ANESTHESIOLOGY INTRODUCTION

Anesthesiologists
Anesthesiologists are physicians who complete a four-year residency after medical school that focuses on providing anesthesia of all types.  AAG has anesthesiologists who have additional subspecialty training.  All members of AAG become board certified within 5 years of joining our practice.

Anesthesia Care Team
In addition to the anesthesiologist, there is a Certified Registered Nurse Anesthetist (CRNA) or Certified Anesthesiologist Assistant (AA-c) that completes the “Anesthesia Care Team” model.

Certified Anesthesiologist Assistants (AA-c’s) receive training from a medical university with an accredited Anesthesiologist Assistant program.  They then are certified by the National Commission for Certification of Anesthesiologist Assistants (NCCAA) in the United States.  The NCCAA certification process for anesthesiologist assistants includes an initial certifying examination, ongoing registration of continuing medical education, and interval examinations for continued demonstration of qualifications.

Certified Registered Nurse Anesthetists (CRNA’s).  After graduation from Nursing School, a CRNA candidate is required to perform Intensive Care Unit (ICU) nursing, followed by two years of anesthesia training in an accredited training program.  Passage of a Certification Examination is required before practicing as a CRNA.

Choice of Anesthesiologist
We make every effort to honor the requests of both patients and surgeons for a particular anesthesiologist.  Our daily scheduler will assign your anesthesiologist unless a request from the patient is received.

Preoperative Preparation
An evaluation by a member of the anesthesia care team may be appropriate for patients with a complex medical history of complex procedure.  If this does not apply then a phone interview may be appropriate for health patients undergoing simple procedures.  Labs and preoperative testing will be decided by your anesthesiologist or surgeon and your procedure to some degree.  Before your surgery you will receive specific instructions as to food and liquids prior to surgery, which medicines to take the morning of surgery, and pre and postoperative nursing/surgical instruction.  Patients who come from home will be admitted to the same day surgery unit the day of surgery.  A history and physician examination with particular emphasis or previous anesthetics will be performed.  A family history of problems with anesthesia is important to mention.  After consideration of your health history, surgical procedure, and your preferences, the anesthesia care team will formulate an anesthetic plan that best suits your needs.

Anesthesia Types
There are three major types of anesthesia: general, regional, and local. General anesthesia is defined as a state characterized by deep sleep, analgesia, muscle relaxation and depression of reflexes. Under general anesthesia, you will have no awareness of the surgical procedure. With regional or local anesthesia, an anesthetic drug is used to numb the surgical area. Regional anesthesia includes spinal and epidural anesthesia as well as specific nerve blocks. Often intravenous sedatives are given in addition to your regional anesthetic to provide added comfort and relaxation during your surgery. MAC or Monitored Anesthesia Care is local anesthesia with intravenous sedation.

General Anesthesia
Induction of general anesthesia begins in the operating room with an intravenous injection of medication. The anesthetic state is maintained by a combination of inhalation gases, and intravenous narcotics, which are dosed as needed. Commonly, a small breathing tube (endotracheal tube) is inserted into your windpipe through your mouth after you are asleep. Inhalation anesthetics are delivered through this tube. Sometimes the anesthetic is delivered through a special facemask. Once surgery is complete, the anesthetic gases are discontinued and a return to the awakened state occurs shortly thereafter. The breathing tube is usually removed in the operating room.

Regional Anesthesia
Regional anesthesia includes spinal anesthesia, epidural anesthesia as well as specific nerve blocks.

Spinal anesthesia is administered by placing a special needle in your lower back below the level of your spinal cord. A spinal provides a rapid dense numbness. A small amount of local anesthetic is administered through the needle and the numbness begins almost immediately. The needle is removed after the injection of medication.
Often intravenous sedatives are given in addition to your regional anesthetic to provide added comfort and relaxation during your surgery.

Your surgeon and anesthesiologist may recommend a dose of a long acting narcotic be given through the spinal needle along with the local anesthetic (intrathecal administration of narcotic). The purpose of this additional medication is to provide pain relief during the immediate post operative period which may last up to 24 hours. This technique works well for certain types of surgeries, but is not appropriate in all situations.
Although uncommon a headache may develop after a regional anesthetic. If it occurs, the headache may last a few days. If so, there are several types of treatment available.

Epidural anesthesia is administered by placing a needle in the epidural space, just outside the sac that holds the spinal fluid. Next, a tiny flexible tube is inserted through the needle. This tube will be left in place during your surgery; however the needle is removed once the tube is in place. A narcotic solution, local anesthetic or a combination of narcotic and local is administered through the tube. This anesthetic solution, which bathes the nerves and blocks the pain, is continually administered through this epidural tube. Epidural anesthesia is typically used along with sedating medications or a general anesthetic. Based on the type of surgery the catheter may be removed at the end of the surgery or left in place to manage post operative pain.
Although uncommon, (1% or less), a headache may develop following an epidural anesthetic. This occurs if the needle nicks the sac that holds the spinal fluid. If it occurs, the headache may last several days. If the headache persists, there are several types of treatments available.

A nerve block interrupts the pain signal from the area of surgery to the brain, therefore decreasing the feeling of pain. Patients are given oxygen and a small amount of intravenous sedation prior to the nerve block. A special needle that emits a pulse of energy from the tip allows the anesthesiologist to identify the nerve. Once the nerve is located local anesthetic is injected into the area. The block takes effect in approximately 10-20 minutes and can last up to 24 hours. This technique is used along with sedating medications or general anesthesia. Nerve blocks are usually used for surgical procedures on the extremities. Nerve injury can occur, however is very rare.

Local Anesthesia
Monitored Anesthesia Care (MAC) involves the administration of intravenous sedatives by your anesthesiologist and administration of local anesthetics by your surgeon.

Care During Procedure
With all types of anesthesia, a member of the anesthesia care team (Anesthesiologist and/or CRNA) is with you at all times in the operating room. During your surgery, the anesthesia team member directs the anesthetic and monitors all vital functions, such as heart rate and blood pressure.

Postoperative Care
After awakening from anesthesia in the operating room you will be brought into the post anesthesia care unit (PACU). Nurses trained in the recovery of surgical patients will monitor you. Medications to treat pain, nausea or shivering will be prescribed by your anesthesiologist. When your vital signs (blood pressure, heart rate, etc.) are stable and pain is under good control you will be discharged from the PACU. Inpatients are discharged to their hospital room. Outpatients go to the phase-2 recovery unit prior to going home.

More Questions
If you have additional questions concerning your anesthesia please visit our resource section.  If you need to arrange a pre-operative consultation with one of our anesthesiologists, please contact the appropriate facility number as follows:

Northeast Georgia Medical Center
(770) 219-3845 Monday through Friday 8:00 a.m. – 4:30 p.m

Specialty Orthopaedics Surgery Center, call (770) 534-9420 Monday through Friday 8:00 a.m. – 4:30 p.m

Billing for Anesthesia Services
You will receive a bill from Anesthesia Associates of Gainesville, LLC separate from your hospital or surgeon bill.  This bill is for the professional anesthesia services performed by your anesthesiologist or CRNA/AA-c during your hospital stay.  The type of procedure, your physical condition, the total time of anesthesia, and the performance of special procedures determine the cost.

As physicians independent of the hospital/clinic, their “participation” status with HMO’s, PPO’s and other third party payor organizations may be different from the Hospital and your surgeon/obstetrician.  Please check with your insurance provider and our office concerning managed care network status prior to your procedure.

AAG’s business office can be reached Monday through Friday 8:00 a.m.-4:00 p.m. at (770) 532-7179.

(*Your bill will be from Ambulatory Anesthesia of North Georgia, LLC if for services rendered at Specialty Orthopaedics Surgery Center, LLC.  You may use the same contact numbers for the business office).
1488 Jesse Jewell Parkway
Suite 100
Gainesville, Georgia 30501
Tel: (770) 532-7179
Fax: (770) 534-1312
2014 Anesthesia Associates of Gainesville, LLC