Patient Information
Overview
Directions
to New York Weill Cornell Medical Center
What
does the anesthesiologist do?
What
happens before surgery?
What
is general anesthesia?
What
is regional anesthesia?
What
happens after surgery?
Post-operative
pain control
Anesthesia Subspecialties:
Ambulatory
surgery
Orthopedic
surgery (coming soon)
Cardiac
surgery (coming soon)
Pediatric
surgery
Neurosurgery
Thoracic
surgery
Vascular
surgery (coming soon)
Labor
and Delivery
Patient
education links
Contact
us
Overview
The Department
of Anesthesiology at the NewYork Weill Cornell Medical Center
of NewYork-Presbyterian Hospital is comprised of over 50 highly
skilled attending anesthesiologists dedicated to providing the
highest quality of care to all of our patients.
While every
member of our faculty has received extensive training in all areas
of anesthesiology, many of our staff members have additional expertise
and training in providing anesthesia for specific types of surgery,
such as cardiac, thoracic, vascular, neurological, obstetric,
and pediatric surgery.
What does the anesthesiologist do?
The anesthesiologist
is your advocate in the operating room.
We are physician
specialists and members of the surgical team. We are responsible
for your welfare when you undergo anesthesia. Our job is to ensure
your comfort and safety during surgery and to make informed medical
judgments to protect you, such as treating and regulating changes
in your critical life functions – breathing, heart rate,
blood pressure – as they are affected by the surgery being
performed. We are the doctors who will immediately diagnose and
treat any medical problems that might arise during your surgery
or recovery period. We are ready to treat sudden medical problems
related to surgery itself, and also to manage your chronic medical
conditions that may need special attention during your procedure
and immediately afterward.
What happens before surgery?
Regardless of
the type of surgery or anesthesia you will be having, it is important
to follow the guidelines about no eating and drinking before any
kind of procedure. You must not eat or drink anything after midnight
the night before your surgery. You may take necessary medications
with sips of water. If your child is to undergo anesthesia for
any kind of procedure, please refer to the section on pediatric
anesthesia for more specific guidelines. Failure to adhere to
these guidelines may result in delay or even cancellation of your
surgery!
Before you come
in for surgery, you should discuss all of your prescription and
over-the-counter medications with your doctor or the person designated
by your anesthesiologist to call you before surgery. Most of the
time, you should continue to take all of your medication as usual.
During a preoperative visit, an anesthesiologist will carefully
evaluate you and your medical history and will inquire about your
prescription and over-the-counter medications, allergies and prior
experiences with anesthesia. This physician will also inform you
about the procedures associated with your surgery and discuss
the anesthetic choices including their risks and benefits. In
some cases, you may not meet your anesthesiologist until you arrive
in the operating room, but you will always have the opportunity
to talk with him or her before you receive any sedation. You are
encouraged to ask any questions and express any concerns you may
have about your anesthesia.
The
type of anesthesia used for any given operation will depend on
many factors which your anesthesiologist will discuss with you
and your surgeon.
What is general anesthesia?
Most
major operations are performed under general anesthesia. This
means that you will be unconscious and have no awareness of the
surgical procedure or other sensations. The carefully controlled
combination of intravenous drugs and inhaled gases will be individualized
to you and your needs by your anesthesiologist to provide the
precise level of effects required for your safety and comfort
and to facilitate your surgeon’s ability to perform the
procedure.
What is regional anesthesia?
Regional anesthesia involves injection of anesthetic medications
near a cluster of nerves so that only the area of your body that
requires surgery will be numb. For example, spinals and epidurals
are types of regional anesthesia which effectively block sensation
and movement in the lower half of your body. This type of anesthesia
is used for many different types of procedures, including orthopedic,
urological, abdominal, gynecologic, and obstetric. With regional
anesthesia, you may remain awake or you may be given IV sedation
so that you will be relaxed and sleepy during the surgery without
being unconscious. In some cases, regional anesthesia techniques,
such as epidurals, can be used very effectively after surgery
to prevent or treat postoperative pain.
What happens after surgery?
Your
anesthesiologist continues to be responsible for your care in
the recovery room. Here, the anesthesiologist directs specially
trained nursing staff who monitor your condition and vital signs
as the effects of the anesthesia wear off. An anesthesiologist
will determine when you are able to leave the recovery room.
Many
of our patients go home the same day after surgery. No matter
what kind of anesthesia you have, it is still possible for you
to go home after your surgery.
Post-operative
pain control
If
you will be staying in the hospital after your surgery, our Inpatient
Pain Medicine Division may be consulted for the treatment of your
postoperative pain. This group of highly specialized anesthesiologists
focuses on making sure you are as comfortable as possible after
your surgery by using any number of pain treatment modalities,
including patient-controlled analgesia (PCA) and patient-controlled
epidural anesthesia (PCEA). It is very important to inform the
pain specialist of all medications and medical problems that you
may have which may determine which options are appropriate for
you.
Ambulatory surgery
The majority
of patients who undergo surgery or diagnostic tests at The
New York Presbyterian Hospital-Weill College of Medicine do
not need to stay overnight in the hospital. Ambulatory (or
outpatient) anesthesia and surgical care has proven to be safe,
convenient and cost-effective. Short-acting anesthetic drugs
and specialized anesthetic techniques as well as care specifically
focused on the needs of the ambulatory patient are used to
make your experience safe and pleasant. Because each patient
is unique, your anesthesiologist and your surgeon will carefully
evaluate you, your health status, and the extent of your surgical
procedure to determine if you should undergo ambulatory anesthesia.
After your early recovery from anesthesia, you usually will return
directly home. In most cases, family and friends can provide
all the needed assistance. If you do not have family members
or others to help at home, you may require additional help (please
let your surgeon know this before scheduling an outpatient procedure).
Appropriate pain management will be included as part of your
discharge planning.
Ambulatory surgery patients will receive a telephone call from
a hospital staff member on the day before surgery. During the
call you will be told what time to come into the hospital and
where to go. You will also be reminded to adhere to the fasting
guidelines, as mentioned above.
What types of anesthesia are available?
There are several types of anesthetic techniques available for
your surgery ranging from local anesthesia to general anesthesia.
The anesthetic technique recommended will depend on several factors.
In some cases, the surgical procedure will dictate what kind
of anesthesia will be required. As an outpatient, some techniques
may allow you to recover more quickly with fewer side effects.
Based on your medical history, a type of anesthetic may have
an additional margin of safety. Your preferences will be incorporated
in the selection of the best anesthetic plan for your procedure.
On the day of your procedure, your anesthesiologist will discuss
the anesthetic choices for your procedure with you.
There are four anesthetic options:
General anesthesia
Regional anesthesia
Monitored anesthesia care
Local anesthesia
General anesthesia provides loss of consciousness and loss of sensation.
Regional anesthesia involves the injection of a local anesthetic to provide numbness
and loss of pain to the area of the body undergoing surgery. You may also receive
medication such as a mild sedative that will make you comfortable, drowsy, and
blur your memory. Regional anesthetic techniques include spinal blocks, epidural
blocks and arm and leg blocks.
With monitored anesthesia care you usually receive pain medication and sedative
through your intravenous line from your anesthesiologist. These medications supplement
local anesthesia injections given by the surgeon into the skin and around the
operative site. While you are sedated, your anesthesiologist will monitor your
vital body functions.
With local anesthesia the surgeon injects local anesthetic to provide numbness
at the surgical site. In addition, the surgeon may direct the operating room
nurse to administer a mild sedative. There will be no anesthesia team member
with you.
Before receiving any sedatives or anesthetics, you will meet your anesthesiologist
to discuss the most appropriate anesthetic plan. Your anesthesiologist will discuss
the risks and benefits associated with the different anesthetic options. Occasionally
it is not possible to keep you comfortable with regional, monitored or local
anesthesia, and general anesthesia may be needed. Although uncommon, complications
or side effects can occur with each anesthetic option even though you are monitored
carefully and your anesthesiologist takes special precautions to avoid them.
With this information, you will together determine the type of anesthesia best
suited for you.
Will I need someone to take me home?
Yes, you must make arrangements for a responsible adult to take you home after
your anesthetic or sedation. Your surgery will be cancelled if you have not arranged
an escort. In addition, it is strongly suggested that you have someone stay with
you during the first 24 hours after your surgery.
If you have local anesthesia only, with no sedation, it may be possible to go
home without someone to accompany you. Check with your doctor first.
Should I take my usual medicines?
Some medications should be taken and others should not. Medications which may
need to stopped several days before surgery include blood thinners, such as coumadin,
and aspirin and aspirin-like products. Also, diuretics or water pills are generally
avoided on the day of surgery. It is important to discuss this with your doctor
before surgery. Do not interrupt medications unless your anesthesiologist or
surgeon recommends it. You may take your medications as directed on the day of
your procedure with a small sip of water.
What happens during my surgery?
Your anesthesiologist is responsible for your comfort and well-being. He/she
leads the anesthesia care team to monitor as well as manage your vital body functions
during your surgery. Your anesthesiologist is also responsible for managing medical
problems that might arise related to surgery as well as any chronic medical conditions
you may have, such as high blood pressure, heart problems, asthma, and diabetes.
A member of your anesthesia team will be with you throughout your procedure.
What can I expect after the operation until I go home?
After surgery, you will be taken to the postanesthesia care unit (PACU), often
called the recovery room, where you will begin to recover from the effects of
anesthesia used during your surgery. Your anesthesiologist will direct the monitoring
and medications needed for your safe recovery. While in the recovery room you
will be watched closely by specially trained nurses. You are allowed to have
two visitors with you in the recovery room. As you continue to recover you will
receive a nutritional snack and a beverage, and you will be assisted in getting
up.
Will I have any side effects?
The amount of discomfort you experience will depend on a number of factors, especially
the type of surgery. Your doctors and nurses can relieve pain after your surgery
with medicines given by mouth, injection or by numbing the area around the incision.
Your discomfort should be tolerable, but do not expect to be totally pain-free.
Nausea or vomiting may be related to anesthesia, the type of surgical procedure
or postoperative pain medications. Although less of a problem today because of
improved anesthetic agents and techniques, these side effects continue to occur
for some patients.
Rest assured that every effort will be made by your anesthesiologist, your surgeon,
and the nurses taking care of you in recovery to minimize postoperative pain,
nausea and vomiting.
When will I be able to go home?
This will depend on the type of surgery and the anesthesia used. Most patients
are ready to go home between one and four hours after surgery. Before you are
discharged you will be given written discharge instructions that the nurse will
review with you and your family. Any other special instructions will also be
discussed. You will be given prescriptions, if needed. You are encouraged to
ask questions! Be sure you understand how to take care of yourself at home before
you leave the hospital.
What can I expect when I go home?
Be prepared to go home and finish your recovery there. Patients often experience
drowsiness and minor after-effects following ambulatory anesthesia, including
muscle aches, a sore throat and occasional dizziness or headaches. Nausea may
also be present, but vomiting is less common. These side effects usually decline
rapidly in the hours following surgery, but it may take several days before they
are gone completely.
In general, for 24 hours after your anesthesia:
- Do not drink alcohol
- Do not take any medications not authorized by your surgeon
- Do not drive a car or operate dangerous machinery
- Do not make important decisions
- Do not travel alone on public transportation
- Do not care for a dependent person
Most patients do not feel up to their typical activities the next day, usually
due to general tiredness or surgical discomfort. Plan to take it easy for a few
days until you feel back to normal. Know that a period of recovery at home is
common and to be expected.
Remember to ask questions! Your experience will be easier if you know what usually
happens and what you should expect.
The focus of ambulatory anesthesia is on you, the patient.
Orthopedic surgery
(coming soon)
Cardiac surgery
(coming soon)
Anesthesia for Pediatric Surgery
A hospital
visit can be an anxious time for you and your child. You both
will meet many doctors, nurses and other people who will do their
best to make your experience a positive one. At the NewYork Weill
Cornell Medical Center of NewYork-Presbyterian Hospital, there
is a dedicated team of pediatric anesthesiologists with specialized
expertise in the anesthetic care of children. These highly skilled
and caring physicians are available 24 hours a day to provide
anesthetic services for children undergoing elective and emergency
surgery or other procedures.
Each year our
pediatric anesthesia service cares for over 2500 pediatric patients
of all ages, including newborns and even very small premature
infants, from a wide variety of surgical subspecialties. These
children undergo procedures ranging from placement of ear tubes
to highly technical urological, neurosurgical, plastic, otolaryngological
and transplantation surgery. We also routinely participate in
the care of children being treated at our world renowned Burn
Center, the largest specialized burn facility in the country.
Our job as pediatric anesthesiologists is to provide safe, optimal
conditions for your child during surgery and to make the entire
surgical experience as pleasant and comfortable as possible. We
know how children react to hospitals and surgery and how to respond
to their special needs.
How will my child be given anesthesia?
When
it is time for your child to be taken into surgery, you will be
invited to accompany your child into the operating room and stay
with him or her until your child is asleep. The presence
of a calm, assured and confident parent can help most children
through the stress of a procedure, usually without the need for
sedation. Only one parent or caregiver is allowed in the operating
room to avoid crowding and contamination of sterile equipment.
The anesthesiologist
wants to make sure that your child is in the best possible physical
condition before surgery. You will be asked important questions
about your child’s general health, including whether he
or she has allergies or asthma, whether there has been any family
history of difficulties with anesthesia and what your child’s
experiences have been with previous anesthetics. You will be asked
when your child last ate or drank. It is very important for your
child’s safety to follow closely instructions about food
and liquid intake prior to surgery (see guidelines below). During
this evaluation, the anesthesiologist will explain how the anesthesia
will be given and invite you and your child to ask questions and
express any concerns.
Sometimes minor illnesses such as sniffles and colds can
cause problems during some types of surgery and anesthesia. For
this reason, the anesthesiologist may feel it is best to postpone
surgery for the sake of your child’s safety.
A commonly
used method of anesthetizing young children is to let them breathe
anesthetic agents until losing consciousness. This is referred
to as a mask or inhalational induction. With this approach, your
child will be asked to breathe through a mask, and no needlesticks
will be performed until after the child is sound asleep. Your
child may become excited and appear to struggle as he or she begins
to lose consciousness, but will soon drop completely off to sleep.
In some children, anesthesia is started by an intravenous injection,
as in adults. With this technique, the patient becomes unconscious
very rapidly. The choice of which method to use will be made by
the anesthesiologist based on many factors.
As soon as your
child starts to lose consciousness, you will be shown to a nearby
waiting area. You will be reunited with your child in the recovery
room, where you may stay while he or she fully wakes up. Your
child will probably have very little memory of the period of separation
from you. Some children may be fully alert upon arriving in the
recovery room, while others may be groggy for hours after surgery.
Your child will
probably have at least one intravenous line (IV) in place in the
recovery room. This will most likely be in the hand or foot, placed
while your child was unconscious. If a surgical procedure is very
brief, such as ear tube placement, an intravenous line may not
be needed.
Although anesthetics can provide complete pain relief and
loss of consciousness during an operation, even our most modern
agents do occasionally have side effects. They tend to decrease
breathing, heart rate and blood pressure. Nausea and vomiting
are also occasional side effects after surgery and anesthesia.
Our anesthesiologists are specially trained to ensure that these
anesthetic effects are minimized. Aided by highly sophisticated,
state-of-the-art anesthesia equipment, they are constantly on
guard for changes in breathing, heart rate, blood pressure or
unexpected events which, although rare, may occur during surgery.
If you have any concerns or questions about your child’s
recovery, you should ask your anesthesiologist.
What about regional anesthesia for my child?
It
is possible to provide pain relief to specific areas of the body
using injections of local anesthetics. This is called regional
anesthesia and can be performed safely in children as well as
in adults. Caudal anesthesia is a type of regional anesthetia
commonly used in children for some types of surgery on the lower
half of the body, such as certain urological procedures. Caudal
anesthesia involves a local anesthetic injected into the tailbone
region, where it numbs the nerves supplying the lower body. This
is very similar to the epidural anesthesia often given to women
during childbirth, when local anesthesia is injected into the
back. This procedure is usually done in addition to general anesthesia
and performed after your child is asleep. The caudal may allow
the anesthesiologist to give your child less general anesthesia
during the surgery, thereby lessening the chances of side effects
occurring from general anesthesia, and also provide for pain relief
after surgery. Caudal anesthesia is commonly given to children
and may safely be performed even in very young babies. Because
caudal anesthesia numbs the nerves to leg muscles as well as sensory
nerves, your child may notice that his or her legs feel weak after
surgery, and they may even have difficulty walking. This weakness
will pass, as will the numbness, at which point they should be
given alternative pain medication if necessary, as directed by
your surgeon. Your child should not have a caudal anesthetic if
he or she has any bleeding problems or is on blood thinners (anti-coagulants).
Your anesthesiologist can discuss the advantages and disadvantages
of this technique with you.
Beyond the operating room
Our pediatric
anesthesiologists also provide anesthesia services for many non-surgical
procedures throughout the hospital. For example, if your child
needs a special test which requires him or her to lie absolutely
still, such as a diagnostic scan, or an uncomfortable procedure,
such as a spinal tap or endoscopy, an anesthesiologist may be
present to provide anesthesia or sedation for your child. Please
note that all of the same anesthesia preparations, guidelines,
and instructions, such as no eating or drinking, apply even when
anesthesia or sedation is given for non-surgical procedures.
How
can I as a parent help?
The
anesthesiologist and the surgeon will do their best to make your
child’s visit to the hospital as pleasant as possible. However,
you also have a key role to play in your child’s care. It
is important that you begin preparing your child for the operation
as soon as a decision is made to perform surgery. Children tolerate
surgery and anesthesia better when they are well prepared. Children
have natural fears of the unknown. Anything you can do to relieve
these anxieties and to inform your child about the coming events
in the hospital and the operating room will greatly improve your
child’s experience.
Honesty is very important. Your child should be told that
he or she will be in unfamiliar surroundings but will meet many
friendly doctors and nurses. Children need to know that they will
have an operation and that there may be some discomfort afterward.
Let them know that you may not be with them every minute but will
be waiting nearby.
Your
composure as a parent is essential. Nothing calms a child more
than a confident parent. Although it is natural for parents to
have anxiety when their children are having surgery, it is best
not to convey this to your child. Talk to your child about what
to expect in the hospital such as corridors, hospital beds and
the presence of other children. Reassure your child that everything
done during the hospital stay will be explained beforehand.
To
help prepare you and your child for this experience, our Child
Life specialists offer a pre-operative program, free of charge,
designed to provide information, reassurance and support prior
to surgery. This one hour program consists of age-appropriate
activities geared towards preparing children for surgery. Children
3 years of age and older and their families may participate. Visits
are by appointment only. Please call the Child Life Program at
746-3518 for more information or to make an appointment.
The
institution now known as The NewYork Weill Cornell Medical Center
has been involved in the care of children of all ages for over
a century and has been at the forefront of many important developments
in the pediatric subspecialties. Continuing in this tradition,
the pediatric anesthesia division is dedicated to providing outstanding
care for your child, ensuring his or her utmost safety as well
as comfort.
|
Pre-operative Dietary Guidelines for Children
ALL AGES: No
solids after midnight. Solids include any food, juices with
pulp, cow’s milk, candy, chewing gum, and carbonated
drinks.
NEWBORN - 6
MONTHS: Formula may be given up to but no later than 6 hours
before surgery. (No whole milk)
ALL
AGES: Clear liquids may be given up to but no later than
3 hours before surgery. Clear liquids include apple juice,
water, sugar water, and pedialyte.
Excerpted from Anesthesia & You . . . When Your Child
Needs Anesthesia, copyright 1994 of the American Society
of Anesthesiologists. A copy of the full text can be obtained
from ASA, 520 N. Northwest Highway, Park Ridge, Illinois,
60068-2573.
|
Anesthesia for Neurosurgery
At
The Weill Medical College of Cornell University, highly skilled
and caring anesthesiologists are available 24 hours a day to provide
anesthesia for your elective or emergent neurosurgical procedure.
We also provide anesthesia for certain nonsurgical neurologic
and neuroradiologic procedures.
Each
year our neuroanesthesia service provides care for over 1200 patients
undergoing all types of neurosurgical procedures. These
include lumbar and cervical microdiscectomies for herniated disks,
lumbar and cervical laminectomies, surgeries for spinal cord tumors,
ventriculoperitoneal shunts, craniotomies for clipping of intracranial
aneurysms, excision of tumors and removal of seizure foci, and
embolizations of intracranial aneurysms, arteriovenous malformations
and vascular tumors.
What should I do to prepare for surgery?
You
may eat and drink until midnight the evening before your surgery.
If you are taking medications, unless you have been instructed
otherwise, you may continue to take them right up through the
morning of surgery with sips of clear liquids, such as water or
apple juice. Typically diuretics, such as lasix are not
taken the morning of surgery and anticoagulants, such as coumadin,
and aspirin are stopped prior to surgery.
What happens in the operating room?
While
the anesthesia for the procedures is as varied as the list of
procedures, several standard procedures are done at the beginning
of an anesthetic. Once you are in the operating room and
while you are still awake, monitors will be put on you to measure
your blood pressure, electrocardiogram and the oxygen saturation
of your blood. Once these monitors are in place, you will
be asked to breathe oxygen through an anesthesia facemask.
Generally the anesthesiologist will then administer intravenous
medication so that you will go to sleep. A second intravenous
line or additional monitors may be placed after you are asleep
should your surgery and medical condition warrant their use.
You will wake up from anesthesia once your surgeon has finished
the operation. Rarely, if necessary, anesthesia will be
continued into the postoperative period.
What happens after surgery?
At
the conclusion of your surgery, you will be taken to either the
post anesthesia care unit or the intensive care unit depending
specifically on the type of surgery you had. There you will
wake up more completely and be carefully monitored.
Our
neuroanesthesiologists are available to discuss your anesthetic
plan with you at any time and would be happy to address your questions
and concerns.
Thoracic surgery
In
general, the most frequently performed thoracic surgical procedures
are bronchoscopy, mediastinoscopy, thoracoscopy, thoracotomy,
and espohagectomy.
What
is a bronchoscopy?
Flexible bronchoscopy is simple examination of the trachea with
a fiber optic device that may progress to biopsy or occasionally
therapeutic intervention such as laser ablation of a mass or site
of bleeding. Post-operative pain is minimal but patients tend
to cough for a while. Rigid bronchoscopy involves placement of
a metal tube through the larynx (voice box) and into the trachea
(windpipe). In comparison to flexible bronchoscopy there is usually
more throat soreness afterward and patients may cough up small
amounts of blood for a short period of time.
What
is mediastinoscopy?
This procedure entails a small neck incision through which a metal
scope is placed to view the structures within the chest and to
biopsy lymph nodes. When performed alone, mediastinoscopy is commonly
an outpatient procedure. Incisional pain afterward tends to be
modest. A variation is the Chamberlain procedure, which entails
making the incision directly on the front of the chest. This tends
to be a bit more painful than mediastinoscopy and raises the possibility
of air being trapped in the chest. Therefore, patients having
the Chamberlain procedure are usually admitted overnight.
What
is thoracoscopy?
This procedures allows for examination of the inside of the chest
and limited removal of lung tissue via 2 or 3 small incisions
with video assistance (Video Assisted Thoracoscopy = VATS). Since
this procedure is performed while the patient is lying on his
or her side (lateral position), patients should inform their anesthesiologist
about sensitive joints that will have to be manipulated during
movement. For most VATS there is always the possibility that a
larger incision will have to be made due to complications (bleeding)
or inability to perform the necessary resection via small incisions.
All VATS patients receive a chest tube to drain fluid and air.
This tube stays in place for about 24 hours. Most patients find
the small VATS incisions only moderately uncomfortable.
What
is a thoracotomy?
For this operation the patient lies in the same lateral position
(on his side) as during a VATS procedure (see above). The incision
is larger than with a VATS in order to facilitate major resection
of lung or esophagus. Post-operatively patients receive aggressive
treatment to help them cough and breath deeply in order to prevent
fluid accumulation and pneumonia. Chest tubes for drainage of
air and fluid stay in place for at least 24 hours and often longer
depending upon the extent of resection and drainage.
What
is an esophagectomy?
In general, this procedure involves incisions in the chest, abdomen
and often neck to remove the esophagus and create a stomach “tube”
to pull up into the chest as an esophageal replacement. These
procedures can be lengthy (often 6 hours or more). Afterward,
close monitoring is continued for at least 24 hours and aggressive
management of pain is maintained.
What
is involved with the anesthesia?
Fundamentally the principles are the same as in any general anesthetic
but with a few modifications. In that you may have significant
medical problems in addition to any lung or esophageal disease,
close monitoring of vital organ function is performed. In addition,
a plan for your post-operative pain management is formulated even
before the procedure starts.
1. Pre-operative epidural catheter placement. This option is generally
offered to anyone having a large chest incision as a means to
initiate and maintain post-operative pain control. On the day
of surgery, a member of the Pain Management Team discusses the
procedure with each patient to help in deciding if it is something
they would like to have. In general, most patients find the epidural
catheter very helpful after the surgery.
2.
Monitoring. For patients having a large chest incision, a small
catheter is often inserted into the radial artery of the dependent
wrist (i.e. left lung operation, right radial arterial catheter)
after the patient is asleep to allow for very close monitoring
of blood pressure. Large catheters are usually placed in neck
veins (also after the patient is asleep) to monitor blood volume
of patients having either complicated lung resection with the
potential for large blood loss or esophageal surgery, due to the
long duration of the procedure. These monitoring devices are left
in place for a period of time after the operation. Large catheters
are not routinely placed in neck veins for uncomplicated lung
resection.
What
happens after surgery?
Patients undergoing uncomplicated VATS or resection of lung via
a large thoracotomy incision seldom require support with a respirator
after the operation. Thoracotomy patients usually spend the night
in the recovery room before discharge to a regular hospital room.
In contrast, major esophageal procedures (which involve entering
the abdomen, chest and neck, and are relatively long) often necessitate
support with a respirator for a period of time after the operation.
For patients with significant medical illness, observation in
the Intensive Care Unit following esophageal surgery is common.
Vascular surgery
(coming soon)
Anesthesia for Labor and Delivery
Obstetrical
anesthesia has for many years been an integral and important service
here at the NewYork-Presbyterian Hospital. Our department provides
24-hour attending coverage in the obstetrical suite, where our
anesthesiologists supervise residents and nurse anesthetists.
We have 6 full-time obstetrical anesthesia attendings. Our services
range from providing routine pain relief for healthy patients
in labor to looking after extremely sick, high-risk pregnant patients.
What kinds of anesthesia can I have for labor and delivery?
The
labor patient has a number of options. She may elect not to have
any labor analgesia. She may choose to have spinal narcotics or
combined spinal and epidural analgesia, both of which allow her
to be mobile and walk around the obstetrical suite. Or she may
decide to have a traditional epidural, providing practically total
pain relief with the possibility of sleeping through her labor!
Naturally, some decisions are made with the input of both obstetrician
and anesthesiologist based on individual labor patterns, but at
any time the laboring patient can discuss her options with a member
of our staff.
We
are also available to discuss labor analgesia prior to labor and
provide an explanatory brochure to allay our patient’s fears.
What if I have a cesarean section?
In
the event of a cesarean section, our patients are able to select
their mode of postoperative analgesia, such as traditional intramuscular
narcotic injections, epidural and spinal narcotics, patient-controlled
epidural analgesia (PCEA), or intravenous patient-controlled analgesia
(IVPCA).
Patient education links
Contact us
Our
Pain Medicine Division manages a busy outpatient center for patients
with chronic pain and cancer-related pain. For more information,
please contact (212) 746-2960.
