Outpatient Surgery (cont.)
At the Surgery Center
- Most outpatient centers ask that the individual undergoing surgery arrives 1-2 hours before surgery to allow time for the following: checking in, placing the IV, and administering antibiotics or other medications. These activities usually occur in a preoperative waiting area, where the anesthesiologist and possibly nurse anesthetists (nurses trained to participate in anesthesia care) may be present.
- The individual is then escorted from the preoperative area to the operating room, which is usually chilly. The operating table (or bed) is well padded, but it is not nearly as comfortable as a bed at home.
- Anesthesia monitors are placed at this time, including heart monitors on the chest, a blood pressure cuff on the arm to monitor blood pressure, and a soft rubber clip on the finger to monitor oxygen level. Extra oxygen is given by face mask or nasal tube while the individual is in the operating room.
- The anesthesiologist begins sedating the individual and perhaps starts an additional IV line. Depending on the procedure, the individual may be given general anesthesia, local anesthesia, regional anesthesia, or spinal or epidural anesthesia.
- General anesthesia, given through an IV or gases to breathe, allows the individual to be completely unconscious during the surgery.
- With local anesthesia, doctors inject local anesthetics (numbing medication) directly around the operative area.
- With regional anesthesia, doctors place local anesthetics (numbing medication) and other medications directly around the nerves that supply sensation to a particular area of the body. Regional anesthesia is similar to a numbing injection the dentist uses to numb a tooth for drilling and fillings. The anesthetic block may be placed in the shoulder, arm, leg, or back. Regional anesthesia requires some cooperation on the part of the individual and may not be suitable for small children.
- Most people receiving regional or local anesthesia also receive additional medications for sedation during the procedure. Some procedures can be done with just sedation.
- Spinal or epidural anesthesia is the injection of a local anesthetic to numb the skin. Before the anesthesiologist injects the anesthetic, the person is asked to sit up and lean forward over a pillow or to lie on his or her side in a curled-up position. The person’s back is also cleaned. With spinal anesthesia, which acts more rapidly, the anesthetic is placed into the fluid that surrounds the spinal cord. Epidural anesthesia involves placing a small catheter in the area outside of the spinal cord sac. Anesthetics used for spinal or epidural anesthesia initially cause a feeling of warmth, followed by a complete loss of sensation in the lower body.
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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