Unlike Joan Rivers who died in a surgi-center during a routine procedure, I would only be given general anesthesia on a hospital campus.

My first experience in taking anesthesia seriously was in 1970 as the Administrative Officer (with the rank of second lieutenant) of the Department of Surgery at Wilford Hall USAF Medical Center. I met an oral maxillofacial surgery resident (a dentist) who was doing a rotation in anesthesiology. Did the patients know who was putting them to sleep?

Around the year 2000 when I had Achilles tendon surgery (It would great if I could tell you the injury was caused by some outrageous athletic adventure, but it just happened….zip, zip, zip, pow!). A doctor walked in the pre-op room, said he was going to do the nerve block, sign here. When I asked his status, I had to ask, he said he was a chief resident. I told him I wanted to see the attending who came in and insisted the resident was better than he was at this. The attending did the nerve block when I insisted he do it.

In 2002 the New York Times reported: “Massachusetts has indefinitely suspended a surgeon’s medical license because he left a patient anesthetized on an operating table with an open incision in his back while he went to a bank several blocks away.” (1)

(Settlement Reached in Joan Rivers Malpractice Case. “In 2015, Ms. Rivers’s daughter, Melissa, filed a lawsuit in State Supreme Court in Manhattan against Yorkville Endoscopy, a for-profit outpatient surgery center where Ms. Rivers, 81, was undergoing a relatively routine procedure when she died in 2014. The suit also named Dr. Gwen Korovin, an ear, nose and throat specialist; Dr. Renuka Bankulla, the main anesthesiologist, and two other anesthesiologists; and Dr. Lawrence Cohen, who stepped down as the clinic’s medical director.”) (2)

Over the years many family members and friends have called me about their research on getting the most appropriate and best surgeon for a serious problem. When I asked them about anesthesia I cannot recall one case where they knew who was putting them to sleep and what type of anesthesia was going to be administered.

So here are some basics.

1. Who will be directly administering the anesthesia? For example; an M.D. trained and board certified (or not) in anesthesiology; an anesthesiology resident-in-training; a sub-specialist such as a cardiac, neurosurgical, obstetrical or pediatric anesthesiologist; an M.D. in residency training in another specialty (e.g., general surgery, ob/gyn, dentistry) rotating through anesthesiology; or a Certified Registered Nurse Anesthetist (CRNA).

2. What type of anesthesia will you be getting?

“In 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.

In regional anesthesia, your anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You may remain awake, or you may be given a sedative, either way you do not see or feel the actual surgery taking place. There are several kinds of regional anesthesia; the two most common are spinal anesthesia and epidural anesthesia.In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery.” (3)

3. Where will your procedure be done? In a hospital operating room. In an OR in a surgi-center on the hospital campus. In a free-standing surgi-center in the community. In a doctor’s office with an operating room. In a dentist’s office.

4. Is the anesthesiologist in-network?

A rule-of-thumb worth considering. The more serious the surgery and the use of general anesthesia, have the procedure done in a hospital “O.R., or in a surgi-center on a hospital campus.

Talk to your surgeon about anesthesia options well before the day of surgery and discuss whether you should meet with whoever will be administering your anesthesia too. And…it is always a good idea to talk to your primary care practitioner, the clinician who knows you best.

(1) http://www.nytimes.com/2002/08/09/us/surgeon-who-left-an-operation-to-run-an-errand-is-suspended.html

(2) http://www.nytimes.com/2016/05/13/nyregion/settlement-reached-in-joan-rivers-malpractice-case.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

(3) https://www.asahq.org/lifeline/types%20of%20anesthesia

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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