Below is a list of some frequently asked questions regarding safety and side effects, but please feel free to contact us if you need additional information. We are always pleased to assist you.
Anesthesia safety has dramatically improved over the last 50 years. The reasons for this improvement are numerous and are better understood by viewing anesthetic care in three stages: 1) Preoperative, 2) Intraoperative and 3) Postoperative.
You will be seen by your anesthesiologist before going to the operating room. This allows your anesthesiologist to better understand all the medical issues you may have which might have an effect on anesthesia. Any pre-existing medical conditions you may have are well evaluated and treated by your regular medical doctor, so that you are in the best possible medical condition for your surgery.
The intraoperative care provided by your anesthesiologist has greatly improved by advances in patient monitoring techniques. Your anesthesiologist continually monitors your breathing, cardiac function, oxygen levels, exhaled carbon dioxide, and blood pressure. Anesthetic drugs and techniques have also improved greatly, increasing safety and reducing side effects.
Finally, in the postoperative care unit (recovery room), you will continue to be monitored until the effects of anesthesia have diminished and you are able to either go home, or be moved to a regular hospital room.
Neuraxial blockade (i.e. "epidurals" and "spinals") with local anesthetic medicines can and do cause temporary interruption of muscle strength and sensation. These effects are expected and desired during surgery. The duration of these effects is determined by the amount and type of local anesthetic medicine given and these in turn are selected based on the requirements of the surgery and surgeon. These effects wears off over a period of minutes to hours in the recovery room (post anesthesia care unit/PACU).
Permanent or long lasting paralysis from epidurals or spinals (although possible) is exceedingly rare. Although difficult to precisely estimate, this risk lies somewhere between one in tens of thousands to one in hundreds of thousands of cases. This can be compared favorably to the risk of a fatal automobile accident in a single year (roughly one in four thousand). The causes of neuraxial anesthesia-related paralysis include direct nerve trauma, infection, and bleeding. In order to reduce the risk of paralysis (which is already very remote), special care is taken in the selection of the placement site for these anesthetics, the sterility of the procedure and avoidance of certain medicines and medical conditions that increase bleeding risk.
If you are concerned about this issue, please discuss it with your anesthesiologist before surgery. During general anesthesia, it is extremely rare to experience what is referred to as "recall". However, this is dependent on the anesthetic technique and the amount and type of drugs that are administered by your anesthesiologist. During regional anesthesia (i.e. spinal, epidural, or nerve block) you may be choose to be anywhere from wide-awake to fully asleep. Many of the sedatives used have memory-blanking properties, and although you may be awake and conversant during the procedure you may have no recollection of these events later, (this is known as conscious sedation or "twilight sleep"). Your level of consciousness is very much under the control of your anesthesiologist. In many cases, your anesthetic can be "customized" to meet your expectations.
Addiction or psychological dependence is extremely rare for people taking opiates for short-term pain control after an operation. The available data confirms the idea that fear of opiate addiction should not be a primary concern in treating postoperative pain. In fact, there is excellent evidence that good postoperative pain control is crucial to facilitate early mobility and a complete rehabilitative process. Tolerance (where the body becomes resistant to higher and higher doses of opiate medication) and physical dependence (where the body goes through a withdrawal syndrome after discontinuation of the medication) can develop with long-term use of opiates, but is exceedingly rare in the postoperative setting. Tolerance and physical dependence are often confused with but not the same as addiction or psychological dependence.
Nausea and /or vomiting are commonly associated with anesthesia and surgery. The reasons are complex, multi-factorial and relate to the type of anesthesia, the surgery itself, and the medications used to treat postoperative pain. You are at increased risk for postoperative nausea and vomiting if you are female and/or have past experience of postoperative nausea and vomiting or a history of motion sickness.
Fortunately, your anesthesiologist has a number of medications to treat this problem. These medications work best when they are given before the symptoms of nausea and vomiting arise. You should feel free to discuss your concerns about nausea and vomiting with your anesthesiologist in the holding area before surgery begins. This way, a plan to prevent or at least minimize this very unpleasant aspect of surgery and anesthesia can be formulated.
Postoperative pain control is an important focus for us at Hospital for Special Surgery. Your anesthesiologist plays an essential role in planning and maintaining your comfort during and after your surgery. Surgery in general and orthopedic surgery specifically results in postoperative pain. To eliminate pain totally after surgery would require complete anesthesia, and the resulting motor weakness and lack of tactile sensations would hinder the recovery and rehabilitation process. Furthermore, pain medications can have side effects such as sedation, nausea, vomiting, or disorientation. The goal of postoperative pain management, therefore, is to control the pain and reduce it to a level that does not distract you from your daily activity and enables you to function and participate with physical therapy. Initially after surgery, pain is managed by various modalities, including epidural infusions, local anesthetic infusions near peripheral nerves, or intravenous/patient controlled infusions of opiates (PCA). As pain gradually lessens in the days following surgery, you will be switched to oral medications. Usually, before going home your surgeon will write you a prescription for medication for pain control to be taken after you leave the hospital.
For your safety, it is very important that your stomach be empty before you have surgery and anesthesia. An empty stomach significantly decreases the chance of having aspiration, a rare but serious complication of both general and regional anesthesia with sedation. It occurs when stomach contents are regurgitated into the lungs, causing significant damage. You can protect yourself from aspiration by carefully following preoperative instructions regarding food and drink. In general, you will be instructed not to have anything to eat or drink after midnight the night before your surgery. You may be permitted to have some clear liquids (any liquid you can see through) up to 4 hours before surgery. You will be given specific instructions about eating and drinking by the nurse who contacts you the day before your surgery.
Given the thousands of medications on the market today, it is impossible to address each one individually. If you are scheduled to have a preoperative medical clearance, you should discuss this question with that physician. All patients scheduled for ambulatory surgery receive a phone call from an HSS nurse on the afternoon or evening before surgery. Medication questions should be discussed with that nurse. Finally, if your medication questions are not answered by the day of surgery, bring your medications with you. If you did not take one of your usual medications up until the time of your arrival at HSS, we may ask you to take one here, prior to your surgery.
A blood clot will form within a blood vessel when there is damage to the blood vessel wall. This occurs when the rate of blood flow is diminished, or when these is an increased clotting tendency (hypercoagulability). The rate of blood clot formation varies greatly, depending on the type of surgery. Total hip and knee replacements have some of the highest rates of deep venous thrombosis of the leg, generally felt to be 30-50%. While most of these blood clots do not cause symptoms, about 1 in 100 patients having a joint replacement will have a clot break off and travel through the heart to the lungs (a pulmonary embolus) which can profoundly affect circulation and respiration. HSS is a nationally recognized leader in epidural anesthesia, which reduces the risk of these complications by 20-50%
Smoking, obesity, and estrogen all increase the risk of blood clot formation. You may want to discuss modifying these risk factors with your doctor prior to surgery. Be sure to tell your doctor if you've had a pervious blood clot.
Postoperatively, you can promote blood flow and reduce your risk of blood clots by doing exercises that will be prescribed, and walking with assistance as soon as possible. You may be given a medication to make the blood less coagulable and/or given a device that intermittently squeezes your calves or feet to promote blood flow.
HSS has been in the forefront of reducing the risk of blood clots after surgery. Research is ongoing and you may become aware of clinical studies designed to increase our knowledge and further reduce the risk of blood clots.
There are many safeguards on our national blood supply to ensure safe blood for patients. First, blood is donated by volunteer donors. Before giving blood, donors must answer questions about their health and risk factors for disease, and only a person with a clean bill of health can give blood. Blood from each accepted donor goes through extensive testing. In addition to tests for blood type, nine separate screening tests are run for evidence of infection with hepatitis, HIV, HTLV and syphilis. Finally, a carefully identified blood sample is tested against blood from the patient who will receive it, a process called crossmatch. Additional checks are then performed to compare the specific donor unit selected with the patient's blood.
If a blood transfusion is indicated during a surgical procedure or other medical treatment, the risks of NOT receiving blood far outweigh the risks of transfusion. Some patients may experience minor changes in the body's immune system after a transfusion, causing mild symptoms, such as fever, chills or hives, which typically require little or no treatment. A small number of patients may also react to donated blood by developing antibodies (immune reactions).
The transmission of disease and the destruction of red blood cells occur only very rarely, and seldom threaten life. The potential risk of contracting AIDS from a blood transfusion has received a great deal of attention. But it is important to know that all donated blood in the United States is tested for the AIDS virus, reducing the risk to a negligible level. When you consider the risks of transfusion, it may be helpful to know that many common activities carry far greater risks - for example, smoking cigarettes, driving a car or being pregnant.
You do have choices other than receiving blood from the community blood supply. Autologous blood transfusion refers to procedures in which you may serve as your own blood donor. In preoperative autologous donation, your blood may be collected and stored before a scheduled surgery if blood use may be required. In intraoperative and postoperative autologous transfusions, blood lost during surgery is saved and returned to the patient. Directed donations can also be arranged in some cases from a person (usually a friend or relative) whom you select.
Prior to the day of your surgery, if you have any questions or concerns related to your anesthesia, you are welcome to call us. An in-person preoperative consultation may be arranged if you wish. An anesthesiologist may be consulted by calling the Department of Anesthesiology at (212) 606-1036. After office hours and on weekends or holidays, you can call Hospital for Special Surgery's page operator at (212) 606-1188 and ask for the anesthesiologist on call, beeper #21530.
All patients meet their anesthesiologist on the day of their operation prior to the time of surgery.
If you have any questions about your operation, you should contact your surgeon.