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Special Concerns for Women

Understanding Anesthesiology

Who is an anesthesiologist?

An anesthesiologist is a fully trained physician who has performed a residency in the specialty of anesthesia. This training takes an added four years beyond medical school to successfully complete. Some physicians will perform further training in a fellowship such as pediatrics to further sub specialize. After successful completion of residency training a physician will take an exam, which provides them with Board Certification if successfully passed. When you request an anesthesiologist you should request a Board Certified Anesthesiologist.

What does an anesthesiologist do?

An anesthesiologist will provide you with care during any surgery or procedure you request one to be present for. She can provide you with medications to relax you during a procedure and decrease your awareness of pain or she can put you to “sleep” with a general anesthetic. Additionally she can provide services for the treatment of low back pain, chronic pain syndromes and other special pain conditions.

Where are anesthesiologists located?

Typically, anesthesiologists are hospital-based physicians. This means you will find a practice in your local hospital by calling hospital information. Many surgeons work with anesthesiologists in surgical centers and day surgery facilities and can recommend one to you. A few anesthesiologists practice in a Pain Clinic setting and can be found by asking for a referral from your family physician or any physician referral center.

When would I need an anesthesiologist?

This is an individual decision solely up to you as a patient. An anesthesiologist can provide her services to you for any procedure from a colonoscopy or pregnancy termination up to major abdominal surgery. You are in control and only have to ask. Your insurance carrier will pay the fees in the majority of instances.

Breast Surgery and Anesthesiology

Unfortunately, many of us will have some sort of surgical procedure on our breasts in our lifetimes or we will be the support for our sisters, mothers, and friends who are having a breast procedure. An anesthesiologist should be an integral part of the plan for many of these procedures.

Fine needle localization breast biopsy, lumpectomy, mastectomy and breast reconstruction are all surgical procedures where an anesthesiologist should be involved with your care. For these procedures your anesthesiologist will discuss all options available to you. These include Monitored Anesthesia Care (MAC), regional or general anesthesia.

Regional techniques for breast surgery are best provided by physicians who do this on a regular basis. As a patient you should ask your physician how much experience she has at performing this technique. The technique itself is known as the paravertebral block. An area of your upper back is cleaned and the skin near your backbone is numbed with local anesthetic. Than a small needle is placed close to the nerves as they leave the spinal column and local anesthetic is applied, numbing these nerves. Multiple levels will need to be done in order to provide numbness and pain relief to your entire breast.

What are the major types of anesthetic techniques?

There are three major types of anesthetic techniques available when you have surgery. These are Monitored Anesthesia Care also know as MAC, regional techniques such as spinal, epidural or peripheral nerve blocks, and general anesthesia.

Monitored Anesthesia Care

Monitored Anesthesia Care or MAC is when an anesthesiologist is present for the entire case and monitors you as their sole job, seeing to it that you are comfortable and safe. Frequently, she will administer medications, which will relax you and make you unaware of major parts of the procedure you are undergoing. She will also provide you with pain medication should you need it.

Regional Anesthesia

There are many regional techniques available to provide anesthesia. Spinal and Epidural are the major choices for a regional technique. Regional means that a portion of your body will be made “numb” to pain that may occur as a result of surgery as opposed to general anesthesia which describes that your whole body will be “asleep” for a surgical procedure.

Spinal anesthesia is where a small needle is placed into the space surrounding your spinal cord. This space is called the subarachnoid space. Think of your spinal cord surrounded by a balloon. This space between the balloon and your spinal cord is filled with fluid. Your doctor cleans an area of your back with a cold sterile solution, then takes a very small needle and numbs your skin first. Then she places another very small needle into this fluid filled space and deposits a small amount of numbing medication into this space. This is usually done in an area of your lower back just above your hipbones. This medication will make you numb from your toes to you belly button or up to you nipples depending on how much medication your doctor uses and what type of surgical procedure you are having.

An epidural is similar to a spinal but has some distinct differences. An epidural is placed along your backbone, generally in the low back area, but it can be anywhere along your spine as needed for your surgery or pain relief. Again your doctor will clean and numb an area of your back and place a needle into you back, this time staying outside the balloon surrounding your spinal cord. Once this space is reached a small soft plastic catheter in inserted into your back, into this epidural space and the needle is removed. This soft plastic catheter can be used to deposit numbing medication at anytime it is needed for your surgical procedure, for labor pain, or for pain you might experience when recovering from a major surgery. The numbing medicine will bath the nerves as they exit the spinal cord and decrease your experience of pain. This small soft catheter may be left in place for days allowing your physician to provide you with pain relief by numbing medication bathing the nerves for your recovery period. It is removed by simply pulling it out and does not hurt at all when removed. All you need is a Band-Aid and you are done.

Regional anesthesia is when a nerve or groups of nerves are numbed by your anesthesiologist so you might undergo a surgical procedure and/or provide you with postoperative pain relief. Again you can expect your doctor to clean an area of your skin, numb the skin using a very small needle and then find the nerve often using a nerve stimulator which feels like your funny bone is being touched and then introduces the numbing medication right at the nerve. Depending on position this can provide anesthesia to the entire arm, leg, breast, etc.

General Anesthesia

Anesthesia has a very interesting history that is important to women. General anesthesia was first used in 1842. We have all heard of ether and that was the original anesthetic. But what is interesting to us as women is in 1847 Dr. James Simpson was the first physician to administer ether to relieve the pain of labor. Then in 1853 Queen Elizabeth was administered general anesthesia by Dr. John Snow during the birth of her son Prince Leopold. This opened the door for other women to receive pain relief for labor and delivery.

General anesthesia occurs when one breathes in a gas or vapor of a drug, which has anesthetic properties. That means the gas will cause one to “fall asleep” and be free from any pain caused by any procedure you are having whether it’s major surgery or a tooth removal. Unlike sleep, most people do not remember. In other words, when we sleep at night we know we are waking up the next day. While under general anesthesia when you wake up you feel as if seconds went by even if hours have gone by. General anesthesia is also very safe to have. Today we have many monitors available to look at your heart, blood pressure, breathing, and even how much oxygen is in your blood. We even have monitors to tell us if you are “deeply asleep” or anesthetized. These monitors are called BIS monitors and you can ask for one to be used on yourself if you need a general anesthetic.

While in the preoperative waiting area you will have an intravenous (IV) catheter placed in your vein. Often the skin is numbed first after cleaning and a soft plastic catheter is put into a vein so that special water can be given to you while you are in the hospital. Also all the drugs you need while in the hospital, like antibiotics and pain relievers, can be given through this IV. You can expect to arrive to the operating room and have all the monitors mentioned placed on you before you drift off to sleep. They do not hurt. They are all cold, sticky and wet. Once the monitors are in place your doctor will have you breathe oxygen through a plastic mask, which may smell like a new shower curtain. The next thing you remember is waking up. Many patients do not remember anything until they are in the recovery room.

Written by: Jill A. Antoine, M.D.
Last revised: March 2005

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