Why is fasting necessary before surgery?
When patients receive anesthesia for surgery, they become very relaxed and sleepy. When patients are this sleepy, the muscles of the stomach and throat which normally stop food from coming up into the throat, going down into the windpipe or trachea, and then into the lungs, are also relaxed. When patients get food or liquid into their lungs from the stomach, this can cause pneumonia or even death. To minimize the risk of this happening, patients are asked not to eat or drink for a certain length of time before surgery. If the stomach is therefore empty, the risk of anything coming up from the stomach and getting into the lungs is extremely low. Anesthesia is therefore much safer. For more information, please view our NPO Guidelines.
What type of liquids are CLEAR LIQUIDS?
Clear liquids are any type of liquids that, when poured into a clear glass, would allow you to see through them. Some examples are water, electrolyte solutions such as Pedialyte, apple juice, and carbonated soft drinks or pop. Any liquid that you cannot see through, such as orange juice or milk, empties from the stomach slower, and should be treated as a "light meal" in terms of fasting.
My child has a cold. Should his/her surgery be cancelled?
In the past, children with colds had their anesthesia and surgery cancelled until they felt better. This practice was based on concerns that the anesthetic made the cold worse and increased the risk of complications during surgery. Nowadays, we know much more about the effects of anesthesia on colds such that cancellation of surgery for children with colds is much less common.
Research has shown that children with colds have slightly more complications during anesthesia than children who are healthy. An important role of the anesthesiologist is to ensure that your child breathes freely when asleep for surgery. This is more of a challenge when a child has a cold because they may have a lot of secretions and their air passages may be more sensitive. Sometimes this can result in coughing, spasm of the airways, and a lowering of oxygen in the blood. It is important to note, however, that these complications are typically mild and can be easily anticipated, recognized, and treated.
The decision to cancel surgery for the child with a cold is based on a number of factors. These decisions should be made in consultation with your anesthesiologist and surgeon who can determine whether cancellation of surgery is necessary.
How long does the Anesthesia last?
The anesthesiologist will provide anesthesia for as long as is necessary for the surgeon to successfully complete your child's procedure. The typical length of the procedure is a question best addressed by your surgeon. Upon completion of your child's procedure the anesthesiologist will decrease anesthetic gas concentrations which will enable your child to awaken. This process usually takes approximately 10-15 minutes. In the recovery room, your child may remain sleepy from the anesthetic gases for approximately an hour after the procedure. Some of the intravenous pain medicines used by anesthesiologists in the operating room provide good pain control and have mildly sedating properties that last for several hours after the procedure. This is advantageous for providing longer lasting pain relief immediately after the procedure.
What if I wake up during surgery?
Some procedures are performed under local or regional anesthesia with modest levels of sedation. In these circumstances, deep unconsciousness is not intended, and patients will predictably have varying levels of recall of events and surroundings without experiencing surgical pain. Your anesthesia provider will clearly explain exactly what you should expect to experience.
Patients who dream during surgery, or who have some perception of their surroundings before or after surgery, may think they have experienced intraoperative awareness. But such a sensation or memory does not necessarily represent actual awareness with recall during the surgical procedure.
No monitor exists that can completely guarantee a patient will not experience intraoperative awareness with recall. As always, your anesthesia professional will guide you safely through your surgery by relying on his or her clinical experience, training and judgment combined with appropriate technology.
What is ambulatory anesthesia?
Ambulatory anesthesia is tailored to meet the needs of ambulatory surgery so you can go home soon after your operation. Short-acting anesthetic drugs and specialized anesthetic techniques as well as care specifically focused of your needs are used to make your experience safe and pleasant. In general, if you are in reasonably good health, you are a candidate for ambulatory anesthesia and surgery.
Will I have nausea? Will I vomit?
Most people don't. Since the days of ether anesthesia, when almost everybody did vomit after anesthesia, we have made great progress. The general rate of post-operative nausea and vomiting ("PONV") is between 10 and 20%.
However the rate varies widely depending on the type of operation you're having. Most of our patients will receive a combination of anti-nausea medications while in the operating room to prevent this uncomfortable event. If you do experience nausea post-operatively, fortunately most instances are short lived, lasting only briefly in the Recovery Room. Some last longer and require combinations of anti-nausea medicines. Rarely a patient will need to be admitted to the hospital longer than originally planned for nausea treatment and re-hydration.
What is Malignant Hyperthermia?
Malignant Hyperthermia (MH) is a rare but life-threatening condition that occurs about one in 50,000 anesthetics. It got its name from the fulminant fever (to 108 degrees) that occurs. A rare genetic mutation makes some individuals susceptible to MH. When these MH-susceptible (MHS) people are exposed to certain anesthetic drugs an MH episode sometimes "triggers." The genetic defect, in conjunction with the triggering drugs, makes muscle cells unable to relax normally. This spastic contraction causes the cells to use up all available energy stores, run short of oxygen, and produce excessive waste products, including heat. Eventually some of the cells die. Cardiovascular collapse and death results if left untreated.
Fortunately there is a drug, dantrolene, which can reverse the process where it starts, at the level of the muscle cells. If given soon enough and in sufficient quantity, the muscle cells can relax and the cascade of derangement will reverse. MH had been 80 - 100% fatal before dantrolene; with dantrolene this figure has been brought down to 5 - 10%.
For more information please see the web site of the Malignant Hyperthermia Association of the United States (MHAUS)