A day-or-two before the procedure, you'll be ordered to report to the hospital or surgery center for a routine pre-surgery workup, which may include a chest x-ray, electrocardiogram (EKG), blood work (chem 36 profile), an evaluation of pulmonary status, and an anesthesia interview. During the anesthesia interview, an anesthesiologist or certified registered nurse anesthetist (CRNA) will ask questions about your health, your knowledge of the procedure, and your preferences of anesthesia. You will be given the choice of three options:
- Procedural sedation: (once referred to as "conscious sedation"), a method of anesthesia which uses a benzodiazepine such as midazolam or diazepam (both members of the Valium family) to relax you during the initial phase of the procedure. The surgeon or anesthetist may also elect to add a narcotic pain medication, usually fentanyl citrate into the IV established soon after your arrival. These meds are all rapidly metabolized, and will allow you to leave the facility within six hours post-procedure.
- Spinal anesthesia: a method of anesthesia whereby an anesthetic is injected directly into the spinal column for means of blocking the impulses of pain and sensation from the area of the surgical procedure. There are two types of spinal anesthesia, the first is known as an epidural, the second is referred to as a spinal block. Spinal anesthesia is most often employed in the patient who has contraindications for general anesthesia.
- General anesthesia, "a.k.a. going under, getting knocked out", a method of anesthesia which today most often employs a hypnotic known as propofol. Yes, the same med which contributed to the death of Michael Jackson, but a medication with a stellar safety record. Sometimes a barbiturate may be employed, however, most anesthesiologists prefer to use propofol becaues it is rapidly metabolized, and allows for the almost immediate awakening of the patient. In the event general anesthesia is selected, an endotracheal tube will be inserted to assure a secure airway.
