ABOUT
YOUR ANESTHESIA
Mark
A. Melish, M.D.
Diplomat, American Board of Anesthesiology
You are excited! You’ve finally scheduled that surgery
you wanted. Dr. Young and his staff have answered all your
questions about your procedure and you’re all set to
show up at the surgery center.
You are also a little bit anxious and you notice that as of
your surgery date comes closer, your anxiety increases especially
about your anesthesia. Your feelings are entirely normal and
very common. To ease your anxiety, I have answered some of
the most common questions concerning your anesthesia.
What are the anesthesiologist’s
credentials?
Dr. Mark A. Melish is Board Certified by the American Board
of Anesthesiology. Dr. Melish is an honor graduate of Southwestern
Medical School in Dallas. He did his internship in General
Surgery and residency in anesthesiology at the University
of Texas Health Science Center at San Antonio, Dr. Melish
has been in private practice for twelve years and has specialized
in anesthesia for Plastic Surgery for eleven years.
When will I meet my anesthesiologist?
Unfortunately, with the advent of outpatient surgery, you
will probably not meet your anesthesiologist till just prior
to your surgery. At that time, you will be questioned about
your medical and surgical history, medication allergies, medications
you are taking as well as any prior problems with anesthesia
you or close blood relatives have had. All “medications”
include prescription, over the counter, herbs, vitamins, weight
loss pills that you take on a regular basis. Please let us
know if there is any possibility of you being pregnant. Don’t
be offended if we run a pregnancy test – patients who
said there was “absolutely no way” have indeed
been pregnant. We do this for your protection as well as ours.
Dr. Young’s office will usually let Dr. Melish know
ahead of time if there are any medical conditions which require
further information or work-up from your family doctor. Any
information you can bring from your doctor or past hospitalizations
is extremely helpful.
You will be given the opportunity to ask Dr. Melish any questions
you may have concerning your surgery and anesthesia. If you
are extremely anxious about your anesthesia or have special
problems, Dr. Young’s office can arrange for you to
speak with Dr. Melish (usually by phone) prior to your day
of surgery.
What kind of and how much anesthesia
will I have?
The type of anesthesia you will receive depends on many factors
including what procedures(s) you are having, the position
you will be in, your prior medical condition, how long it
will take and how anxious you are. Most of our procedures
are done under a general anesthetic although we may use sedation
with local anesthesia if we can do it safely and comfortably.
If we have to give you high doses of sedation to do the surgery
with “local anesthesia” you maybe essentially
getting a “general anesthetic” with LESS safety
margin than with a well controlled and planned general anesthetic.
Anesthesia is a dynamic process with continuous adjustment
of your anesthesia level throughout your procedure. Dr. Melish
usually uses a mixture of intravenous and inhalation (gas)
anesthesia for maximum advantage. The medications that initially
put you to sleep would only keep you anesthetized for a few
minutes without additional anesthesia.
Regardless of the type of anesthetic you receive, you will
be monitored with an automatic blood pressure cuff, EKG, and
a device that measures your oxygen saturation in your blood
by shining a light through your finger (pulse oximeter). When
you have a general anesthetic, a special monitor to watch
the gases going in and out of your lungs is used. Other special
monitors maybe required from time to time depending on your
procedure and medical condition. The improvement and advances
in anesthesia monitoring technology have dramatically improved
anesthesia safety.
I have heard that you may have
a sore throat after surgery. What causes this?
For maximum safety during a general anesthetic, most often
a tube is inserted into your windpipe (trachea) usually through
your mouth. –AFTER YOU ARE ASLEEP!
This tube secures your “airway” and insures us
of the most secure way to deliver oxygen to you, This tube
is 99% of the time removed before you are truly awake and
aware. If it weren’t for a sore throat, most people
would never realize that anything had been there.
Not everybody gets a sore throat from these tubes and Dr.
Melish is as gentle as possible in inserting this tube. Some
things are more likely to cause a sore throat. Some of these
are-turning you over for liposuction surgery around the head
and neck, especially when we have to turn your head back and
forth when performing a procedure, and in smokers who usually
have a chronically inflamed throat. The sore throat may last
for a few hours to a few days and is usually treated with
throat lozenges.
Occasionally, in very short procedures that do not involve
turning or surgery around your head and neck, Dr. Melish my
not put the tube in.
Why can’t I eat before
surgery?
You are given instructions not to eat for at least eight hours
prior to surgery. This is done to prevent you from vomiting
as you go to sleep which could get into your lungs and cause
a very serious, life-threatening pneumonia. Compliance
with this is very important for your safety and your surgery
will probably be canceled if you don’t follow this simple
but important rule.
Should I take my daily medicines
before surgery?
Yes, you should take your regular medicine before surgery
especially blood pressure, heart, asthma and seizure medicine.
Try to take them with water no later than three hours before
surgery. If you use any inhalers for asthma or other breathing
problems bring them to the surgery center with you.
An exception concerns diabetic medicine-both oral and insulin.
We usually do not have you take your diabetic medicine prior
to surgery since you won’t be eating. If your surgery
is late in the day and you will be eating some breakfast,
we may have you take your medicine. Please ask us about this.
I don’t want to throw
up after surgery – is there anything you can do about
this?
We attack this problem aggressively. Unfortunately, some procedures
and people have a higher incidence of associated nausea and
vomiting. Because of Dr. Melish’s experience, multiple
medications are used to prevent this as much as possible.
Our rate of nausea and vomiting is low because of this aggressive
treatment.
Also, unfortunately, the pain medications you are given both
immediately post-op and for home can cause nausea/vomiting.
We attempt to use other methods to treat the pain including
local anesthesia (even during a general anesthetic) so we
don’t have to use as many narcotics.
What are the risks from anesthesia?
Anesthesia is now the safest it has ever been thanks to advanced
technology. Better medications with less side effects, and
better training of anesthesiologists. Risks include everything
from heart and lung problems to damaged teeth to allergic
reactions to rare diseases, which can happen during anesthesia.
Of course, the more medical problems you have, the higher
your risk may be. You will not have your elective surgery
unless your pre-existing medical conditions are under good
control.
Dr. Melish, a physician, will administer your anesthesia.
He will be in the operating room throughout the entire procedure.
Safety is our number one priority. You probably take a bigger
risk driving to the hospital than having your surgery.
What about these horror stories
about fires during laser surgery?
Dr. Melish and Dr. Young are thoroughly trained in preventing
this rare but destructive occurrence from happening. Every
precaution is taken including protecting your eyes, protecting
the breathing tube from getting hit by the laser and adjusting
the lowest safe oxygen level necessary for you to breathe.
Every detail is continually monitored even when not using
the laser.
What about these stories on
Oprah about people being awake during their surgery?
It is extremely rare these days to have any recall from anesthesia.
The new medications we use have excellent amnesic qualities.
We also have monitors that tell us if we are delivering the
amount of gas we turn the machine to. We usually give more
medicine than is probably necessary to keep recall from happening.
In an emergency, if the gas were to be turned off for an extended
period of time and no intravenous medicine were additionally
given, then it is possible for recall to happen, but we are
very cognizant of that. Additionally, people who are on chronic
Valium, Xanax, Ativan, or other Benzodiazepines maybe at higher
risk of having recall because their brain has adapted to these
medicines. Again, Dr. Melish recognizes this and treats accordingly.
When will I get medicated for my anxiety?
Since Dr. Young often has to have you stand to put marks on
you, we don’t usually medicate you till after you are
marked. We also want the nurse to check your permit before
medicating you so that if changes need to be made, you can
legally sign. We then medicate you once these things have
been done – prior to going into the operating room.
If you are extremely nervous, we can give you a prescription
for something to take the night before or the morning of surgery.
We probably have not answered every question you may have
about anesthesia but hopefully have answered the biggest ones.
Feel free to ask any other questions you may have at any time.
Dr. Melish’s goal is to alleviate as much anxiety as
he can and to provide you with the best experience possible.
|
