What to Expect During Surgery

You will discuss the options for anesthesia and pain control with your anesthesiologist in the holding area. Some of the decision will be determined by the preferences of your surgeon.

If a nerve block is selected, you will receive IV sedation in our holding area. The anesthesiologist will use an ultrasound machine and a small needle to numb your leg. There are two main nerves in your leg: the femoral nerve on the front and sciatic nerve on the back. Sometimes we just numb the femoral nerve because it supplies the majority of sensation to the knee.

After the block, you will be taken to the operating room and put under general anesthesia. You will wake up after your surgery and spend about an hour in the recovery room before going to your hospital room.

Your block will last about 12-24 hours. The surgical team will prescribe oral and IV medications to control your pain as the block wears off. It is important to remember not to try walking on your own, as your leg will be very numb.

For simple knee arthroscopy, we commonly give a general anesthetic. If the surgeon is planning a more extensive procedure (such as an ACL repair), we will administer a femoral nerve block along with a general anesthetic.

After the surgery, we will wake you up and take you to the recovery room. Once you are awake and comfortable, usually in an hour or two, you will be sent home. If you have had a block, it will last about 12-24 hours. Your surgeon will provide a prescription for pain medicine for when your block wears off.

After meeting your anesthesiologist, you will be given some sedation in the holding area. The anesthesiologist will use a small needle to inject numbing medicine around the nerves of the brachial plexus, which controls sensation to the arm. You will then be taken to the operating room and given general anesthesia. 

Once the surgery is complete, we will wake you up and take you to the recovery area. Your arm will be heavy and numb. The block will last 12-24 hours. Side effects of the block that are fairly common and well-tolerated include hoarseness of the voice, feeling a bit short of breath, and a droopy eye on the side of the block. Some people get numb tingly patches (parasthesias) on the arm that may last a few weeks after surgery and go away with time.

After meeting your anesthesiologist, we will discuss your anesthetic based on your desires as well as your surgeon's preferences. A general anesthetic is most commonly used for hip replacement, but sometimes a spinal anesthetic is the best option.

You will meet your anesthesiologist in the holding area. He will extensively review your medical history and discuss any concerns with you. You will be given some sedation in the IV and brought to the operating room. You will be given more medicine in the IV and go to sleep. 

Once asleep, your anesthesiologist will place a breathing tube as well as one or two central lines. A central line is basically a big IV that can be used to measure pressures and give medicines directly into the major veins of the body. 

Your anesthesiologist will also place a TEE probe (transesophageal echocardiography). This probe will allow the anesthesiologist to view the heart muscle function, valve function, and any other abnormalities before and after surgery. We use it to help guide the surgeon, especially for minimally invasive procedures, in placing various catheters. 

After the surgery, we use TEE to make sure the heart function is good, to make sure a new valve is working well, and to assist with the placement of devices meant to assist the heart in pumping blood if the heart muscle is weakened. 

After the surgery is complete, your anesthesiologist will take you to the open heart recovery unit. You will be sedated and on the breathing machine for several hours at a minimum. Once the heart and breathing function look good, the sedation will be turned down and you will be weaned off the ventilator. Sometimes this process takes days or rarely weeks, but our goal is to get you off the ventilator quickly. Your family will be allowed to visit after you are stable in the recovery unit – usually about an hour after surgery.

You will meet your anesthesiologist in the holding area. He will extensively review your medical history and discuss any concerns with you. You will be given some sedation in the IV and brought to the operating room. You will be given more medicine in the IV and go to sleep. 

Once asleep, your anesthesiologist will place a breathing tube as well as one or two central lines. A central line is basically a big IV that can be used to measure pressures and give medicines directly into the major veins of the body. 

Your anesthesiologist will also place a TEE probe (transesophageal echocardiography). This probe will allow the anesthesiologist to view the heart muscle function, valve function, and any other abnormalities before and after surgery. We use it to help guide the surgeon, especially for minimally invasive procedures, in placing various catheters. 

After the surgery, we use TEE to make sure the heart function is good, to make sure a new valve is working well, and to assist with the placement of devices meant to assist the heart in pumping blood if the heart muscle is weakened.

After the surgery is complete, your anesthesiologist will either wake you up in the operating room or leave you sedated and on the breathing machine for a while. This will depend on the surgical approach and your heart and breathing function. Either way, you will be taken to the open heart recovery unit after the procedure. Your family will be allowed to see you once you are stabilized – usually in about an hour.

After meeting your anesthesiologist in the holding area, you will be taken back to the procedure room and hooked up to monitors. You will be given medicine in the IV and put under general anesthesia. Once the procedure is finished, you will be brought to the recovery area for about an hour. Once you are awake and comfortable, you will be taken to your room.

You will meet your anesthesiologist in the holding area. She will discuss your medical history with you as well as the options for pain control after anesthesia. If you receive an epidural for pain control, you will sit up on your stretcher and some IV sedation will be given. The anesthesiologist will clean your back with sterile solution and use a small needle to numb the skin on the back. Another needle will be advanced into the epidural space, and a small catheter about the size of a fishing line will be threaded into the epidural space.

After the surgery, a pump will be hooked up to the epidural catheter and numbing medicine will run continually until the epidural is removed (usually 3-6 days total). After the epidural is inserted, you will be wheeled back to the operating room where the anesthesiologist will give you more medicine in the IV to induce general anesthesia.

After you are asleep, the anesthesiologist will insert a breathing tube to help you breathe during surgery. The breathing tube allows the anesthesiologist to selectively ventilate one or both lungs at a time.

Once the surgery is complete, you will wake up and the anesthesiologist will typically remove the breathing tube and take you to the recovery area for about an hour or two. If you are not breathing well on your own, you may be sedated and taken to the intensive care unit (ICU), where you will stay on the breathing machine until you are ready to breathe on your own.  

A number of our patients are on long-term pain medication to treat back pain, cancer, or a variety of other ailments. Many patients have concerns about pain control after their surgery. We generally recommend continuing your chronic pain medications as prescribed, except for NSAID-type medications. Some medications like Suboxone need to be discontinued before surgery. This is best done by coordinating the transition with your pain doctor.  

Anticoagulants are excellent drugs for preventing blood clots in blood vessels and strokes. However, most anticoagulants increase the risk of bleeding during an operation. If you are taking an anticoagulant, please let us know during your pre-admission appointment. We feel it is best to manage these medications with the help of your primary doctor or specialist, and we will often discuss with them the best way to manage these medications during your operation.

Many of our patients have a history of heart attack and have stents or heart failure. As having any surgery is a stress on the body, we are always very concerned about making sure your heart is healthy enough for an operation. This is best done by contacting your cardiologist before surgery to make sure your medications are appropriate and no additional testing needs to be performed.

Usually, we will have you stop any blood thinners before surgery with your cardiologist’s permission and continue your other medication. If you have had any recent heart studies performed, please let our pre-admission nurses know so that we can have these records available for your operation.

If you have asthma, COPD, or another lung issue, it is best to continue taking your inhaled medications as prescribed. If you are on oxygen, you should continue to use it normally. Please let your anesthesiologist know if you have been having any recent difficulties breathing. 

Normally, we will ask how often you are using your rescue inhaler. After surgery, we will monitor your breathing closely as you recover.  It is not uncommon for patients to need oxygen or an extra breathing treatment following an anesthetic.  

If you are on dialysis, it is best to continue your dialysis as scheduled. When you meet your anesthesiologist, we will ask about your last dialysis session. We will also draw a potassium level prior to surgery. Please let us know if and where you have an AV fistula or shunt so that we can place a blood pressure cuff and IV appropriately.