Anesthesiologist Dr. Philip Nye has some good news for those facing surgery: “Anesthesia has gotten a lot safer through the years because the anesthetic techniques and equipment we use has gotten better,” Dr. Nye told Vero Beach 32963. “Almost all operating rooms have immediate access to fiber optic equipment, which makes it much safer to secure an airway.
We can now monitor your oxygen saturation continuously through the procedure. We also have arterial lines which can give us a beat-to-beat variability on what your blood pressure is doing throughout the surgery. Everything has gotten better and as a result the recovery time has improved.
“During an anesthetic preoperative assessment, we consider the nature and urgency of the procedure and evaluate the patient’s medical history and comorbidity issues like cardio disease, allergies and medications that might interfere with the anesthesia,” said Dr. Nye, who operates Anesthesia and Sleep Medicine Services of Florida in Vero Beach.
“We get a baseline assessment of hemodynamic status to determine if the patient’s blood pressure, heart rate, breathing and oxygenation is stable or not.
“While the surgeon is focused on the surgery, the anesthesiologist is focused on making sure the patient is optimized for the surgery so they can safely proceed through their operation and wake up with no adverse effects.”
Anesthesia is administered to keep patients comfortable and pain free during surgery, medical procedures or tests. But according to the American Society of Anesthesiologists, there some key differences in the types of anesthesia administered, depending on the procedure, your health and your preference.
General Anesthesia is used for major operations such as a knee replacement or open-heart surgery and causes you to lose consciousness. It is administered through a mask or an IV placed in a vein. A tube may be placed in your throat to help you breathe.
IV/Monitored Sedation is used for minimally invasive procedures like colonoscopies. Your level of consciousness can range from being able to talk to being unconscious. Sedation is usually provided through an IV placed in a vein.
Regional anesthesia is often used during childbirth and surgeries of the arm, leg or abdomen. It numbs a large part of the body, but you remain aware. The medication is delivered through an injection or small tube called a catheter.
Local anesthesia is for procedures like having a mole removed or getting stitches. It numbs a small area with a one-time injection of medicine, and you are alert and awake.
“The most common medication used for colonoscopies and endoscopies is propofol,” Dr. Nye continued. “It’s known as the ‘milk of anesthesia’ because it actually looks like milk. It’s also used to put you to sleep and keep you asleep during general anesthesia for surgery. It has very few side effects and is not associated with post-operative nausea.”
Your anesthesiologist is with you throughout the entire surgery.
“We don’t just give the anesthesia and go into cruise control,” Dr. Nye explained. “We are at the head of the bed monitoring the blood pressure and vitals continuously. We want to keep the vitals within 20 percent of the patient’s baseline vitals.
“We are in constant communication with the surgeon, and if something is going on during the surgery a conversation happens immediately and together we determine what to do to try to optimize the patient’s hemodynamic status. We do that by giving intravenous fluids and medications that slow or increase the heartrate.”
Your anesthesiologist stays with you through the post-operative phase as well, managing your vitals in the recovery room. He makes sure you aren’t having any cardiac, pulmonary or blood pressure issues. He also monitors your pain level and has techniques to help with post-op pain and address any side effects such as nausea and vomiting.
Even as anesthesia has gotten “a lot safer through the years … surgeries have also gotten better,” noted Dr. Nye. “They are much more minimally invasive. The incisions have become smaller. And more surgeries are being performed laparoscopically and robotically which has been shown to be associated with less blood loss. We can do things now that we couldn’t do 20 to 30 years ago.”
In general, the dosage of anesthetic is based on how long the procedure will take, so less invasive and faster surgeries typically reduce the amount of anesthesia drugs needed for a procedure – but how does the anesthesiologist know if the patient is really feeling no pain?
“If the blood pressure and heart rate are high, that may indicate to me there may by some sympathetic activation and I may need to increase the anesthetic level,” said Dr. Nye. “A BIS monitor is occasionally used to give us a rough idea of the patient’s level of awareness.
“Trauma patients have a higher incidence of reporting recall because when a trauma patient comes into the operating room, they are usually unstable and have lost a lot of blood. You can’t give these patients a very deep level of anesthetic because their blood pressure is already tenuous and low. Anesthesia drops blood pressure and too much of it could potentially kill them.”
Others have reported they were aware of what was going on, when actually what they reported was at the end of the surgery when everything was done, and they were coming off the propofol and waking up.
“Medicine doesn’t just shut off like you turn off a switch,” Dr. Nye explained. “It takes time.
I’ve titrated my medicine after the surgery is over and the patient will have a conversation with me as we are leaving the operating room. Those are things they report as being awake during surgery. Oftentimes a spinal anesthetic takes about 45 minutes to an hour to wear off, usually in the recovery room.”
After 20 years as an anesthesiologist, Dr. Nye has noticed a direct correlation between patients who had low oxygen levels while anesthetized and those with sleep apnea.
“I was performing a lot of endoscopies and colonoscopies which require the use of intravenous propofol,” Dr. Nye explained. “We give a large enough dose of propofol to render the patient asleep or unconscious and since we are not intubating the patient, we are relying on the patient to breathe on their own while also keeping them unconscious.
“I noticed a lot of patients were becoming apneic. Prior to the surgery they never reported any issues with sleep apnea but when I talked to them after the surgery and told them they dropped the oxygen levels low, we’d find they had undiagnosed sleep apnea. That’s what piqued my interest in sleep medicine.”
Dr. Philip Nye opened his own sleep medicine clinic in Vero Beach two years ago where he treats sleep apnea, restless leg syndrome, insomnia, narcolepsy and a whole gamut of sleep disorders. He now splits his time between his sleep clinic and as a staff anesthesiologist at Good Samaritan Hospital in West Palm Beach. He can be reached at Anesthesia and Sleep Medicine Services of Florida, 1485 37th St. Vero Beach, 772-266-6855.