Dr. Steven McCornack

Often times, patients receiving local anesthetics may get additional medications which might be responsible for drowsiness. Local anesthetic injected into any tissue will find its way into the bloodstream and circulate in the body. At certain concentrations it can cause lightheaded ness, drowsiness, or even a seizure. Physicians and dentists know this and keep the total amount of local anesthetic within safe levels when injecting.

There is very little risk of any sort of problems with multiple epidurals. Many people with chronic pain or cancer pain may get multiple epidurals and it does not seem to create specific issues. With any labor epidural, the biggest risk is that it does not get adequate relief. If this is the case, it is simply replaced. This occurs 10-20 percent of the time, according to clinical studies. The next biggest risk, 3-10 percent of the time, is that you could have an unintentional dural puncture and get a post-dural puncture headache, which is treated with a
procedure called a blood patch. The nice thing about an epidural for any laboring patient is that in the event that you must have a cesarean section, you may use the epidural catheter to dose.

Good luck!

Anesthetic medications typically reduce blood pressure to some extent during anesthesia. In any case, your blood pressure will be continuously monitored during the procedure, and there are many medications to control your blood pressure at the anesthesia provider's fingertips

There are several questions the anesthesia provider will want to know. Do you have a fever? Productive or non-productive cough? Sputum production? They will also want to listen to your heart and lungs before making a decision. Are you short of breath? In general, it is not risky to undergo general anesthesia with a common cold. Your symptoms may worsen if an inhaled anesthetic is used. Typically, if you start off with a scratchy throat, it may worsen. This may be partially due to the laryngeal mask airway, supraglottic device, or endotracheal tube which may be used to secure your airway. The anesthetic gases are also very dry, and this is particularly responsible for the dry throat afterwards. In large pediatric
studies, researchers looked at many thousands of cases where children undergoing minor procedures had an upper respiratory infection (URI). The issue was that if you cancelled these cases, at great inconvenience and cost to everyone involved, and then brought the child back in a couple of weeks there was still a large number who had another cold or still had symptoms. They looked at the rates of serious complications with anesthesia and found that they were not changed by going ahead rather than rescheduling. There was an increase in throat irritation and minor symptoms. You may want to speak with your surgeon and or the anesthesia team to determine if your 'bad' cold is bad enough to warrant postponing the procedure.

Very normal. The local anesthetic adds some volume to the tissue. Also, the circulation to the area can be reduced temporarily. Depending on the type of local anesthetic used, it may be anywhere from 2-4 hours or even longer. It may take 10-12 hours for it to feel near 'normal' again. It is important to remember to be very careful with your numb cheek, teeth, and or gums. You don't want to chew on that side, and avoid hot or cold beverages or you might accidentally bite or burn that surface.

This is a topic with some controversy. Officially, many anesthesia groups and organizations may still instruct to 'pump and dump' for 24 hours. If you child is not a premature baby and has no respiratory issues like apnea, the amount of anesthetic which might appear in breast milk after such a short procedure is barely detectable and would be more of a theoretical risk than an actual risk. You may be able to consult with the anesthesia team in advance next time and formulate an anesthesia plan to minimize this already miniscule risk if that appeals to you

The answer depends on several factors. First is the choice of anesthetic or sedative agent. Some medicines last longer than others and are chosen to be appropriate for the procedure. Second is the dose of the anesthetic used. Higher doses will last longer, but may be necessary to assure a successful procedure. Some medications can be "reversed" by other medications if necessary.The goal is to prevent anxiety and allow the child to remain still during the procedure. Otherwise, the scans are blurry and unusable. All of this should be explained to you and your questions should be answered before the procedures. Most facilities provide written instructions for reference. Most current anesthetic agents and techniques are selected to allow for a rapid recovery after the procedure. Some locations use older protocols which do not involve utilizing specialized anesthesia providers and use older medications, which may result in longer recovery times afterwards. Another factor is the general health of your child. Some medical conditions and concurrent medications may slow the elimination of the sedative medications, which are typically eliminated by the liver and kidneys in the case of intravenous medications, or simply exhaled in the case of inhaled anesthetic agents. For most adult and pediatric patients, we often use the 24-hour rule, which states that although many agents are out of their system much faster (2-4 hours or 6-8 hours for most medications) than 24 hours, resuming "normal" activity is a matter of concern until a day has passed. If your child becomes more sedated or does not appear to be progressing, you may need to contact your care team or initiate a medical emergency if conditions seem to warrant that (examples would be respiratory difficulty or increasing lethargy).

Prior to any procedure, your surgeon and anesthesia provider will, together with your input, formulate a plan for your anesthesia. If you have specific fears or concerns, this is the time to discuss them. We always have a discussion which includes Risks, Benefits, and Alternatives before getting the consent of the patient for the anesthesia care plan. In certain instances, there may be a bigger benefit or a bigger risk than normal, and all this will be factored in, It is not unusual to have patients have anxiety about having a general anesthetic where they will be rendered unconscious. Most of the time, preparation and education will allay those fears. Often, some anti-anxiety medication can also be helpful

For this type of procedure, some local anesthesia is almost always used. Depending on the amount of time and extent of the removal, intravenous sedation or a general anesthetic may also be appropriate. Toes can be quickly anesthetized with a 'digital block' where local anesthetic is injected on both sides of the affected toe. This may involve only a few seconds of discomfort before the toe gets numb.

Anesthesia providers have several medications which are commonly used to increase blood pressure during a procedure. If the dentist or oral surgeon is simply injecting local anesthesia in the affected area to numb it up before the procedure, it is unlikely to affect your blood pressure to any significant extent.

Often times, when children need to have a scan done, they need to have sedation to be able to lie still. The scans are not clear if the patient moves, just like in a photograph. There are two methods of sedation commonly used, oral medication or intravenous medication. Many institutions use oral sedation. It may take several hours for these medications to be metabolized by the child’s body. So your experience is not uncommon. Over time, he should be more and more like his normal self. It is important to get assurance from the facility and the supervising personnel that your child is ready for discharge to your care. Normally, this means the child is rousable and not overly sedated. Depending on the dose and the type of sedation used, it may be several hours.

There are many different anesthetic techniques which can be used in a situation like this. The diabetes itself is not huge problem, but all of the accompanying medical problems must be considered. In some cases, surgeons may want to postpone surgery until tighter control of blood glucose can be obtained. A case like this is more of an emergency. Diabetic patients are more prone to infection and less able to heal than other patients. Anesthesia is very safe for almost all patients, and monitoring systems have made it unusual to have complications related strictly to the anesthesia. Most complications are related to medical or surgical issues and are not related to the anesthetic choice or technique

If you are referring to spinal or epidural anesthesia, the research does not support this claim. Many pregnant women have back pain related to the weight gain and changes in ligament laxity due to pregnancy. Back pain is a common complaint among all groups, regardless of whether someone has had a spinal or epidural anesthetic.

Anesthesia in this modern era of monitoring is extremely safe. By comparison, the most dangerous thing you will do the day of surgery is to drive to the facility. Deaths during surgery are almost always due to pre-existing conditions or issues arising from the surgery itself. Actual deaths attributable to the anesthetics are estimated in the one in a million to one in six million range, which means that there are only a handful each year in this country. The anesthesiologist will monitor your vital signs continuously throughout the perioperative period. They will probably use a 'depth of anesthesia' monitor like the BIS or bispectral analysis monitor which is like an EEG and measures how asleep you are. This allows the anesthesia provider to adjust the level of anesthesia to meet your needs and the surgeon's needs throughout the case. Good luck with your procedure! There are plenty of other things to worry about. Your anesthetic shouldn't be one of them!

Most anesthesiologists and surgeons would recommend withholding any stimulant medications for at least the day of surgery. The fear is that these medications might interact with anesthetic medications to cause hypertension, cardiac arrhythmias, lower the seizure threshold, and/or make vasopressor medications less predictable.

Clinicians always look at these problems in terms of a risk-benefit ratio. The 'risk' of withholding medication for a day or so is relatively minor compared to the possible 'benefit' of avoiding a potentially serious medication interaction. The stimulant medications may be started relatively soon postoperatively, so the inconvenience should be minimal.

Always inform your surgeon and anesthesiologist of all the medications that you are taking during your preoperative visit or phone interview, including over-the-counter medication and herbal supplements. Some of these may need to be withheld for a period of time before and after surgery as well.

It is possible to have a hip replacement surgery with a regional anesthetic instead of a general anesthetic, but medications are almost always withheld in a similar fashion in this circumstance also, just in case to avoid the possible situations mentioned above.

This is a issue where more information is needed to give a good answer. The
type of medication taken, the clinical reasons for taking the medication,
and the type of surgery must all be considered before giving you an answer.
Consult your surgeon and the physician who prescribed the blood thinners
before any decision to stop or "hold' medication. You wouldn't want to have
your surgery canceled or delayed unnecessarily due to a miscommunication or
misunderstanding. You can do an internet search of guidelines for holding
medications prior to surgery, but as I said, you must consult both the
surgeon and the physician responsible for prescribing your blood thinning
medication. Some medications may need to be discontinued for a significant
amount of time, so make your inquiries as early in the process as possible.
Other medications may be continued before surgery, particularly heart and
blood pressure medications. Be sure to let your surgeon and
other physicians know which medications you are taking. Don't forget to
mention all non prescription, vitamin, and herbal medications also. Be sure
to ask when you should restart any medications which you may have stopped
for surgery. Good luck with your procedure!