There are many ways to skin a cat and the same applies for anesthesia and surgery. Most of the techniques we use today have been around for a long time but it is amazing how creative many practitioners have become by using a combination of tried and tested techniques to make the surgery more efficient, keep the patient safe and allow for a seamless emergence and recovery.
After all the preparations by the nurses and the anesthesia providers you are finally ready to move on to the beginning of your operative experience. Many patients may require special procedures prior to undergoing anesthesia or surgery. If you require these techniques this is the time when they are likely to be performed. In most situations, you will be taken to a special procedure area directly outside the operating room where this will happen.
The time will arrive when all necessary preparations and procedures are complete. It is time to go to the operating room. In many centers, the nurses from the operating room will arrive to take you away for surgery. They will review your chart, ask you who you are, what surgery you expect to have and the name of your surgeon. Once they are satisfied all is correct you will be taken to the operating room.
To begin your surgery, you will go through a process known as induction of anesthesia. If you and your anesthesia professional have elected to use general anesthesia there are certain steps that will take place. The first thing you will notice is that your caretaker will get busy placing all the important monitoring devices. These will include an EKG to monitor your heart electrical activity, and automatic blood pressure cuff that will check your blood pressure every 5 minutes, an oximeter to check your oxygen levels continuously and BIS monitor to measure EEG activity for awareness. If your case requires an arterial line or central line it will be attached to a machine that will do all the monitoring.
Now that you are asleep or sedated and properly numb, it is time for the surgery to take place. During this time, your anesthesia personnel will be with you constantly maintaining your level of anesthesia. This includes carefully monitoring your vital signs and measuring the level of the anesthetic you are receiving. Once the anesthesiologist is satisfied with the level of the anesthesia it is now time for the surgeon to start the case. For a general anesthetic, it usually takes 10 to 15 minutes from the time a patient gets in the room until the surgery starts.
One of the frequent remarks we hear around the operating room is “the surgeon is the captain of the ship.” In the early years of surgery and even until recently it was assumed that all medical care in the operating room was under the direction of the surgeon. This made sense in the early years of surgery when the anesthesia was in the hands of a nurse while the surgeon operated. This was a difficult time for patients since the surgeon remained focused on the surgery and had little time to be interrupted by the nurse when things got out of hand. In that era neither the surgeon nor the nurse received advanced training in anesthesia.