The thought of going under anesthesia causes undue stress for many patients. The anesthesiologists at HSS have helped thousands of orthopedic surgery patients understand the role anesthesia plays in the operating room and in their recovery.
Your anesthesiologist makes sure your vital signs – blood pressure, heart rate, temperature and oxygen levels – are stable throughout the surgery. He or she also manages your level of consciousness and sleep during the procedure.
If you encounter a problem during surgery (blood loss, changes in blood pressure, heart arrhythmias, and many others), your anesthesiologist will work to correct the problem. Anesthesiologists at HSS are experts on developing the best way to approach anesthesia for your specific operation.
Every anesthesiologist at HSS has finished medical school, an internship, and residency program in anesthesia – adding up to more than eight years of medical education after college, in addition to years of experience in the operating room. Most of our anesthesiologists have also completed fellowships in fields such as pediatric anesthesia, critical care medicine, chronic pain, and regional anesthesia. We match your specific procedure with the clinical skills and expertise of our staff to ensure the best care.
Regional anesthesia is the preferred anesthetic technique for patients undergoing orthopedic surgery because it is associated with less postoperative pain and nausea, a lower incidence of blood clots, less blood loss, and a lower infection rate compared with general anesthesia. Each anesthesiologist at HSS has expertise in regional anesthesiology.
If your anesthesiologist suggests regional anesthesia for your procedure, he or she will place a local anesthetic medicine near the nerves that go to the part of your body that is being operated on. Your anesthesiologist may refer to this type of anesthesia as a peripheral nerve block. In some cases, you have the option to be awake during the surgery. Your preferences can be discussed with your anesthesiologist prior to surgery, according to Dr. Carrie Guheen, an anesthesiologist at HSS.
The Department of Anesthesiology has made great strides in advancing anesthesia safety for orthopedic surgery patients. Based on your specific needs, your anesthesiologist will develop a comprehensive anesthetic plan before, during, and after surgery. Dr. Richard L. Kahn, an anesthesiologist at HSS, discusses the common side effects of anesthesia you may encounter.
You will meet your anesthesiologist the day of the operation before surgery. If you have any questions or concerns related to your anesthesia, you are welcome to contact the Department of Anesthesiology to arrange for a pre-anesthesia consultation. We always have an anesthesiologist on call to answer your pressing questions.
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.
If you have any questions about your operation, you should contact your surgeon's office.
Your anesthesiologist will be assigned to you the day prior to surgery. Many factors go into determining the choice of anesthesiologist for any given patient or procedure, but the most important consideration is matching the clinical expertise of the anesthesiologist with your medical history and procedure type.
While our expert staff is highly trained and an expert in his/her field, some have developed particular areas of interest and clinical expertise. For example, several anesthesiologists specialize in pediatric anesthesia and these physicians care for the vast majority of pediatric patients.
Although we cannot promise a specific anesthesiologist to you prior to surgery, we do consider patients’ preferences. If you have been to HSS in the past and liked your anesthesiologist, we will try to arrange for the same physician for your next surgery at HSS. To request the same anesthesiologist, please call your surgeon's office or the Department of Anesthesiology.
To improve patient outcomes and the standard of care for our patients, some of our anesthesiologists are involved in clinical research studies. If your anesthesiologist is involved in a study, he or she will discuss it with you before your surgery.
You should refrain from eating at least eight hours before your scheduled procedure in order to reduce side effects related to an aspiration. An aspiration is when stomach contents are expelled into the lungs and can cause significant damage. You can protect yourself from an aspiration by carefully following preoperative instructions regarding food and drink. You will be given specific instructions about eating and drinking by the nurse who contacts you the day before your surgery.
You should discuss your medications with your physician at your preoperative medical clearance appointment or with your surgeon before surgery. All patients scheduled for ambulatory surgery will be contacted by an HSS nurse on the afternoon or evening before surgery – you should ask about your medications then. If your medication questions are not answered by the day of surgery, you should bring your medications with you.
It is extremely important to inform your anesthesiologist of any allergies you may have. Your providers need to know what you are allergic to and how you react to those allergens. At the time of your admission, a color-coded wristband will be given to you to indicate to your care-givers that you have an allergy.
Some people have allergies specifically to anesthetic agents. Allergic reactions range from skin rashes, hives, breathing problems, and anaphylaxis to a very rare condition called malignant hyperthermia. If you do have an allergic reaction in the hospital, it can be treated. However, the safest way to avoid these types of problems is by avoiding exposure, according to anesthesiologist Dr. Devan Bhagat.
Your anesthesiologist can often find safe, alternative ways of providing anesthesia without using medications that may have caused problems in the past. For your safety, your anesthesiologist may even recommend preoperative testing by an allergist to confirm drug allergies.
If you know that you have sleep apnea, please alert your surgeon, anesthesiologist, and the hospital staff prior to surgery. If you have special home equipment for sleep apnea, such as nasal continuous positive airway pressure (CPAP) mask, please bring it with you to the hospital on the day of surgery.
If you have sleep apnea, as a precautionary measure, you may be admitted overnight to be observed by our specialized nurses to ensure that the medications prescribed to control pain after surgery do not interfere with your breathing.
HSS has a dedicated Acute Pain Service to address postoperative pain issues. Our goal is to keep you safe and comfortable regardless of the medications you are taking for pain preoperatively. You should contact the Department of Anesthesiology for a preoperative consultation with a chronic pain specialist if:
Addressing these pain management issues will allow your anesthesiologist to develop a specialized plan of care for your postoperative pain treatment.
Many procedures at HSS are well-suited for regional anesthesia in combination with intravenous sedation, sometimes called twilight sleep. Combining regional anesthesia and intravenous sedation has unique advantages compared to general anesthesia – lower infection rates, less post-operative nausea and vomiting, better pain control, and reduction in some post-operative complications.
It is extremely rare to wake up during surgery during general anesthesia. Depending on the anesthetic technique and the amount and type of drugs that are administered by your anesthesiologists, you may be able to choose from being wide-awake to fully asleep during your procedure.
Many of the sedatives your anesthesiologist will use can cause amnesia, and although you may be awake and conversant during the procedure you may have no recollection of these events later, explains anesthesiologist Dr. Meghan Kirksey.
Your level of consciousness is a decision made between you, your surgeon and your anesthesiologist. In many cases, your anesthetic can be customized to meet your expectations.
Your anesthesiologist will do everything he or she can to keep you comfortable following surgery. You will be closely monitored by physicians, nurses, and other medical staff throughout your time in the recovery room to help ensure the safest and most comfortable recovery, according to Dr. Philip Wagner, an anesthesiologist at HSS.
If you are staying in the hospital after your surgery, the Department’s Acute Pain Service may coordinate your pain control. The Acute Pain Service is available 24 hours a day, seven days a week.
Your anesthesiologist will review your case to see if you are a candidate for regional anesthesia. Patients who undergo regional anesthesia are less likely to report feelings of nausea or vomiting following surgery. In fact, only 5% of patients at HSS report throwing up after undergoing surgery with a regional anesthetic compared with 40% to 50% of patients that receive a general anesthetic. HSS anesthesiologists routinely combine anti-nausea medications into your regional anesthetic to lower your risk of post-operative nausea and vomiting.
If you have a history of nausea and vomiting following surgery or a history of motion sickness, please talk to your anesthesiologist before surgery. He or she will make necessary adjustments to the anesthetic plan to ensure the best approach to keep you comfortable and safe throughout your stay at HSS.
After your procedure, you will be moved to the Post-Anesthesia Care Unit (PACU). Once you are stable and/or awake, family visits may be allowed to visit for a short time. Your family will have to check with nursing staff about the exact time frames allowed. Pediatric patients are permitted to see up to two parents or guardians upon arrival in the PACU. Ultimately, visitation is decided by the nursing staff in the PACU.
Like charges from your surgeon, your anesthesiologist's fees are not included in your hospital bill. Many insurance plans cover our charges in full but some do not. While all of our physicians participate with Medicare and Medicaid, we may not participate with your specific insurance plan. To obtain information about your particular insurance plan, we recommend that you contact your insurer.
The Department of Anesthesiology at HSS is contracted with over 96% of HSS patients’ insurances. Regardless of your insurance coverage, you will receive a bill for anesthesia services. Our billing company, Billing Services Inc. (BSI), will also file this claim directly with your carrier. In many cases you may be required to intervene with your insurance company to ensure that they cover all the charges they should. BSI will assist you in this process.
If you have an outstanding balance after your insurance payment you will be responsible for that amount. In the case of financial hardship or other extenuating circumstances, you should contact BSI to resolve the matter. If you have further questions about our billing practices, contact BSI toll-free at 888.877.3850.
Dr. Ellen Soffin, associate director of the research division within the Department of Anesthesiology, answers the questions she and other researchers get most frequently from patients about participating in clinical trials.
A clinical trial is a research study. Each study is designed to answer specific questions to find new and better ways to help patients. A clinical trial has a master plan called a protocol that explains how the trial will work, what will be done, why, how many patients will be studied, and what type of data will be collected. If you are asked to participate in a trial, we will discuss the protocol with you, and provide a summary in writing.
People decide to participate for a wide variety of reasons. Often, patients want to help others by generating knowledge that will someday benefit patients with the same condition. Sometimes patients decide to join a trial so that they might receive the latest, most innovative care from experts in the field.
Depending on the purpose of the trial, you may have more tests or medical examinations than you would if you were not taking part. For example, you may have extra blood tests or provide a tissue sample during your surgery. You may be asked to keep a diary about your health or medications, or fill in questionnaires at specified times. Some of these tests or questionnaires may need to be completed days, weeks or even months after your surgery or treatment at HSS!
Clinical trials can have some risks. In general, a new strategy or therapy may not work, or it may not work better than the care we already provide patients. Sometimes a new therapy works for some patients, but not everyone, so it might not work for you. Before you agree to join a trial, your study team will discuss the specific risks (and possible benefits) in detail and you will have a chance to ask questions.
No! Agreeing to participate is voluntary, and if you change your mind at any time you can drop out of the study. However, please consider participation very carefully: the results of the study can be affected (negatively, in some cases) if patients drop out. We would rather that you say “No”, and be certain, than say “Yes” if you are uncomfortable doing so, and then drop out later.
Protecting your safety is our priority. At HSS, every clinical study must be approved by our Institutional Review Board (IRB). The IRB is a committee that includes doctors, nurses, statisticians, and community members. The job of the IRB is to provide scientific oversight of all clinical trials. A trial can only be approved by the HSS-IRB if it is deemed medically important, ethical, and protects the privacy and confidentiality of the patients who participate.
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