James J. Romano, MD
More than 25 million surgical procedures are performed each year in the United States alone. Certainly many people close to you have been helped and treated by the science of anesthesiology. Routine surgical procedures are carried out in the operating room by the thousands every day. Even though the numbers and safety statistics are impressive, I do not take this for granted, and want you to have the benefit of this information to answer some common anesthesia-related questions.
Why do we recommend a general anesthetic?
Over the years we have developed a specialized program for your increased comfort and safety. We use the most modern anesthetic techniques and medications specially customized and developed for cosmetic surgery patients and procedures. This means you will go to sleep gently and quickly and wake up the same. You will be completely asleep during your surgery. You will not hear or remember or feel anything. All of this gives Dr. Romano the opportunity to do his very best and devote his full attention to your surgery. For operations over one hour, our general anesthetic actually uses less medication and is safer than sedatives or “twilight” sleep, allowing a more rapid recovery usually free of nausea.
When will I see my anesthesiologist?
We will review your chart and history and medical information prior to surgery and call you if needed. We will see you the morning of surgery prior to your procedure in a quiet and private setting and answer your questions and give you our undivided attention. The preoperative area, operating room, and recovery room are designed without any open windows or passageways in order to allow for your privacy at all times.
Will I hear or feel anything?
No, you are completely asleep. You will feel no discomfort whatsoever.
When will I wake up?
Shortly after the surgery is completed, you will gently awaken in the recovery room, and Dr. Romano and a nurse will be at your bedside. You will be covered with warm blankets to keep you comfortable. Monitors will be in place to record your vital signs. Your throat and mouth will be dry.
Will I be nauseated?
Our customized anesthesia has virtually eliminated postoperative nausea (less than 5%, compared to about 30% for most anesthetics). Special medication will be utilized to help eliminate any nausea, especially if you have a history of this. It is extremely important to not take anything by mouth after midnight the night before. We will advise you of any medications you may take with a sip of water.
Will my anesthesiologist be present at all times throughout my surgery?
Yes, the anesthesiologist will be present at all times without interruption throughout your surgery. Dr. Romano and the anesthesiologist will give you their undivided attention. There are no distractions during your surgery such as resident trainees, visitors, jokes, or radios. You are the focus of everyone’s undivided attention, and Dr. Romano sees to this.
What are the risks of anesthesia?
All operations and all anesthesias carry some small risks. They are dependent upon many factors including the type of surgery and medical condition of the patient. Fortunately, adverse results are extraordinarily rare. Your anesthesiologist and Dr. Romano take many precautions to prevent problems. Some risks include nausea, which we have mentioned; sore throat, which is usually mild and treated with soothing gargles; some hoarseness, which disappears on its own; and dreams or recalls, which we prevent by minimizing the use of muscle relaxants; generalized muscle aches; pressure damage to nerves, which we prevent by careful positioning and padding. Fortunately, catastrophic problems (death, major disability) are extraordinarily rare and less of a risk than air travel. It is actually safer to have a general anesthetic than to drive in your car.
Will I have any tubes and monitors?
To help your anesthesiologist and Dr. Romano provide the best and safest patient care possible, we use the most modern monitoring techniques. We place an intravenous line to administer fluids and medications. We monitor your blood oxygen with a pulse oximeter, a sticky probe or thimble on your fingertip. We place EKG (heart rate) pads on your chest, and we use temperature monitors. We give you oxygen gas by a small tube or mask near your nose and mouth; you will breathe comfortably. For most surgeries you will need a breathing tube, which we place after you are asleep and gently remove as you wake up. This lets us regulate your respirations and monitor your carbon dioxide elimination. Depending on the surgery, you may have a tube in your bladder to save you the discomfort of getting up and down to the bathroom while you are recovering. This is removed easily and comfortably. You may also have stockings that pump up and down to improve the circulation in your legs.
What about smoking, alcohol, and drugs?
Cigarette smoking affects your body just as strongly and sometimes more than any of the medically prescribed drugs you may be taking. This also includes second-hand smoke, which is even worse. Because of its effects on your lungs, heart, blood vessels, and wound healing, cigarette consumption will change the way an anesthetic drug works during surgery and profoundly affect your surgical results. So it is important to eliminate cigarette smoking and second-hand smoke completely before and after surgery. This is also true for any alcohol, herbal supplements, or recreational drugs such as steroids, marijuana, cocaine, and amphetamines.
What about vitamins, herbs, and supplements?
We are very aware of the benefits of all of these things and their contribution to healthy and longer lives. New evidence now proves that these things exert their main beneficial effects by thinning the blood! This complicates your anesthesia, surgery, and healing. It is therefore critical to inform Dr. Romano about any of these you are taking and to NOT take any dietary supplements, vitamins, herbals, homeopathics, or other enhancements for at least three weeks prior to surgery.
What about my medical health and any underlying medical conditions?
Dr. Romano will thoroughly question and evaluate you for your medical health. You must be as detailed as possible in giving all information and a full history, as your medical condition, bleeding tendency, and any medications profoundly affect your anesthetic. We will contact your private medical doctor prior to surgery. Anything that needs to be evaluated or treated will be done so prior to your surgery. With all of this done, your anesthesiologist will be well prepared to treat any such conditions during and immediately after.
If I have any more questions, can I meet or speak to my anesthesiologist prior to surgery?
Absolutely. Ask the office to give you the name and number, and you can contact or meet directly with your anesthesiologist.
What are the anesthesiologists’ training and background?
Anesthesiologists are MDs who, after graduating from college with a strong background in physics, chemistry, biology, and mathematics, obtain an MD degree after four years of medical school. Then they complete four years of post-graduate training (one-year internship and three years of anesthesiology residency). This includes cardiology, critical care, internal medicine, pharmacology, and surgery. Anesthesiologists choose and administer the medications that keep you from feeling pain or sensation, and they control your breathing and blood pressure during surgery; they also make careful medical judgments that protect you during and after surgery. Dr. Romano does not use any nurse anesthetists.