When surgery is pending, a certain level anxiety regarding your surgical team is very understandable. That’s why it’s important to get to know, and have complete confidence in your entire surgical team. Speaking with an anesthesiologist prior to surgery may help alleviate your concerns.

When your surgeon works with IAA, our anesthesiologist will be happy to answer all of your questions and explain their role in your operation, step by step. You can speak with your surgeon as well and have them recommend an anesthesiologist who specializes in procedures like yours.

Finding the best anesthesiologist for you and your situation is easy. Get to know us. We look forward to meeting you.

Please contact Integrated Anesthesia Associates (IAA) if you’d like to discuss surgical anesthesia with one of our Board Certified Anesthesiologists.

The type of surgery you are having, i.e. orthopedic surgery, cardiovascular surgery, labor and delivery, etc., may indicate which IAA anesthesiologist is right for your case.

With a staff of more than 100 highly skilled anesthesiologists, you can rest assured that a qualified anesthesia team of specialists from Integrated Anesthesia Associates will be providing you and your family with the services and outcome you expect and deserve.

Please contact Integrated Anesthesia Associates (IAA) if you’d like to discuss surgical anesthesia with one of our Board Certified Anesthesiologists.

There are four main types of anesthesia; local, monitored, regional and general anethesia. Depending upon your procedure and your individual needs and circumstances, your anesthesiologist will choose and discuss the correct anesthesia for you.  Choices include: local anesthesia, monitored anesthesia, regional anesthesia, and general anesthesia. Each has many forms and uses.

Local Anesthesia
In local anesthesia, the anesthetic drug is usually injected into the tissue to numb the specific location of your body having minor surgery, (for example, the hand or foot).
Monitored Anesthesia
With monitored anesthesia (also called “light sedation”) an anesthesiologist provides close patient monitoring for a patient receiving local or regional anesthesia during surgery. Intravenous sedation is often used. The patient is typically awake but in a condition that ranges from relaxed to groggy. This type of anesthesia is frequently used with minor surgeries.
Regional Anesthesia
In regional anesthesia, your anesthesiologist injects near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake or you may be given a sedative. Either way, you will not see or feel the actual surgery take place. There are several kinds of regional anesthesia. Two of the most frequently used are spinal anesthesia and epidural anesthesia, which are produced by injections made with great exactness into the appropriate areas of the back. Both are typically used during childbirth and prostate surgery.
General Anesthesia
With general anesthesia, you are unconscious and have no awareness or sensation. General anesthetic drugs include gases and vapors inhaled through a breathing mask or tube and medications introduced through a vein. During anesthesia, your anesthesiologist will carefully monitor and control your major bodily functions via sophisticated equipment. A breathing tube may be inserted through your mouth and frequently into the windpipe to maintain proper breathing during this period. The length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesiologist will reverse the process and you will regain consciousness in the recovery room.

Yes. All of your physicians, including your Anesthesiologist need to be made aware of all of your pre-existing conditions. Please be sure to share this information.

Your surgeon’s office will provide you with explicit instructions for you to follow prior to your surgery. Every person and situation are different so it is critical that you receive this information and follow directions regarding preparation for your surgery.

Although awareness under general anesthesia is possible, it can be prevented. Our anesthesia care team members are well-trained professionals who are extremely vigilant during administration of anesthesia to ensure the patient’s safety and well-being. When patients are only sedated, awareness is not uncommon depending the depth of the sedation; this should not be confused with awareness under general anesthesia.

Please contact Integrated Anesthesia Associates if you’d like to discuss surgical anesthesia with one of our Board Certified Anesthesiologists.

Depending upon the type of anesthesia you receive, you may or may not be completely sedated. Your doctor will determine which type of anesthesia is right for you based upon the type of procedure you are receiving. If you are put under full sedation, you will more than likely only remember gently falling asleep and not wake until you are in the recovery room where you will be fully cared for by the nursing staff.

Receiving anesthesia is not painful. In fact, it’s purpose is to relieve any pain associated with the surgical procedure. If you’re concerned about pain or pain intolerance before, during or after surgery, please speak with your IAA Anesthesiologist about your concerns so that they may answer your questions and reassure you and your loved ones.

Your anesthesiologist will discuss the risks and benefits associated with each anesthetic option, as well as any potential complications or side effects they may cause. Some patients may experience nausea or vomiting. Medications to treat nausea and vomiting are available if needed.

All operations and all anesthesia procedures have some associated risk. These risks depend may depend surgery type, underlying medical condition and other personal factors.

High reliability is our number one goal and fortunately, adverse anesthesiology events are very rare. You can rest assured that your IAA anesthesiologist will take every precaution to prevent an accident from occurring, just as you do when driving a car or crossing the street.

Since your specific risks may vary depending on your procedure and your condition, we suggest you ask speak candidly with your anesthesiologist about the risks and ask any questions or voice any concerns you or your loved ones may have.

As a general rule, you should not eat or drink anything after midnight the night before a surgery. In certain cases, the anesthesiologist may give a patient permission to drink clear liquids up to a few hours before the anesthesia procedure.

There are several types of anesthesia. We have detailed them in the “Anesthesia Techniques” FAQ section below.

Some medications can and should be taken and others should not. It is important to discuss this issue with your surgeon or anesthesiologist thoroughly to prevent any adverse effects. Do not interrupt any medication unless your anesthesiologist or surgeon specifically recommends it.

Anesthesiologists are currently researching exactly how certain herbs and dietary supplements interact with particular anesthetics. They are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risk of bleeding or raise blood pressure.

Some effects may be subtle and less critical, but for anesthesiologists it is better to anticipate a possible reaction than to react to an unexpected situation. That is why it is very important to tell your doctor about everything you normally take before you have surgery.

Regional anesthesia is a targeted way to provide anesthesia and pain relief for your surgery. Regional anesthesia involves the injection of a local anesthetic to provide numbness, loss of pain or loss of sensation to a large region of the body. Regional anesthetic techniques include spinal blocks, epidural blocks, and arm and leg blocks. During regional anesthesia, medications can be given to make you drowsy and blur your memory.

Nerve blocks are another name for regional anesthesia. Nerve blocks, a.k.a. regional anesthesia, are a way of providing targeted anesthesia and pain relief specifically for your surgery. Speak with your IAA anesthesiologist to discuss the different types of anesthesia and learn more about what is right for you and your specific situation.

Regional anesthesia, is a procedure that utilizes a needle to deliver local anesthetic to the nerves for the area where your surgeon is operating. Benefits include superior pain relief while minimizing side-effects such as nausea, vomiting and constipation. Some nerve blocks take away all pain for a procedure while others significantly reduce it.

For certain types of surgeries, a piece of plastic tubing (catheter) can be used to continue to deliver numbing medicine for a few days.

When is regional anesthesia administered?

Sometime before or after your surgery, the anesthesiologist will locate the optimal injection site using ultrasound or electrical stimulation. The numbing medication can be injected with precision, with minimal risk of irritating or injecting the nerves themselves.

Usually this nerve block is no more painful than getting an IV. Your skin will be numbed for the block, and you may also receive mild sedation prior to the procedure.

Depending on the type of surgery, regional anesthesia can be used by itself or with the combination of other regional techniques such as spinal/epidural anesthesia or even general anesthesia. You will have the opportunity to discuss your preferences with your anesthesiologist before surgery.

Nerve blocks are very safe. The risk of problems with bleeding and infection is extremely low. A small number of people experience mild numbness, tingling or weakness that goes away after you heal after surgery. This may be related to the block or the surgery itself.

The risk of complications from too much numbing medication or a permanent reaction to numbing medicine is extremely low.

Hand Surgery
For minor hand and wrist surgeries, we use intravenous regional anesthesia (“Bier Block”), which involves placing a second IV catheter in the hand undergoing surgery. We inject numbing medicine into the venous system, which is trapped by a tourniquet. The numbness is very short-lived. For more extensive surgeries involving bones and/or joints, we perform nerve blocks at different locations. Nerve blocks for hand and wrist surgery are most commonly performed in the axilla/armpit (axillary block) or at the shoulder (infraclavicular block).

Elbow/Forearm Surgery
For surgeries involving the elbow, nerve blocks are most commonly performed in the axilla (axillary block) or at the shoulder (infraclavicular block).

Upper Arm/Shoulder Surgery
For surgeries involving the upper arm or shoulder, nerve blocks are most commonly performed in the area around the collarbone (interscalene block). This facilitates your rehabilitation and reduces your need for other pain medications.

Knee Surgery
For surgeries involving the knee, nerve blocks are most commonly performed at the groin (femoral block). For ACL reconstruction and knee replacement, we routinely place a catheter near the nerves; this can deliver numbing medicine into the area for two days. In addition to a femoral nerve catheter, we may perform an additional nerve block behind the thigh (sciatic block).

Hip Surgery
For hip surgery, nerve blocks may be performed in the back to numb the nerves responsible for sensation of the hip joint (lumbar plexus block) or an epidural may be placed. A lumbar plexus block is different than an epidural because a lumbar plexus block only numbs the nerves to one side.

Foot/Ankle Surgery
For surgeries involving the foot or ankle, nerve blocks are most commonly performed in the area behind your knee (popliteal sciatic block) or at the level of the ankle (ankle block). For more invasive surgeries of this area (for example, tendon/ligament repairs and fractures), we routinely place a catheter near the nerves; this can deliver numbing medicine into the area for two days. This type of pain relief facilitates your rehabilitation and reduces your need for other pain medications.

With monitored anesthesia (also called “light sedation”) an anesthesiologist provides close patient monitoring for a patient receiving local or regional anesthesia during surgery. Intravenous sedation is often used. The patient is typically awake but in a condition that ranges from relaxed to groggy. This type of anesthesia is frequently used with minor surgeries.

IAA anesthesiologists use monitored anesthesia for many surgical procedures that do not require deep sedation or a general anesthetic. During monitored anesthesia the patient is typically awake but in a calm condition that ranges from relaxed to groggy.

In this type of procedure, an anesthesiologist provides close patient monitoring to maintain the state of consciousness needed to keep the patient safe and comfortable. In order to avoid sudden changes or complications, the anesthesiologist monitors the patient’s blood pressure, heart rate and the amount of oxygen carried to vital organs. Monitored anesthesia is frequently used with minor surgery. With this type of anesthesia, patients are often able to respond to questions or instructions.

Although monitored anesthesia can carry some risks, major side-effects or complications are uncommon. The most common side-effect of monitored anesthesia is nausea, but since fewer anesthetics are administered relative to general anesthesia, the incidence of nausea is much less. Deeper levels of sedation can cause lowered blood pressure and loss of wakeful breathing patterns.

Patient safety and education are extremely important at Integrated Anesthesia Associates. At your request, prior to performing monitored anesthesia procedure the anesthesiologist can discuss potential risks associated with monitored anesthesia.

Since monitored anesthesia can range from light to heavy sedation, its advantages often depend on the depth of sedation and the amount of anesthetic used. However, it’s safe to say that lower doses of anesthetic can result in a faster recovery.

In addition, since the patient breathes naturally, there are no risks associated with artificial respiration.

In some cases, patients who undergo monitored anesthesia can bypass the recovery room altogether and are able to leave the hospital much sooner than they would have if they had received a general anesthetic. On the other hand, monitored anesthesia can transition to general anesthesia

General anesthesia is a treatment that results in a lack of consciousness during medical procedures. Patients undergoing general anesthesia don’t feel or remember anything that happens during the procedure. There’s no response to pain signals or surgical manipulations.

General anesthesia is usually produced by a combination of inhaled gases and intravenous drugs. The practice of general anesthesia also includes controlling the patient’s breathing and monitoring the patient’s body’s vital functions during a procedure.

With general anesthesia the patient is unconscious, with no awareness or other sensations. Several different types of drugs can be used for general anesthesia, including pain relievers, sedatives and muscle relaxants. Some of these drugs can be injected while others are inhaled. During a procedure that involves general anesthesia, the patient’s breathing may be controlled with a ventilator, which requires the insertion of an oral airway tube

General anesthesia is administered by a specially trained physician called an anesthesiologist. Sometimes assistance is provided by a specially certified registered nurse called a nurse anesthetist.

Your physician or surgeon may recommend general anesthesia for procedures that:

• require the patient to be in an uncomfortable position
• take a long time
• affect the patient’s breathing, such as surgery for the chest or upper abdomen.

Ask your surgeon and anesthesiologist questions. They are responsible for your comfort and safety before, during and immediately following your surgical procedure.  While in the operating room, your anesthesiologist will manage vital functions including heart rate and rhythm, blood pressure, body temperature and breathing. They are also responsible for fluid and blood replacement when necessary.

Although general anesthesia can carry some risks, major side-effects or complications are uncommon. General anesthesia can cause various temporary side-effects such as nausea, vomiting or a sore throat. More serious complications, although rare, include:

• temporary mental confusion
• lung infections
• stroke
• heart attack
• regaining consciousness during anesthesia
• death

Several factors can increase the risk of complications, including:

• medical conditions involving the lungs, heart or kidneys
• aspirin and other medications that can increase bleeding
• smoking
• alcohol or drug use
• a family history of adverse reactions to anesthesia
• food or drug allergies
• sleep apnea
• obesity
• advanced age

Patient safety and education are extremely important at Medical Anesthesiology Associates. At your request, prior to performing general anesthesia the anesthesiologist can discuss potential risks, your personal risk profile, and any questions you might have.

Additional information
Please contact Medical Anesthesiology Associates if you’d like to discuss general anesthesia with one of our anesthesiologists.

Integrated Anethesiology Associates specializes in several types of anethestia. Our clinical anesthesiology expertise at IAA includes:

• Surgical (every subspecialty represented)
• Labor and Delivery
• Critical Care
• Pediatric and Neonatal anesthesia
• Pain Management
• Ambulatory anesthesia

Your insurance provider will be able to give you complete details as to what services are covered and to what extent. Contact your insurance provider to discuss your pending surgery and associated anesthesiology costs.

Thank you for choosing Integrated Anesthesia Associates. Please note: all bills from IAA are due upon receipt. You can use our secure online billing service to pay your bill now.