When a patient undergoes surgery, a team of medical staff assists the surgeon in the procedure. The number of team members differs depending on the type of surgery performed. Among others, most teams include a surgeon, an anesthesiologist, a certified registered nurse anesthetists (CRNA), and an operating room (OR) nurse.
Anesthesiologists are the physicians trained to administer and manage anesthesia given during a surgical procedure. They are also responsible for managing and treating changes in your critical life functions - breathing, heart rate, and blood pressure - as they are affected by the surgery being performed. Further, they immediately diagnose and treat any medical problems that might arise during and immediately after surgery.
An anesthesiologist has completed four years of postmedical school training in anesthesia, in addition to the required four years of medical school. Anesthesiologists usually further specialize in certain surgery specialties, such as neurosurgical anesthesia. The anesthesiologist is involved in all three phases of surgery: preoperative, intraoperative, and postoperative management.
Prior to surgery, the anesthesiologist will evaluate the patient's medical condition and formulate an anesthetic plan which takes that patient's physical condition into account. It is vital that the anesthesiologist knows as much about your medical history, lifestyle, and medications as possible. Some particularly important information he/she needs to know includes the following:
Reactions to previous anesthetics
If you have ever had a bad reaction to an anesthetic agent, you need to be able to describe exactly what the reaction was and what your specific symptoms were. Give the anesthesiologist as much detail as possible, such as you felt nauseated when you woke up or the amount of time it took you to wake up, etc.
Current herbal supplements
It has recently been learned that certain herbal products, commonly taken by millions of Americans, may cause changes in heart rate and blood pressure, and may increase bleeding in some patients. The popular herbs gingko biloba (an herb used for many conditions associated with aging, including poor circulation and memory loss), garlic (an herb often used for cardiovascular conditions and to help prevent colds, flu, and other infectious diseases), ginger, and ginseng (used as a general tonic to increase overall body tone; considered helpful in elevating energy levels and resistance to stress) may lead to excess blood loss by preventing blood clots from forming. In addition, St. John's wort (a popular herb used for mild to moderate depression) and kava kava (another popular herb used for depression and to elevate mood) may prolong the sedative effect of the anesthetic. The American Society of Anesthesiologists advises patients planning to have surgery to stop taking all herbal supplements at least two to three weeks prior to surgery to rid the body of these substances.
Any known allergies
Discussing any known allergies with the anesthesiologist is very important, as some anesthetic drugs trigger cross-allergies, particularly in persons who have allergies to eggs and soy products. Allergies to both foods and drugs should be identified.
Recent and/or current prescription and over-the-counter medications
It is also important to let your surgeon and anesthesiologist know about both prescription medications and over-the-counter medications you are taking, or have recently taken. Certain prescription medications, such as coumadin, a blood thinner, must be discontinued for some time prior to surgery. In addition, as many people take a daily aspirin to prevent heart attack, and certain dietary supplements, physicians need to be aware of these habits, as they can prolong bleeding and interfere with muscle relaxants used by anesthesiologists.
Cigarette smoking and drinking
Cigarette smoking and alcohol can affect your body just as strongly (and sometimes more strongly) than many prescription medications you may be taking. Because of the way cigarettes and alcohol affect the lungs, heart, liver, and blood, these substances can change the way an anesthetic drug works during surgery. It is important to let your surgeon and anesthesiologist know about your past, recent, and current consumption of these substances prior to surgery.
Undergoing surgery can be a good motivator to quit smoking. Most hospitals are smoke-free and physicians, nurses, and other health professionals will be there to give you support. In addition, you will heal and recover faster, especially in the incision area, or if your operation involves any bones. Quitting smoking also reduces your risk of heart disease and cancer.
Use of street drugs (such as marijuana, cocaine, amphetamines, etc.)
Patients are often reluctant to discuss matters of illegal drug consumption, but you should remember that all conversations between you and your surgeon and anesthesiologist are confidential. It is crucial that he/she know about your past, recent, and current consumption of these substances. It is important to keep in mind that the only interest your physician has in this information is learning enough about your physical condition to provide you with the safest anesthesia possible.
Meeting the anesthesiologist before the surgery
Because anesthesia and surgery affect every system in the body, the anesthesiologist will conduct a preoperative interview. Sometimes this is done in person; in other cases, the anesthesiologist will interview you over the telephone. During this interview, the anesthesiologist will review your medical history, as well as discuss the information mentioned above. He/she will also inform you about what to expect during your surgery and discuss anesthetic choices with you.
If you have not personally met during the preoperative interview, the anesthesiologist will meet with you immediately before your surgery to review your entire medical history as well as results of any medical tests previously conducted. By this time, he/she will have a clear understanding of your anesthetic needs.
Pre-existing medical conditions and anesthesia
If you have a pre-existing medical condition such as diabetes, asthma, heart problems, arthritis, etc., your anesthesiologist will have been alerted to this and will be well prepared to treat these conditions during your surgery, as well as immediately afterward. Anesthesiologists are trained to handle sudden medical problems related to the surgery, as well as any chronic conditions that may need attention during the procedure.
Condition monitoring during surgery
Monitoring is one of the most important roles the anesthesiologist handles during surgery. Second-by-second observation of even the slightest changes in a wide range of body functions gives the anesthesiologist a tremendous amount of information about the patient's well-being. In addition to directing your anesthesia, the anesthesiologist will manage vital functions such as heart rate, blood pressure, heart rhythm, body temperature, and breathing. He/she will also be responsible for fluid and blood replacement, when necessary. Sophisticated technology is used to monitor every organ system and its functioning during surgery.
Operating room/circulating nurse
Registered nurses are registered and licensed by the state to care for patients. Some nurses concentrate in a specialized field, such as surgery. The operating room nurse assists the surgeon during surgery. Operating room nurses are certified in various surgical areas.
Certified registered nurse anesthetist (CRNA)
The nurse anesthetist takes care of the patient before, during, and after surgical or obstetrical procedures. The nurse constantly monitors every important function of the patient's body and can modify the anesthetic to ensure maximum safety and comfort. A nurse anesthetist has a bachelor degree in nursing, followed by specialized training in anesthesia. Nurse anesthetists are required to pass a national certification examination to become CRNAs.
A surgeon has completed four years of medical school and has received further specialized training after medical school. Most surgeons have passed exams given by a national board of surgeons for "board certification." In addition, some surgeons have the letters F.A.C.S. behind their name. This means they passed review by the Fellows of the American College of Surgeons (FACS).
Stanford Health Care (formerly Stanford Hospital & Clinics) provides comprehensive services to refer and track patients, as well as provides the latest information and news for physicians and office staff. For help with all referral needs and questions visit Referring Physicians.
HOW TO REFER
Fax a referral form with supporting documentation to 650-320-9443.
Track your patients' progress and communicate with Stanford providers securely online.