The anesthetist doctor
In France, the anesthetist is a doctor who has specialized in anesthesia and resuscitation for 5 years, for a total of 11 years of study.
He is responsible for anesthesia and post-operative analgesia techniques.
He practices in a team of anesthesiologists, allowing the continuity of care 24 hours a day. He is often assisted by nurses specialized in anesthesia (IADE).
The risks of anesthesia have considerably decreased in recent years, but they remain the constant preoccupation of a specialty which has constantly developed means of surveillance and medical organization in order to limit them as much as possible .
This organization of anesthesia was facilitated by legislative provisions, intended by the whole of the specialty, which forced hospitals and clinics to ensure the anesthetic safety of the patients.
Anesthesia allows an intervention to proceed smoothly and at the least risk.
Performing anesthesia requires monitoring which must include scopic monitoring of the electrocardiogram, measurement of arterial pressure and pulse oximetry (oxygen saturation of the arterial blood).
When mechanical ventilation is instituted, a pressure alarm sensitive to disconnection, a measurement of the carbon dioxide partial pressure in exhaled air and the partial pressure of oxygen in the inspired air are mandatory.
The opening of an intervention room requires precise control of the ventilation device and instruments used by the anesthesiologist-resuscitator, established by the operating room opening card (FOSOP) which is signed by the anesthetist doctor.
After anesthesia (general or loco-regional), the patient must be admitted to a post-interventional surveillance room. Each location in this room is equipped with the necessary equipment for hemodynamic (scope, blood pressure) and ventilatory (pulse oximeter) monitoring, return to normal thermal equilibrium and the arrival of medical fluids (oxygen, air) and vacuum suction. The post-intervention ward has a ventilator, a defibrillator and a curarization monitor. It is placed under the authority of an anesthetist-resuscitator doctor who can intervene at any time and without delay. Nursing staff are assigned exclusively to this ward and include at least one trained nurse for this ward.
Legally, any anesthesia requires consultation with an anesthetist-resuscitator doctor in the days preceding the intervention, sufficiently in advance (at least 48 hours before and sometimes up to a month before for the heaviest interventions). It is an integral part of the concept of anesthetic safety.
Since the decree 94-1050 of December 5th, 1994, the consultation of anesthesia is registered in France in a medico-legal framework. It is expressly stipulated that:
• is mandatory before any scheduled intervention
• must take place « several days before the intervention »: so at least 48 hours before.
• is performed by an anesthesiologist-intensive care physician in outpatient settings, or in his office, or on the premises of the institution and results in a written or computerized record.
• includes the results of additional examinations and any specialized consultations (cardiologist, pulmonologist, dentist or other specialist)
• is inserted in the patient’s medical file
• does not replace the pre-anesthetic visit performed by an anesthesiologist-intensive care physician in the hours preceding the scheduled time for the procedure.
During the consultation you must bring the following documents:
• The duly completed health questionnaire, which was given to you when you made an appointment (download it here), where you will carefully note everything about your health (it is essential for your safety).
• Your identity papers and health insurance cards, CMU, ARE, complementary health (valid).
• A means of payment (cash or checkbook, no credit card for now)
• Your work stoppage or sick leave documents are up to date.
• Your blood type card (if you have one).
• Your health and vaccination book (if you have one).
• All your current prescriptions.
• The results of blood tests prescribed for the procedure.
• Your last exams (cardiac consultation with electrocardiogram, and / or pneumological consultation, and dental or other specialized examination …).
• An authorization to operate signed by both parents for minors, or by your legal representative (guardian or curator) (essential).
Any ongoing infection or alteration of your condition may delay your intervention. Consult your doctor.
An estimate concerning the fees related to your intervention will be proposed and given to you: you must sign it and send it to your complementary.
You will need to designate a trusted person and give us the contact details of your attending physicians or specialists.
A delocalized consultation (in your area) is possible but must be done with our agreement: contact the secretariat!
Information to the patient
It is registered in the law of March 2, 2004. This information will allow you to give your informed consent. It relates to:
• the state of the patient and its foreseeable evolution, which requires explanations about the disease or the pathological state, and its usual evolution with and without treatment;
• description and conduct of examinations, investigations, care, therapies, interventions envisaged and their alternatives;
• their purpose, usefulness and expected benefits; their consequences and disadvantages;
• their potential complications and risks, including exceptional or serious ones;
• general and special precautions recommended to patients.
Anesthesia allows an intervention to proceed smoothly and at the least risk.
Several types of anesthesia exist: local, central peri-medullary locoregional (spinal anesthesia, epidural anesthesia), peripheral locoregional (peri-nervous) and, obviously, general anesthesia.
During any anesthesia and intervention, the medical team monitors your vital constants. After the procedure, you will be monitored in the recovery room (post-interventional surveillance room) for one to several hours before being able to return to your room.
Your discharge from home or center should be scheduled in advance with your surgeon. It’s imperative !
During local anesthesia, an anesthetic is injected under the skin. It removes pain in a very localized area while you stay conscious. You do not have to be an anesthesiologist to practice local anesthesia.
Dentists use it for dental extractions or implant placement. In dermatology, or in small surgery, local anesthesia is performed during the resection of a mole or the treatment of an ingrown toenail eg.
The surgeon can infiltrate the operating area or scar with local anesthetic at the end of the procedure.
No anesthesia consultation is necessary before a local anesthesia.
Epidural anesthesia or spinal anesthesia
Epidural and spinal anesthesia are two variants of central locoregional anesthesia called peri-medullary. They aim to desensitize a part of the body by blocking the nerves of the spinal cord, which temporarily eliminates pain, sensitivity and sometimes motor skills.
The anesthetist injects a local anesthetic between two vertebrae. This type of anesthesia is practiced frequently, especially during deliveries. This injection is practically painless because one practices, before, a local anesthesia. During the surgery, you will not feel any pain and your legs will be asleep.
Either you will be aware or you will sleep if a general anesthesia is performed as a supplement. You will not see anything of the intervention because the place operated will be masked by a fabric called operating field.
Peripheral locoregional anesthesia.
Anesthesia peripheral locoregional anesthesia consists of desensitizing part of a limb most often (or the rest of the body) by directly blocking the peripheral nerves, which removes pain, sensitivity and sometimes motor skills.
This type of anesthesia can last up to 24 hours so is very helpful in better managing postoperative pain. The anesthetist injects a product in contact with the nerve (without the touch) using a needle connected to neuro-stimulator (which can trigger some electrical impulses and involuntary movements) and, most often now, under ultrasound . This type of anesthesia is practiced especially during surgery of the shoulder, the upper limb (elbow, hand) or the lower limb (hip, knee, foot).
This injection is practically painless because one practices, before, a small intravenous sedation. During the surgery, you will not feel any pain. Either you will be conscious, or you will sleep if a general anesthesia is practiced in addition (it is often the case to improve the comfort during the intervention). You will not see anything of the intervention because the place operated will be masked by a fabric called operating field.
General anesthesia is a condition comparable to artificial sleep. The anesthetist injects an anesthetic product by infusion into a vein or asks you to inhale anesthetic gas.
Whatever the type of anesthesia, you must remain fasting for at least 4 to 6 hours before the procedure (this will be repeated during your consultation) and do not drink, smoke or chew gum.
Before the procedure, the day before and the morning of the procedure you will have to wash (total shower and shampoo) with antiseptic soap (Iodine: Betadine® or non-iodine: Ibiscrub®), rub and cut the nails, to wash your teeth.
You must remove your jewelry, wedding rings, piercings, dentures and contact lenses. Nail polish and makeup must be removed.
Some medicines should not be continued before the procedure. Your anesthesiologist (and him alone) will validate with you those you can continue. The nurse will give you detailed explanations. Do not hesitate to ask him questions.
Smoking multiplies by 3 postoperative complications (poor healing, increased length of stay, respiratory complications). Weaning should be started at least 8 weeks before surgery even if there is still a benefit to quit smoking between 3 weeks and 48 hours before the procedure. A stop within a time close to the intervention can indeed reduce the risk but do not cancel it. Nicotine replacement (most commonly patch and candy) should be the rule for all hospitalized smokers. Associated if necessary with respiratory physiotherapy and aerosols to help bronchial evacuation in those who cough and become congested …
Regardless of anesthesia, all steps are taken to minimize the risks.
Complications are nevertheless possible because any medical act, even conducted with competence and in respect of the data acquired from science, carries a risk. Current conditions of practice, monitoring of anesthesia and the waking period, electronics, risk management a priori, can quickly detect the occurrence of abnormalities and treat them.
Thus, the death or serious complications of anesthesia, whether cardiac, respiratory, neurological, circulatory, renal, allergic, metabolic, infectious, dental, ENT etc … have become very rare.
Apart from serious complications, anesthesia and surgery are sometimes followed by unpleasant events. Nausea and vomiting may occur upon waking and in the days that follow. Painful redness, hematoma, superficial phlebitis in the vein into which the products have been injected can be observed. The puncture points can be painful (a little Nifluril® ointment will be effective).
The introduction of a tube into the trachea (intubation) or throat (laryngeal mask) to provide breathing during general anesthesia may cause sore throat or hoarseness during the course of the procedure. Dental trauma (or gums and lips) is also possible. That is why it is important to point out any dental prosthesis and any dental fragility. The opinion of a dentist (with panoramic radio) is also frequently requested preoperatively before the consultation. Difficulty urinating may require temporary insertion of a urinary catheter. Prolonged position on the operating table may result in compressions of the skin, nose, eyes and some nerves, which may cause numbness or, exceptionally, paralysis of an arm or leg . Verification of the points of support is therefore essential before each intervention.
After anesthesia, memories of the operative period may remain. Memory problems or a decrease in concentration or even disorientation with temporary agitation can also occur in the hours or days following anesthesia (even locoregional). Very rarely, there is a decrease in hearing, or a disturbance of vision.
Accidents related to the passage of vomiting into the lungs are very rare if the instructions for 4 hours (clear fluids) to 6 hours (fasting) foods are well respected. Unforeseeable complications involving a life-threatening risk such as severe allergy, cardiac arrest and asphyxiation are fortunately extremely rare.
Fortunately, all the aforementioned symptoms are usually rare and transient but their persistence should prompt you to consult us postoperatively.
Any locoregional anesthesia may be incomplete and require additional anesthesia or general anesthesia. This justifies the same fasting instructions as for general anesthesia. The same complications as above are possible, but there are risks specific to peri-medullary anesthesia (spinal anesthesia, epidural anesthesia): a repeat of the puncture may be necessary in case of difficulty; blood pressure, heart rate, state of consciousness can be changed and are regularly monitored. Difficulty urinating may require temporary insertion of a urinary catheter. Headaches can occur and sometimes require several days of rest and / or specific treatment. Very rarely, there may be a decrease in hearing, or a vision disorder or neurological disorders. Pain at the puncture site in the back is also possible.
There are also rare risks specific to other locoregional anesthesia. Thus during certain anesthesia of the upper limb or the thorax, respiratory complications are possible. Depending on the associated medications, nausea, vomiting, itching, transient memory problems or decreased concentration may occur within hours to days of anesthesia. All techniques of locoregional anesthesia can also give rise to serious but rare local complications: paralysis and / or insensitivity more or less extensive, temporary or permanent, cardiovascular accident, cerebral, convulsions, injury of a nearby organ.