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If you have questions about the anesthesia or any other perioperative services offered by MAG, we’re happy to provide answers. Browse our Frequently Asked Questions below to find answers to our most common questions.

What type of education and training does the Anesthesia Team have?

The MD Anesthesiologist has four years of medical school and an additional four years of advanced training in anesthesiology. In addition, some MD Anesthesiologists elect to complete a fellowship and spend an additional year of specialty training in a specific area like cardiac anesthesia, pediatric anesthesia, neuroanesthesia, obstetric anesthesia or critical care medicine.

The CRNA (Certified Registered Nurse Anesthetist) is an Advance Practice Registered Nurse (APRN), who has acquired a graduate-level education and board certification in anesthesia. CRNAs practice under the medical direction of a MD Anesthesiologist. The CRNA is the oldest nurse specialty group in the United States, dating back over 150 years in service.

Are there different kinds of Anesthesia?

There are three main types of anesthesia: local, regional and general.

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 Team member makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You might be awake, or you may be given something to help you relax, sometimes called a sedative. There are several kinds 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 prostate surgery.

General anesthesia: You are unconscious and have no awareness or other sensations. There are a number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein. During anesthesia, you are carefully monitored, controlled and treated by your Anesthesia Team. A breathing tube may be inserted through your mouth and frequently into the 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 Team will reverse the process and you will regain awareness in the recovery room.

Is anesthesia safe?

Due to advances in patient safety, the risks of anesthesia are very low. Over the past 25 years, anesthesia-related deaths have decreased from two deaths per 10,000 anesthetics administered to one death per 200,000 to 300,000 anesthetics administered.

Certain types of illnesses, such as heart disease, high blood pressure and obesity, can increase your anesthesia risks. Even so, Anesthesia Teams routinely bring even very sick patients through major operations safely.

What are the risks of anesthesia?

All operations and all anesthesia have some risks, and they are dependent upon many factors including the type of surgery and the medical condition of the patient. Fortunately, adverse events are very rare. Your Anesthesia Team takes precautions to prevent an accident from occurring.

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

May I request what type of anesthesia I will receive?

Yes, in certain situations. Some operations can be performed using different anesthetic procedures. Your Anesthesia Team, 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 your Anesthesia Team in order for the most appropriate anesthetic plan to be made.

Should I continue to take my medications prior to surgery?

It is important to tell the doctors providing your care what medications you are taking prior to surgery so that they can be involved in making the decision about stopping or continuing these medications.

Some examples of common medications are:

• Aspirin and Plavix are drugs that are used to prevent blood from clotting. They are used to treat patients with certain disorders of the heart and blood vessels. Because of the way aspirin and Plavix work, they can cause increased bleeding when you get a cut or undergo surgery. If you are taking either of these drugs, you should talk to your primary care physician about stopping them before surgery. The decision to stop aspirin or Plavix is based on the reason why you need to be on the drugs (your medical condition) and on the risk of bleeding from the surgery.
• Diuretics (“water pills”) are commonly prescribed for treating high blood pressure. This class of drugs can cause changes to electrolyte levels, such as potassium. If you take diuretics, your Anesthesia Team may perform certain laboratory testing before surgery.
• Diabetic patients are commonly treated with insulin or oral agents. Your MD Anesthesiologist may decrease your usual morning insulin dose or discontinue your oral agents before surgery. Always speak with a MD Anesthesiologist or your regular doctor to discuss your particular medications, before any surgical procedure.

Could herbal medicines, vitamins and other dietary supplements affect my anesthesia if I need surgery?

Anesthesiologists are conducting research 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 risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists 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.

What happens during a preanesthesia visit with my Anesthesia Team?

The preanesthesia visit is an important visit when you will have a chance to learn about your options for anesthesia and to ask questions. It is also a time when the Anesthesia Team can review your medical records, do a focused physical exam and make decisions about ordering additional tests and consultations.

The interview with the Anesthesia Team is a key part of this review. During this interview, they may ask questions that cover the following:

• your general health, including any recent changes
• allergies to medications or other items
• chronic (long-term) medical problems, such as high blood pressure, heart disease, diabetes, asthma, acid reflux and sleep apnea
• recent hospital admissions, including surgery or procedures
• previous experiences with anesthesia, especially any problems

Some people keep their own health records on paper or in an electronic format. To help you answer these questions it is a good idea to bring any documents that describe your health history, as well as a list of all your medications.

When there are different anesthesia alternatives, such as general or regional (nerve block) anesthesia, your Anesthesia Team may give you information about these options and then ask about your preferences.

At the conclusion of your visit, you should

• have clear instructions on when to stop eating and drinking before surgery
• know what medications you should or should not take on the day of surgery (and sometimes even a few days leading up to surgery)
• know what type of anesthesia will be given to you (keep in mind that things may change between the day of your pre-operative visit and your procedure that result in modifying the anesthesia plan)

How will my Anesthesia Tem know how much anesthesia to give me?

There is no single or right amount of anesthesia for all patients. Every anesthetic must be tailored to the individual, and to the operation or procedure that the person is having. Individuals have different responses to anesthesia. Some of these differences are genetic, or inborn, and some differences are due to changes in health or illness. The amount of anesthesia needed can differ according to such things as: age, weight, gender, medications being taken or specific illnesses (such as heart or brain conditions).

Among the things the Anesthesia Team measures or observes, and uses to guide the type and amount of anesthetic given are: heart rate and rhythm, blood pressure, breathing rate or pattern, oxygen and carbon dioxide levels and exhaled anesthetic concentration. Because every patient is unique, the Anesthesia Team must carefully adjust anesthetic levels for each individual patient.

Why do I need to have an empty stomach prior to surgery?

It is very important that patients have an empty stomach before any surgery or procedure that needs anesthesia. When anesthesia is given, it is common for all the normal reflexes to relax. This condition makes it easy for stomach contents to go backwards into the esophagus (food tube) and mouth or even the windpipe and lungs. Because the stomach contains acid, if any stomach contents do get into the lungs, they can cause a serious pneumonia, called aspiration pneumonitis.

Can I smoke cigarettes before I have surgery?

You should stay off cigarettes for as long as you can before and after surgery. This will help you have the best possible results from your surgery. For example, quitting will reduce the chances you will have problems like a wound infection after the operation. It is especially important that you not smoke the morning of surgery – just like you don’t eat the morning of surgery, don’t smoke.

Many people find that surgery is also an excellent opportunity to quit smoking for good because most people do not have cravings for cigarettes while in the hospital, and your chances of successfully quitting are almost doubled if you try it around the time of surgery.

Can I get a pre-operative sedative before I go to surgery?

After you talk to your Anesthesia Team and sign all consents, a sedative may be administered to relax you before going in for your surgery.

What are the different types of sedation?

Sedation allows patients to be comfortable during certain surgical or medical procedures. Sedation can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests.

During light or moderate sedation, patients are awake and able to respond appropriately to instructions. However, during deep sedation, patients are likely to sleep through a procedure with little or no memory. Breathing can slow and supplemental oxygen is often given during deep sedation.

What happens after I lose consciousness during general anesthesia?

A great deal besides surgery takes place between the beginning of your anesthesia and your return to consciousness in the Post Anesthesia Care Unit. Exactly which medications will be administered to you during anesthesia will be determined by your physical responses. Therefore, your Anesthesia Team will carefully tailor your anesthetic just for you. Some of these medications will be the actual anesthesia 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, brain and kidney functions.

Your Anesthesia Team is constantly 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. For example, in most operations, specialized equipment is used to actually control the patient’s every breath.

Your Anesthesia Team is also responsible for and will treat any medical problem that may develop during surgery, such as a blood pressure problem. However, your Anesthesia Team wants to help prevent any medical problems by using and interpreting today’s sophisticated monitoring equipment and knowing when and how to treat your body’s responses to surgery.

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 Anesthesia Team to permit you to return to consciousness in the recovery room unaware of what has occurred during the operation.

When is a breathing tube necessary for surgery?

General anesthesia often results in the loss of the ability to breathe on your own. There are different ways to assist your breathing - one is the breathing tube (known as an endotracheal tube). There are many situations when the placement of the tube is the safest and most reliable method to assure adequate breathing. There are alternatives in other cases including breathing through mask or other devices.

You can discuss this with your Anesthesia Team to see if these other alternatives are appropriate for you. Patients who are more likely to need a breathing tube include those who ate or drank prior to surgery, have medical problems that cause acid reflux, or those who are vomiting or are extremely overweight.

Will I be nauseated after anesthesia?

While nausea and vomiting were quite common after general anesthesia, many strides have been made in recent years. There are several medications that your Anesthesia Team can give you to prevent nausea and vomiting. Please be sure to speak with your Anesthesia Team about your specific concerns.

What is awareness under anesthesia?

Awareness under general anesthesia is an extremely rare event that occurs when a patient recalls specific events, sometimes even pain, during their surgery. While recollections of the procedure are likely during sedation, local or regional anesthesia, it is unlikely during a general anesthetic.

TELL YOUR ANESTHESIA TEAM if you think that you may have experienced awareness while under general anesthesia. They can best explain the events that occurred in the operating room and why you may have been aware at certain times.

You can get more information about awareness from the American Society of Anesthesiologists website at www.asahq.org.

Reminder: Most Federal Surprise Billing Requirements Begin January 1, 2022

As health care organizations are generally aware, most regulatory requirements related to the federal No Surprises Act apply beginning January 1, 2022. These surprise billing regulations implement a number of new patient billing and cost-sharing limitations in the emergency services context, as well as in situations involving non-emergency services rendered by out-of-network providers at in-network facilities (as further discussed in our client update from earlier this year).  

As 2021 draws to a close, we want to remind clients of two aspects of these new regulations that have not received as much attention, to ensure they are not overlooked:
 
Patient Notice Requirement

In addition to complying with other surprise billing requirements, health care facilities and facility-based providers are required to give insured patients general written notices regarding federal and state protections against balance billing (see, for example, CMS' Model Form). CMS requires that the applicable providers and facilities must:

• make such notices available on their public websites (if applicable);
• post such notices on a sign at any publicly accessible location of the facility or provider; and
• make the notice available on a one-page form (can be double-sided) given in-person, via postal mail, or via e-mail, as selected by the individual. 

The providers and facilities must give such notices to insured patients prior to billing the patients or their health plans. 

Please note that facility-based providers can avoid the sign and one-page notice requirements (but not the website notice requirement) by entering into an agreement with their facilities to have the facilities provide the applicable notices in the required form and manner. If the provider has entered into an agreement with the facility and the facility fails to provide the notices, CMS will not view that failure as a violation of the regulations by the provider. We expect that many facilities will be willing to enter into such agreements in the interest of avoiding duplicate patient notices. Accordingly, we recommend that our facility-based provider clients discuss this with their facilities if they have not already. 

Good Faith Estimates for Uninsured or Self-Pay Patients
 
The regulations also require health care facilities and providers to give uninsured or self-pay patients a good faith estimate of the expected charges (GFE) for health care items or services (a) upon request or (b) upon scheduling of health care items and services. The regulations also allow such patients to initiate a dispute resolution process if they are billed for charges substantially in excess (at least $400 more than total expected charges) of a good faith estimate. 

Important things to bear in mind regarding this requirement include:

• This requirement applies to a wide range of state-licensed providers and facilities (i.e., not just to those covered by the surprise billing restrictions and requirements)
• A "convening provider" that receives a GFE request or is responsible for scheduling the primary health care item or service (i.e., the item or service that is the initial reason for the visit) with the patient must determine at the time of the request or at the time of scheduling whether a patient is uninsured or self-pay
• Determining whether a patient is self-pay will require asking the patient if the patient is seeking to have a claim submitted to health insurance for a particular item or service
• "Convening providers" must verbally inform uninsured and self-pay patients of the availability of GFEs when scheduling and when cost questions arise
• Providers must generally display a notice about the availability of GFEs on their websites and on-site (different from the patient notice discussed above, and CMS has provided a model notice)
• GFEs must be provided on specific timeframes (i.e., within three business days after the date of a patient request, within one business day after scheduling for items/services scheduled at least three business days in advance of the date the item or service is scheduled to be furnished, and within three business days after scheduling for items/services scheduled at least 10 business days in advance)
• The regulations include requirements for co-providers or co-facilities from which convening providers must gather information for purposes of providing GFEs
• Providers must update GFEs to reflect any changes they anticipate or become aware of
• Any discussion or inquiry from a patient about costs should be viewed as a GFE request
• CMS has published information and a standard form covering what must be included in GFEs
• GFEs should be considered part of the patient medical record and maintained as such

We recommend that clients consider these requirements, if they have not already, and incorporate them into their patient intake processes. Additionally, they should plan for coordination with other providers and facilities when third-party information is necessary for purposes of preparing GFEs. 

Our Chambliss team continues to monitor health care developments, including issues related to the No Surprises Act. Please contact Cal Marshall or your relationship attorney if you have any questions or need additional information.  

Final Rule on Surprise Billing

[ICYMI — July 26, 2021] Most provisions of the Rule are applicable beginning January 1, 2022, and impact group health plans, health insurance issuers, health care providers, health care facilities, and providers of air ambulance services. The Rule's requirements include the following...  READ MORE

About the Author

Cal Marshall

Chambliss Law