General Anesthesia

General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. General anesthesia is administered via the circulatory system, either by the injection of different medications through a vein, the inhalation of anesthesia gases or by a combination of inhaled gas and injected drugs. Consciousness and awareness are completely lost under general anesthesia, and patients feel no pain. The ability to independently maintain breathing is often impaired. Patients often, although not always, require assistance in maintaining an airway through a breathing tube or similar device to assist with respiration during surgery.

Regional Anesthesia

Regional anesthesia is the loss of sensation in a specific area of the body such as a limb to prevent pain. It is produced by drugs that interrupt the action of nerves that carry the sensation of pain. These drugs are known as local anesthetics. It involves placing a needle near nerves supplying the affected area and then injecting long acting local anesthetic. The needle placement is generally done with sedation to help with anxiety and apprehension. A continuous catheter may be used to allow medication to be given over a prolonged period of time.

Unlike general anesthesia, patients may remain awake during the procedure, resulting in reduced side effects and enabling the anesthesiologist and / or surgeon to converse with the patient. Regional Anesthesia allows you to be comfortable during the procedure and provides pain relief after the surgery is over.

There are several types of regional anesthesia that are named according to where the anesthesia is administered and what area loses the sensation. Regional anesthesia may be divided into central and peripheral techniques. The central techniques include so-called central neuraxial blocks (epidural anesthesia, spinal anesthesia). The peripheral techniques can be further divided into plexus blocks such as brachial plexus blocks and single nerve blocks.

Spinal Anesthesia or Block is a type of anesthetic that is performed by injecting a very small amount of local anesthetic through a very small needle into the spinal fluid around the spinal cord. This is done in the low back where the nerves are least vulnerable to injury. Spinal anesthesia is frequently used for procedures such as knee or hip replacement, Cesarean sections, foot or leg surgery, or surgery on the lower abdomen. Sedation is generally provided for patient comfort during the surgery.

Epidural Anesthesia or Block is a type of anesthetic that is performed by injecting local anesthetic through a very small needle or catheter into the area around the spinal cord but not into the fluid.

Nerve Block is a type of anesthetic that is performed by injecting local anesthetic through a small needle next to a nerve or group of nerves, often using ultrasound guidance.

Obstetrics (OB)

USAP-Tennessee incorporates an anesthesia care team model including CRNAs (Certified Registered Nurse Anesthetist) providing quality care under the close medical direction of an Anesthesiologist (a medical doctor). A care team model provides flexibility in the obstetric service by minimizing wait times for labor epidurals.

USAP-Tennessee provides epidural analgesia for labor, as well as spinal and epidural (regional) anesthesia for both elective and emergency Cesarean sections (c-section) as well as support for high-risk deliveries. Although general anesthesia is also an option for c-sections, most often a safer regional anesthesia technique allows patients to be pain free and awake during childbirth.

New moms often have questions about their anesthesia plan. USAP-Tennessee welcomes pregnant women to meet with us prior to their due dates to address any issues or concerns.

Epidural

The majority of laboring patients choose to have epidurals for comfort. Epidural anesthesia involves placing an injection in the lower back with a special needle and inserting a very fine tube through the needle to be left in place during labor.

Once the obstetrician has confirmed that a woman is in active, progressing labor, an epidural can be offered with the obstetrician’s approval. If patients have no serious medical problems, epidurals are a safe and effective way to provide comfort and a choice for many moms.

Typically, the patient is asked to sit up in bed and dangle her legs over the side. Occasionally the patient may be given the epidural while lying on her side. While sitting, the patient will be asked to push her lower back out to make the back C-shaped. It will be important to hold this position to allow the spaces in the spine to open to ensure easy passage of the epidural needle.

The anesthesiologist or CRNA will feel the bones in the back to determine the best place to insert the epidural. Once that spot is determined, the area will be made numb with a small injection of local anesthetic or numbing drug. Generally this feels like a little pinch or insect bite.

Through the numb spot, the epidural needle will be advanced into the epidural space in the back. This is the space just outside the sac of fluid bathing the spinal cord and spinal nerves. Most patients report that the placement process feels like pressure and is otherwise fairly comfortable.

Once the needle is in the right place, a small amount of anesthetic is injected to confirm that it is properly placed. Next, a small plastic tube about the thickness of fishing line is passed through the needle. This tube (called an epidural catheter) is left in place and the needle removed. The tube will be connected on the outside to a special pump ensuring consistent flow of the same type of medicine already in place. There will be a slow and steady flow of new medicine through the tube throughout labor. The pump is turned off after delivery and then the epidural catheter can be easily removed.

Risks of Epidural/Spinal Anesthesia

Backache

Back soreness after epidural anesthesia can occur. Generally this is mild and improves over a number of days after delivery. Soreness can be treated with warm compresses and mild pain relievers such as Motrin or Tylenol. If the pain is more severe and does not improve, patients are advised to call their doctors to make certain there is not a serious problem.

Headache

Headache is another potential issue with epidurals and spinals. Epidural headaches are initially treated with mild pain medicines, an abdominal binder or wrap around the midsection, drinking lots of fluids, and bed rest. These headaches typically go away in a few days to a few weeks in most patients.

If the headache is severe, an epidural blood patch may be done to eliminate the headache. The headache is caused by a tiny leak of spinal fluid from the sac of fluid that bathes the spinal cord. The blood patch involves placing another epidural needle in the same spot as the original one. However, this time through the needle, some of the patient’s own blood is injected. This blood tends to clot around the tiny hole in the spinal fluid sac and seals the little hole that was leaking. This treatment is highly successful in most patients.

Nerve Injury

This is a rare complication of spinals and epidurals in 0.03 to 0.1% of all spinals and epidural cases. In this situation the patient may experience continuing numbness or weakness or both. Severe cases are even more unusual. Most of these complications are temporary and go away on their own over the course of a number of weeks.

Spinal Anesthesia

For planned c-sections or in laboring patients who don’t already have an epidural, this pain relief is the most common choice. Spinal anesthesia is similar to epidural anesthesia except the needle used is much finer and is passed on purpose into the sac of fluid bathing the spinal cord. Unlike with the epidural where a tube continues to feed anesthesia, with spinal anesthesia all necessary medicine is given in one injection through the needle. There is no epidural tube or catheter involved. The procedure for placement is otherwise similar to epidural placement.

Interventional Pain Management

USAP-Tennessee’s pain management group offers comprehensive and convenient interventional pain services. When a patient’s pain has not been effectively managed by traditional approaches such as physical therapy, medication or chiropractic manipulation, our comprehensive pain treatment and management services may be the next step.
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Cardiac, Thoracic and Vascular Anesthesia

Cardiology—Diagnostic, Interventional and Electrophysiology

USAP-Tennessee primarily administers general anesthesia for cardiac electrophysiology (EP) procedures such as EP ablations working in conjunction with heart specialists. In addition to routine monitoring USAP-Tennessee often places arterial catheters in the wrist for these complex ablation procedures. The anesthesiology care team carefully monitors the patient throughout the procedure and is prepared to rapidly address any issues should the need arise. In addition USAP-Tennessee also provides IV general anesthesia for diagnostic cardiac procedures such as TEE (transesophageal echocardiography) allowing rapid sedation, wake up, and discharge from the unit.

Cardiothoracic and Vascular Surgery

Our team of cardiac anesthesiologists provides anesthesia for all open-heart procedures such as coronary artery bypass and valvular repairs done most often under cardiopulmonary bypass (using the heart-lung machine). In addition, our expertise in intraoperative transesophageal echocardiography (including 3D TEE) helps guide our surgical colleagues in their clinical decision making, and with valvular repairs and replacements allows us to evaluate the function of the new valve before the patient leaves the operating room.

In addition to routine monitoring, we place arterial catheters and Swan-Ganz cardiac catheters for intensive monitoring of the patient’s cardiovascular system during these complex open-heart procedures. USAP-Tennessee also provides anesthesia for all vascular cases such as aortic aneurysm repair (open and endovascular) and carotid endarterectomy, as well as thoracic (lung) surgeries.

Pediatric Anesthesia

Pediatric Anesthesiology includes the evaluation, preparation, and management of pediatric patients undergoing diagnostic and therapeutic procedures in operative and critical care settings. In addition, this discipline also entails the evaluation and treatment of children with acute and chronic painful disorders.

A pediatric anesthesiologist is a fully trained anesthesiologist who has completed at least 1 year of specialized training in anesthesia care of infants and children. Most pediatric surgeons deliver care to children in the operating room along with a pediatric anesthesiologist. Many children who need surgery have very complex medical problems that affect many parts of the body. The pediatric anesthesiologist is best qualified to evaluate these complex problems and plan a safe anesthetic for each child.

Through special training and experience, pediatric anesthesiologists provide the safest care for infants and children undergoing anesthesia