taking chronic pain medications. There is a common misconception that they may interfere with anesthesia, but that is not true.
“You do want to take your scheduled pain meds, especially if you have been on a pain med for a significant period of time,” he said. “If you don’t, it puts the anesthesiologist at a disadvantage when we are working to control your pain because then we’re already behind in regards to getting that pain under control.”
The goal is to stay ahead of the pain, he said. If a patient doesn’t take their regularly scheduled pain medication in the morning and they have a late afternoon surgery, it’s possible they will have missed two doses before the surgery even begins. That makes it almost impossible for the anesthesiologist to catch up to the pain.
While most people tolerate anesthesia with no difficulties, there are some co-morbidities that can make anesthesia trickier, such as obesity, sleep apnea, or significant heart or lung disease. Those patients sometimes take longer to recover from general anesthesia after a breathing tube is inserted.
“You can have issues where their lungs may take insult or their hearts may not tolerate the anesthesia as well, so we have to tread lightly,” Dr. Vilsaint said.
Over the past 20 years the trend has been to use regional anesthesia more frequently, when possible. For surgeries to the extremities like the hands, local anesthesia with minimal sedation is plenty to keep pain away, he said.
In January of 2017, anesthesiologists at Cape Cod Healthcare developed a multimodal pain approach that has been very effective for joint replacements and ambulatory surgeries, Dr. Vilsaint said. Pain medicine is given to the patient prior to surgery to alleviate pain and allow a better and faster recovery.
“With these surgeries, a significant number of patients notice a difference,” he said. “Patients leave earlier and feel better. Patients who’ve had the other joint replaced the old way compared to the new way say it’s a night and day difference.”
After surgery of any kind, you need someone to drive you home. The recommendation is then to take it easy for at least 24 hours, even if your surgery was minor. If your surgeon prescribed temporary pain medication, you should refrain from driving, operating machinery and drinking alcohol until you stop taking the medication. You should also have someone stay with you for 24 hours after surgery, especially at night while you are recovering.
Another important subject that Dr. Vilsaint discusses with patients is post-operative cognitive dysfunction. After general anesthesia, some patients are disoriented and have cognitive impairment. Patients with baseline deficits like Alzheimer’s disease or Parkinson’s disease are at higher risk, as are patients over the age of 65. It is also more common if it occurred after a previous surgery.
“We believe it’s multi-factorial and it involves fluid status, pain status, the type of surgery, the length of surgery and blood loss,” he said. “We try to do a good job of limiting the effects of that, but I think the multimodal pain approach is going to help, especially if you have older patients coming in with joint replacements.”
The bottom line is that the less anesthesia you receive, the quicker your recovery from it will be.
Most people bounce back with no problem after anesthesia, Dr. Vilsaint said.
“If they listen to their surgeon’s instructions, the majority of people will be fine after anesthesia.”