Anesthesiology

The Anesthesia Department at Valley Regional Hospital consists of Certified Registered Nurse Anesthetists, CRNA, committed to providing a safe, efficient and pleasant anesthetic experience for all our patients. The department follows guidelines established by the American Society Anesthesiologists (A.S.A.), the American Association of Nurse Anesthetists (A.A.N.A.), and the Joint Commission.

All of our CRNAs are certified yearly in basic CPR and biannually in Advance Cardiac Life Support, Pediatric Advanced Life Support, and Neonatal Resuscitation from the American Heart Association. Our CRNAs are all Advanced Practice Nurse Prescribers and licensed by the Drug Enforcement Administration.

High-Quality Anesthesia Equipment

VRH provides the department with high-quality anesthesia equipment for administering and monitoring anesthetic patients. Each anesthetizing location throughout the hospital has identical Datex-Ohmeda Aestiva anesthetic workstations.

The workstations are maintained on a regular schedule by an in-hospital VRH Clinical Engineering Technician in conjunction with periodic maintenance and vaporizer exchange contracts with the manufacturers. Each workstation has monitors capable of providing our anesthesia personnel with instant monitoring of our patient's vital signs and other important parameters to provide a safe, efficient anesthetic experience. Each anesthesia monitor has a Bispectral Index System (BIS) for gauging the patient's level of awareness while under anesthesia.

If you have any questions about your anesthesia, you may call Valley Regional Hospital's Anesthesia Department at (603) 542-1889.

Valley Regional Hospital Anesthesia Department

• Dennis Heibein CRNA
• John Tomlinson CRNA

Frequently Asked Questions

Q. What is Anesthesia?
A. Anesthesia is a specialty dedicated to the relief of pain and total care of the surgical patient before, during, and after surgery. The anesthesia care team is responsible for management and anesthetic care of the patient throughout the duration of surgery. They must carefully match the anesthetic needs of each patient to that patient's medical condition, responses to anesthesia, and the requirements of the surgery.

Q. Are there risks to anesthesia?
A. All operations and all anesthetics have some risks, and they are dependant upon many factors including type of surgery and the medical condition of the patient. Fortunately, adverse events are rare. Your anesthesia provider takes precautions to prevent an accident from occurring just as you do when driving a car or crossing a street. Complications from anesthesia have declined dramatically over the past 25 years as education and technology have improved. In just the past decade, estimates for the number of deaths attributed to anesthesia have dropped 25-fold from 1 in 10,000 anesthetics to 1 in 250,000. All this has occurred during the time when the youngest of premature infants in neonatal units survives intricate, lifesaving procedures and 100-year-old patients undergo and recover from major surgeries that were once thought to be impossible.

The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesia provider about any risks that may be associated with your anesthesia.

Q. What about eating or drinking before my anesthesia?
A. As a general rule, you should not eat or drink anything after midnight before your surgery. Under some circumstances you may be given permission by your anesthesia provider to drink clear liquids up to a few hours before anesthesia.

Q. Should I take my medications?
A. Some medications should be taken and others should not. It's important to discuss this with your physician before surgery. Do not interrupt medications unless your physician or anesthesia provider recommends it.

Q. Could herbal medicines and other dietary supplements affect my anesthesia if I need surgery?
A. Researchers are trying to determine exactly how certain herbs and dietary supplements interact with certain anesthetics. They are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risk of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesia providers, anticipating a possible reaction is better than reacting to an unexpected condition. So it is very important to tell your doctor about everything you take before surgery.

Q. How is the epidural block performed for labor and delivery?
A. An epidural block is given in the lower back. You will either be sitting up or lying on your side. The block is administered below the level of the spinal cord. The anesthesiologist will use a local anesthetic to numb an area in your lower back. A special needle is placed in the epidural space just outside the spinal sac.

Q. May I request what type of anesthesia I will receive?
A. Yes, in certain situations. Some operations can be performed using different anesthetic procedures. Your anesthesia provider, after reviewing your individual situation, will discuss any available options with you. If there is more than one type of anesthetic procedure available, your preference should be discussed with the anesthesia provider in order for the most appropriate plan to be made.

Q. What happens after I lose consciousness during general anesthesia?
A. Beginning Phase: A great deal besides surgery takes place between the beginning of your anesthesia and your return to consciousness in the Post Anesthesia Care Unit. Your anesthesia will probably be started with an induction agent. A common one you may be familiar with is sodium thiopental (Pentothal). You may have heard that this induction agent is used as a "truth serum", that is a myth. The real truth is that thiopental or another drug called Propofol is used basically during the first step (induction) of your anesthesia when you "drift off to sleep" and it lasts only a few minutes.

To keep you anesthetized, your anesthesia provider administers and regulates additional and more potent medications necessary to maintain your anesthesia for the rest of the procedure. Some of these medications are injected into your veins and others, such as nitrous oxide, are inhaled through your lungs because they are gases. Inhaled gases are administered to patients who receive general anesthesia, with oxygen being the most important gas. These gases are administered either through a mask or a special breathing tube which is inserted into your windpipe (trachea) depending on your surgical procedure and physical condition.

Middle Phase: Exactly which medications will be administered to you during anesthesia will be determined by your physical responses and how they will be affected by the type of surgery you are having as well as by your medical status. Therefore, your anesthesia provider will carefully tailor your anesthetic just for you. Some of these medications will be your actual anesthetic agents that help you to remain unconscious and experience no sensations, while others are administered to regulate your vital functions such as heart rate and rhythm, blood pressure, breathing, and brain and kidney function.

Your anesthesia provider constantly is monitoring, evaluating, and regulating your critical body processes because they can change significantly during the operation due to the stress and reflexes from surgery itself, the effects of the anesthetic medications, and your medical condition. Your anesthesia care team is responsible for and will treat any medical problem you may develop during surgery such as a blood pressure problem, for example.

Recovery Phase: When surgery is completed, the recovery phase is carefully timed and controlled. Anesthetic agents are discontinued and new medications may be given to reverse the effects of those administered previously. Body temperature, breathing, blood pressure, and other functions begin to normalize. Before your total recovery, you may receive some medications to decrease postoperative discomfort. All of this is calculated precisely under the supervision of your anesthesiologist to permit you to return to consciousness in the recovery room unaware of what has occurred during the operation.

Q. Why are so many questions asked about my past and present medical condition?
A. Anesthesia and surgery affect your entire system it is important for your anesthesia provider to know as much about you as possible. It is important to know exactly what medical problems you have and any medications you have been taking recently since they may affect your response to the anesthesia. You should inform your anesthesia provider about your allergies, any hard drug or alcohol usage, and past anesthetic experience. This important knowledge will allow your anesthesia provider to continue your current medical management into surgery which will help prevent complications, and expedite diagnosis, and treatment of any medical problems should they occur. Your continued medical management during surgery is necessary to help facilitate your speedy recovery.

Q. Why talk about drinking and smoking?
A. Cigarettes and alcohol affect your body just as strongly and sometimes more than any of the medically prescribed drugs you may be taking. Because of their various effects on your lungs, heart, liver, and blood, to name a few, cigarette and alcohol consumption can change the way an anesthetic drug will work during surgery, so it is crucial to let your anesthesia provider know about your consumption of these substances. This is also true for so-called street drugs-marijuana, cocaine, amphetamines, and the rest. People are somewhat reluctant to discuss these things, but it is worth remembering that such discussions are entirely confidential between you and your doctor. The anesthesia provider's only interest in these subjects is in learning enough about your physical condition to provide you with the safest anesthetic possible.

Q. Why are patients not allowed to eat or drink anything before surgery?
A. For most procedures it's necessary for you to have an empty stomach so that the chance of regurgitating any undigested food or liquid is greatly reduced. Some anesthetics suspend your normal reflexes so that your body's automatic defenses may not be working. When awake you have protective reflexes to prevent undigested food from entering your stomach. However, this natural protection does not occur while you are anesthetized. So for your safety you may be told to fast (no food or liquids) before surgery. Your doctor will tell you whether you can or cannot eat or drink and for how long. In addition, you may be instructed to take certain medications with a little water during your fasting time. For your own safety, it is important that you follow these instructions carefully about fasting and medications; if not, it may be necessary to postpone surgery.

Q. How can I be assured that I will not be awake during anesthesia?
A. Certain procedures do not require that the patient be totally unconscious during the procedure. Regional anesthetics will usually have a certain amount of sedation involved and you may discuss it with your anesthesia provider the level of sedation you require. General anesthetics are expected to have the patient unconscious for the entire procedure. This is monitored by observing multiple patient parameters. A patient's heart rate, blood pressure, and muscle control are monitored to determine patient safety, awareness, and optimum surgical conditions. One parameter available at Valley Regional Hospital is a monitor used to determine awareness during anesthesia. This monitor is a Bispectral Index Monitor that is a level-of-consciousness monitor. It provides information to the anesthesia care team to assure that the patient does not experience unintended intraoperative awareness during general anesthesia. If you have ever experienced awareness during an anesthetic procedure, always provide this information to your anesthesia provider and your physician.

Q. Are there different kinds of anesthesia?
A. There are several kinds of anesthesia. The one chosen for you is based on factors such as your physical condition, the nature of your surgery, and your reactions to medications. Frank and open discussion with your anesthesia provider is essential in the selection of the best anesthetic for you. In particular, you must speak freely and follow instructions closely regarding your intake of medications, food, and beverages before anesthesia. Such substances can react negatively with anesthetic drugs and chemicals. There are three main categories of anesthesia: local, regional, and general. Each has many forms and uses.

Local Anesthesia: The anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery, for example, on the hand or foot.

Regional Anesthesia: Your anesthesia provider makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake, or you may be given a sedative. You do not see or feel the actual surgery take place. There are several different types of regional anesthesia. Two of the most frequently used are spinal and epidural anesthesia, which are produced by injections made with great exactness in the appropriate areas of the back. They are frequently preferred for childbirth and joint replacements on the lower extremities.

General Anesthesia: In general anesthesia you are unconscious and have no awareness or other sensations. There are a number of general anesthesia drugs. Some are gases or vapors inhaled through a breathing mask or tube and other medications are infused through a vein. During anesthesia, you are continuously monitored, controlled and treated by your anesthesia provider, who uses sophisticated equipment to track all your major bodily functions. A breathing tube may be inserted through your mouth and into your windpipe to maintain proper breathing during this period. The length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesia provider will reverse the process and you will regain awareness in the recovery room.

Q. What are Femoral Nerve Blocks?
A. We now offer patients with lower extremity surgeries a pain relieving technique that lowers the amount of pain medication required and increases the patient's comfort level in the post-operative period.

The patient receives IV sedation then a local anesthetic is administered in the groin area above the femoral nerve. A needle attached to a nerve stimulator is inserted and advanced until the nerve responds to the proper amount of stimulation. A catheter is then advanced through the needle and secured in place. Initially a bolus of local anesthetic is given to aid in pain control during the surgical procedure. Post-operatively in the Post Anesthesia Care Unit the patient's catheter is attached to a Stryker pain pump that allows a continuous infusion to bath the nerve in local anesthetic.

Patients scheduled for Total Knee Arthroplasty and Anterior Cruciate Ligament repairs are the largest patient population benefiting from this procedure. They are experiencing increased pain relief and mobility of the joint in the immediate post-operative period. A decrease in the amount of narcotics and narcotic related side effects such as nausea or ileus has occurred.