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    A VIRTUAL PRE-ANESTHETIC INTERVIEW

This page is only an example. Questions asked of you will vary from these, depending on your health status.  This page just introduces one aspect of the anesthesia process.  So relax.

Familiarization lessens anxiety about the unknown.                                             -- Unknown
 
 

wj, CRNA   Anxiety is a healthy and normal response to stress.  It's all part of how our minds and our bodies gear up to prepare for stress.  Of course too much anxiety is not good.  An anesthetist's first approach will often be to allay your fears.
 
    I might say, "Hello.  Good morning, Mr/Mrs/Miss/Ms YourName.  [As I check the ID band to be sure of the identification. SAY HELLO, GRACIE.]  Pleased to meet you.  I'm Wayne Johnston.  I am a CRNA, Certified Registered Nurse Anesthetist, here to take good care of you and help you to take a nap through these proceedings today.  How are you?  Comfy?  Warm enough?  Ready to get your procedure over with?

    "Good.  Of course I have some paperwork here.

    "Now, to be clear ... what procedure is it you're having today?
    "And you do have a driver to take you home afterward, someone to stay with you overnight?
    "You have had nothing to eat or drink this morning, right?
    "Are you allergic to any medication?
    "What medications do you normally take?
    "Has a previous anesthetic ever caused you any trouble, problem or complication?
    "What about family history of that sort of thing?  Any blood relative ever had a complication with anesthesia?
    "Do you have, or have you ever had, major health problems?  Trouble breathing?  Heart trouble?  High blood pressure?......"
    "Do you have a cough, cold, sore throat or fever?......."

     .... After a health history as detailed as is required by each individual's current health status, and after a focused physical exam, listening to the heart and lungs, for example, there follows a discussion of the Anesthesia Permit form.
    I might say, "This form (sorry about all the fine print) simply serves to document -- with your signature there at the X -- that you do in fact give me permission to administer your anesthetic. It says that we have discussed how all forms of anesthesia involve some risk.  Naturally, we always aim to give you the most benefit possible with the minimum attendant risk.

    "It says ... I cannot make you any guarantees or promises as to outcome.  All I can do is assure you that my sole mission here today is to be at your side the entire time, watching over you with all the fancy computerized technology on hand for me to monitor you.  I do not help the surgeons with their instruments, I don't leave the room, don't read a book, don't take a nap; I am by your side the entire time, watching over you continuously.  At your side, on your side.

    "It's largely thanks to modern technology that anesthesia has become so very safe today.  We monitor your vital signs, oxygen saturation, exhaled carbon dioxide, temperature -- even your brain waves, with a sticky thing on your forehead.  Close monitoring is my best means to see to it that you breeze through your procedure today with the least disruption possible."

 
    .... At this point we would discuss the risks and side effects associated with the specific anesthetic plan for the individual, such as the possibility of sore throat after a plastic airway.
    "Now then, the worst part of undergoing your procedure is usually just the needle stick to start your IV.  Even for that, I'll use local to make a numb spot, so the big needle won't be so bad.  Once the IV's going, you'll get some sedative; then later in the O.R., I start you off to sleep more medication, all through the IV.

  "IV medication starts you off to sleep, then we keep you asleep through the procedure with oxygen inhalation anesthesia.  At the end, you breath pure oxygen, without anesthetic vapor, and you exhale most of the anesthetic right away quickly.

   "We will make sure, even before you wake up, that you have had plenty of pain medicine, and a combination of drugs to combat nausea.  Nausea, of course, used to be a very common side effect of anesthesia, but modern drugs prevent nausea most of the time.

    "Pain medicine now, cannot make all your discomfort go away, not totally.  We will keep you as comfortable as we safely can.  Narcotics have side effects such as nausea, itching, and also respiratory depression.  Don't worry.  You are watched very carefully.   You will receive oxygen.   Trained personnel will be by your side in Recovery until you are pretty much back to yourself, taking liquids, ready to go back home.

    "So ... we've pretty well covered this permit form.

    "Are there any special considerations we should observe in taking care of you here today, Mr/Mrs/Miss/Ms YourName?  Any special requests?  Extra information we ought to know?

    "Do you have any questions for me about anesthesia matters?  Any questions at all?

    "OK then.  If what we've discussed suits your understanding, your signature right there gives me permission to proceed, and we can get your IV going.  Then the worst part of undergoing this today will be behind you already.

    "Yes, sign right there at the X.  ... Thank you."
 

Now for the venipuncture, and the IV sedation.

    Just a little stick and sting for the numb spot.  Intravenous is the fastest means and the most reliable, predictable route for administering medication.  In the short time it takes for a milligram of midazolam to flow in the IV tubing, up your veins, one lap around your heart and lungs and then on to your brain -- in just those few seconds you begin to feel all calm and less anxious about your procedure today.  Nice and relaxed.

    There now.  Isn't that better?
 
 

Have a question for Wayne?

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