For Patients

• Your anesthesia team will consist of a physician anesthesiologist, a medical doctor who specializes in anesthesiology. Your care team may also include a certified registered nurse anesthetist (CRNA) working in collaboration with, and under the supervision of, the physician anesthesiologist.
• Certified Registered Nurse Anesthetists (CRNAs) are board certified, master’s and/or doctorate prepared Advanced Practice Nurses who specialize in anesthesia. At AAM, we practice in an anesthesia care team model. The anesthesia care teams at AAM are dedicated to providing high quality, safe and compassionate care.
• You will meet with your anesthesia team before your surgery. They will closely monitor your anesthesia and vital functions during the procedure, and take care of you until you recover from anesthesia. An anesthesiologist will continue to monitor and oversee your recovery and pain management in a post-anesthesia care unit (PACU) up to the time that you are discharged from the PACU. 
• Your preoperative discussion with your anesthesia provider(s) should be one of openness and focused on safety. Specific topics to discuss include:
  • Your health, health habits and all medications. 
  • When discussing your anesthesia plan with your team, it is very important to inform them of any and all substances you take. This includes prescribed medications, over-the-counter medications, supplements, tobacco, alcohol (beer, wine or liquor) and legal or illegal drugs. The time before an operation can be stressful, but there will be no judgement about your past choices. Having an open and honest discussion about your history will facilitate safe and effective care during and after your procedure. Knowing this aspect of your history allows us to decrease potential side effects or interactions that might occur so we can give you the best care possible.
  • Any past experience with anesthesia. Tell the anesthesia team if you or a family member has ever had a negative reaction to anesthesia or pain medication. Tell them any other side effects you’ve experienced. 
  • Your fears about anesthesia. It’s natural and normal to fear anesthesia and surgery. If you are afraid, your anesthesiologist and/or nurse anesthetist can give you information that should help you feel safe.
  • Your questions about anesthesia, if you have any. As you prepare for surgery, write them down beforehand so you don’t forget any when you speak to your care team.
  • How your pain will be managed post-surgery. Your anesthesia care team will participate in your post-surgical pain management, so be sure to express any concerns or questions you may have about that as well.

As with any surgery, there is always a risk of complications from anesthesia, and there are no guarantees for a successful outcome. Improving your health before surgery may lower the risk of complications and improve your recovery.

With anesthesia and surgery, some risk factors can be modified by lifestyle changes if you have enough time prior to your scheduled surgery. These include:

• Obesity. Patients suffering obesity often have coexisting medical conditions caused by or worsened due to the extra weight. These conditions can increase risks during surgery, such as high blood pressure, sleep apnea, diabetes or gastroesophageal reflux disease (GERD). If your surgery is not urgent, working to improve your weight under a doctor’s supervision will be very helpful towards achieving a successful surgery.
• Smoking. Quitting as soon as possible prior to surgery can, potentially, lower your risk of postoperative complications. Ideally, you should quit smoking at least two weeks prior to your surgery. Immediately upon quitting levels of toxic nicotine and carbon monoxide start to drop and continue dropping, improving blood flow and oxygen delivery to help you heal. However, it takes at least two weeks for your lungs and immune system to start to return to their baseline function after quitting.
• Vaping. Vaping may affect your lungs and body in ways similar to smoking. However, our knowledge and experience with vaping continue to evolve. The ingredients used in vaping are variable and less regulated—and the effects unpredictable in scale and duration. Your anesthesiologist may require that you stop vaping 2-4 weeks prior to receiving anesthesia and may even opt to cancel your procedure, otherwise.

• Your surgeon or medical facility will provide you with pre-surgical instructions.
• You will be told not to eat or drink anything after midnight before your procedure, or, you may be given a specific time by which to stop prior to surgery. This step is crucial to avoid food and drink getting into your lungs while you are under anesthesia. 
• Your surgeon and other medical professionals will work together to determine which medications you should stop or continue.
• Bring a friend or other support person to take you home after surgery if you are not staying overnight. You will not be allowed to drive after outpatient surgery, or possibly for a few days if you’re taking pain medication. 
• Wear comfortable clothing to the surgical center.
• Wear or bring loose-fitting clothing to wear home. You might be sore or swollen from surgery, or you may have bulky bandages over your incisions. 
• Leave all jewelry and other valuables at home. Do not wear any jewelry, such as piercings, either. If you have sleep apnea and use a CPAP machine, please bring it with you.
• Do not wear perfume. Avoid putting makeup on or around your eyes.
• Dentures must be removed before surgery. If you are staying overnight after surgery, you should bring all associated denture cleaning and storage supplies. If you are having outpatient surgery, you may wish to leave your dentures at home.
• If you wear hearing aids, ask your surgeon and anesthesiologist if you can keep them in during surgery. Depending on the type of surgery, you may be able to wear them. Remember to bring your nighttime storage and recharging equipment and/or extra batteries if you will be staying overnight.  

• After surgery, you will be moved to a recovery area, commonly called the Post Anesthesia Care Unit (PACU). 
• Some people feel sleepy or groggy as their anesthesia wears off.
• Pain medication will be available to you in the recovery room under the direction of the anesthesiologist.
• Whether you received inpatient or outpatient surgery, you will need someone to drive you home.
• The facility where you had your procedure performed will give you specific instructions for what is required to go home safely. Please check with them regarding details. However, in general, if you received general anesthesia, you will need someone to stay with you for at least 24 hours after surgery. Your judgment and reflexes may still be impacted by anesthesia for at least 24 hours.
• Some pain medicine that you might receive after surgery can affect your ability to perform normal tasks, such as walking or even driving. It is important to follow instructions about activity. Take it slow!
• If you are breastfeeding, it is safe to continue to do so immediately after anesthesia with very few exceptions. Please check with your anesthesiologist if you received any medications that require you to discard breast milk for a period of time. 

• Your surgery may not require general anesthesia but may use sedation (also called twilight sedation and monitored anesthesia care) or regional anesthesia. 
• The effects of sedation can range from remaining awake and able to talk, to being asleep and unaware of your surroundings. Depending on the anesthesia plan and other factors, you may or may not recall parts of your procedure. Your anesthesia team will discuss the anesthesia plan with you. 
• The recovery from sedation is similar to general anesthesia, but you may wake up faster and your recovery time should be shorter. 
• You still will not be able to drive that day, and should have someone stay with you for at least the first several hours after you return home.
• Regional anesthesia numbs a large part of the body, such as an arm, leg or from the waist down. Sometimes you may have side effects depending on the type and location of what is numb. Be sure to talk with your anesthesia provider about side effects relevant to your procedure. Please see the Regional Anesthesia section below for more information.

• You will be given eating and drinking instructions prior to surgery.  It is very important to follow these instructions due to the risk of stomach contents going into the lungs during anesthesia and surgery.
• Presurgical procedures are the same as with adults. For elective procedures, your anesthesiologist may allow one (1) parent to be present in the operating room as your child goes to sleep. In some instances, this may not be possible due to safety concerns. This decision is made on a case-by-case basis.  
• Anesthesia medicines are typically inhaled using a breathing mask in infants and younger children and administered by IV in older children. Your child will be closely monitored, just as with adult surgeries, and medication adjusted as needed.
• The amount of time for your child to awaken after surgery is dependent on the length of the procedure and type of anesthesia required. Some children regain consciousness right away and are alert, others are drowsy for several hours. You will be allowed to be with your child as they recover from anesthesia.

Epidural Anesthesia:

An epidural provides pain relief from contractions. After numbing the skin, a tiny tube called a catheter is passed through a needle inserted in the lower back. The needle is removed, but the plastic catheter is left in place to administer medication continuously until after your baby is born. During placement, it is very important to remain still as this will decrease your chances of having possible complications related to the epidural. Once the epidural is in, your legs may feel weaker than normal, and you will be required to stay in bed for your safety. You should feel the pressure of the contractions but not significant pain. It is normal for your blood pressure to be lower as a result of the medication, so please let us know if you feel lightheaded or nauseated as these can be indicators of low blood pressure.

A spinal block, or epidural, are the preferred type of anesthesia for cesareans according to the American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists. Spinals and epidurals expose the baby to the lowest amount of medication and also allow you to be awake and experience the baby’s birth. Under certain circumstances General Anesthesia is required. A member of the anesthesia care team will be with you the entire time to make sure you are safe and as comfortable as possible. 

• Spinal Anesthesia: If you don’t already have a labor epidural in place you will most likely receive a spinal for your C-section. A spinal block is accomplished by injecting medication into the spinal fluid through a needle inserted in the lower back, after which the needle is removed. The onset of the anesthetic effects is almost immediate and lasts from an hour and a half to three hours. While you will remain awake for your baby’s delivery your abdomen and legs will be very numb, and you will not be able to move your legs until the medicine wears off. While we will make sure you do not feel sharp pain, you will still be aware of pressure and pulling by the surgeon. This is expected and does not mean the spinal is not working. It is normal for your blood pressure to be lower as a result of the medication, so please let us know if you feel lightheaded or nauseated.
• Epidural Anesthesia: On occasion, epidural anesthesia is the preferred choice for your C-section.  If you already have a Labor epidural in place it can be used for a C-section. A stronger dose of medication will be given through the catheter to get you numb enough for surgery. It will still be normal to feel touch and pressure, but you will not feel sharp pain.
• General Anesthesia: In some cases, such as in an emergency, general anesthesia may be necessary for your C-section. This means you will be completely asleep during your baby’s birth. Your baby will be exposed to some of the medications, but we will make every attempt possible to minimize the exposure. The anesthesiologist’s role is to take care of you, and a team of pediatric practitioners will be present to take care of your baby.

Peripheral nerve blocks are typically performed prior to the administration of general anesthesia. Using ultrasound guidance, local anesthetic is injected via a small needle around particular nerves to anesthetize or “numb” these nerves. Prior to the block, the anesthesiologist may administer some calming medicines to make you more comfortable. Nerve blocks lead to superior postoperative pain control, decrease need for narcotic pain medicines, earlier discharge times and overall improved patient satisfaction. Depending on the block you receive, you may experience the numbness in that particular area for a few days.

Neuraxial anesthesia refers to an injection of local anesthetic into the spinal or epidural space via a small needle in your back to numb the lower half of your body. This type of anesthesia is typically used for orthopedic lower extremity procedures such as knee and hip replacements, for labor and delivery of babies, and as postoperative pain management after certain surgeries.

You will receive general anesthesia and be unconscious and pain free. Typically, catheters are placed in a vein and in an artery before you are completely asleep.  If needed, medicine is available to ensure you are comfortable. After you are unconscious, you will have an additional IV placed in your neck, a breathing tube in your windpipe, and an echocardiogram probe placed into your mouth and down your esophagus to monitor your heart. Let your anesthesiologist know if you have any difficulty swallowing or have ever had surgery on your esophagus or your stomach. At the end of the procedure, you will be kept asleep with medicine through the IV and brought to the Cardiac Post-Anesthesia Care Unit (CPACU). There, you will slowly wake up over the next few hours as your body begins to recuperate from surgery. When it is safe, you will be awoken to perform a breathing test before the breathing tube is removed. Relaxing medicine will ensure this is not a stressful event for you. This is a common source of concern for patients undergoing open heart surgery, and it is tolerated by the vast majority of patients far better than they anticipate. The ICU team will progress your care in collaboration with your surgeon.

The Division of Critical Care Medicine at AAM currently cares for our patients in the Cardiac Care Unit, Cardiac Intensive Care Unit and the Cardiac Post-Anesthesia Care Unit. Each physician has subspecialty training and board certification in critical care medicine. Every member of this cohesive group brings knowledge and experience, features that collectively foster an environment of ongoing collaboration, lifelong learning, and delivering state-of-the-art care.  

• Be sure your insurance coverage is up-to-date before surgery so you don’t receive any unexpected bills.
• Before having surgery, find out who will be involved in charging for your care and whether they are in your plan’s network.
• To view the insurance companies with which Anesthesia Associates of Morristown (AAM) participates click here. This list can change so please double check with your insurance carrier.
• All AAM employees participate in the same plans. We all practice under one tax ID number.
• Call your insurance company to check that the hospital or medical center, surgeon and AAM, our group, are in-network. If out-of-network, you may wish to change locations and/or physicians.
• You will receive a separate bill for anesthesia services.
• Ask if there is a co-pay or deductible or other items that you might be responsible for and are not covered by your insurance.
• In addition, your surgeon and anesthesiologist will work together to tailor a specific peri-operative plan for pain management. Certain procedures, such as nerve blocks for postoperative pain management or other procedures related to your care, may result in additional charges. You should ask your surgeon or anesthesiologist if they foresee this possibility. Contact your insurance company ahead of time to inquire about coverage for these additional procedures.
• You can also ask our billing company, HSS, for assistance or to answer your questions. They can be reached by telephone at 973-631-8119 ext. 2.