Sherif Zaafran

The Governor issued an executive order a couple of days ago that specifically targets four counties in Texas. These are Harris, Dallas, Bexar, and Travis Counties. What it says is that elective surgery that would impact the number of beds for COVID-19 should be delayed. If your surgery is one that you can go home the same day, then it probably won't be delayed. If you have to stay in the hospital after surgery, then it depends on the number of beds available at the hospital. For all practical purposes, right now, most hospitals at least in the Houston area have bed capacity and it probably won't be delayed. Your surgeon will help answer your question more specifically based on your surgery and where it's being done.

Unless this is an emergency, it is best to delay the anesthetic if you have a bad cold. Obviously, it's a risk versus benefit type of circumstance. If you are bleeding uncontrollably, then we would have to work with the risk of dealing with your potential breathing issues as the risk of bleeding can be potentially worse. Having a bad cold usually means that your airway is very irritated. We worry about your breathing becoming more difficult as your lungs would react to us manipulating your airway during the anesthetic. We also worry about seeding an infection in your upper airway and increasing your chance of a lower airway infection such as a pneumonia. It's a discussion that you should have with both your surgeon and your anesthesiologist.

It's understandable that if this is the first time you are receiving a general anesthetic, that you would be nervous. It's important that you get a chance to talk to you Anesthesiologist the day of surgery, and have all your questions answered. As far as what to expect, it really depends on the extent of the surgery itself. General anesthesia means that you will be rendered unconscious for the duration of the procedure. A very short procedure under a general anesthetic is somewhat approached differently than an extensive longer surgery under a general anesthetic. General things that you'll be asked to do is to not eat or drink anything for a period of time. We generally say 8 hours for solid food, and 2 hours for clear liquids. The instructions can vary depending on your general health condition. When you come in for surgery, you will sign an anesthesia consent form which will explain the risks and benefits involved. They will place an IV catheter. A lot of us will use numbing medicine in placing the catheter so that it's not too uncomfortable. Before going back to the operating room, some Anesthesiologists will give you a sedating drug and some anti nausea drugs in your IV. If you have a history of motion sickness, let your Anesthesiologist know ahead of time because you will be more prone to nausea after surgery. I typically put a scopolamine patch on motion sick prone patients prior to surgery. Most folks don't remember much after given the sedating agent. In the operating room, once on the surgical bed, they will put some basic monitors on you and have you breathe oxygen through a mask. You will start receiving medicine in your IV that will render you unconscious. While asleep, your anesthesiologist and/or anesthetist will be with you in the room managing all aspects of your medical care during the surgery. They will also make sure you receive pain medications before even waking up from the general anesthetic. At the end of surgery, they will wake you up and make sure you are breathing well on your own. They will take you to PACU (Post Anesthesia Care Unit) where a nurse will monitor you as you wake up from the anesthetic. Typically most people start remembering their consciousness about 15 minutes after being in PACU. While in PACU, you'll receive additional pain medications or nausea medications as need be. They will make sure your vital signs are stable before leaving PACU. From there you will either be discharged to a step down unit before going home, or to an inpatient hospital bed. I hope that answers most of your questions.

Managing a patient around the perioperative setting is very important to reduce delayed wound healing, risk of infections, and other affects of high blood sugar. Prior to surgery, it's important that she be seen by the physician managing her diabetes to make sure her HgbA1C is under control. Prior to surgery, we like to see the Glucose below 180. That's not only important during surgery but also the days after surgery and during recovery in the following weeks. You will receive specific instructions as to how much of your normal diabetes medications to take the night before or the morning of surgery. Being told not to take anything at all is not accurate. Usually it's a percent of what you normally would take. Once again, make sure your treating physician, surgeon, and Anesthesiologist are all coordinating this care.

There isn't really a thing about being allergic to anesthesia in general. Anesthesia is generally putting you into a certain stage of consciousness or unconsciousness. To do so, we use a wide variety of different medications to achieve that state, but we also might give medications that affect your heart rate, your blood pressure, etc. You might be allergic to one of these specific types of medications. When we do your pre anesthetic assessment, we ask you about any drug or non drug allergies you might have. This allows us to avoid drugs you might have an allergy or a sensitivity toward. We obviously can't predict what drug you might be allergic to that you had not received in the past, but that is part of why we monitor your vital signs every step of the way. If you were to develop an allergic reaction after receiving any medication we give you, we would be able to recognize that you're having some type of reaction to it and intervene immediately.