Anesthesia
Myths & Misconceptions Make Patient Education Vital
"To many patients, anesthesia is still an unknown," said Dr. Gary Dove, Chief of Anesthesia for Carolinas Hospital System. "The whole idea of being put to sleep and having someone else in control of their breathing and their faculties for a time is scary. Some people fear anesthesia and the loss of control more than the operation they will be going through," he said.
Dr. Dove understands the worries that can burden patients before surgery. That's why communication is so important between patients and the anesthesia staff. Good communication starts a week or two before surgery is scheduled during an initial interview at the hospital. During this time, vital information is obtained about medical history and current health problems.
"We tailor the anesthesia based on the individual's systemic illnesses. What one person can tolerate being young and healthy is not the same as a 76-year-old with kidney problems and coronary artery disease," he noted. It's also necessary for the anesthesiologist to find out all medications the patient is currently taking and any existing allergies. "We use so many different drugs – to fight infection, for sedation, to prevent nausea – and some drugs don't mix well. Some medications they are taking can be held back and restarted; others need to be continued the morning of the surgery," he said.
The pre-surgical meeting provides patients with an opportunity to ask questions and address any concerns. "We explain what we do to whatever extent the patient wants to hear," Dr. Dove said. He added, "We give them good solid reassurance that the anesthesia drugs we use today are extremely clean and safe, and that we have excellent, experienced anesthesiologists and certified registered nurse anesthetists (registered nurses with two additional years of specialized anesthesia study and clinical training who work under the direction of anesthesiologists) providing high quality care."
Acommon misconception voiced by patients is the fear that their severe health problems make it too dangerous for them to undergo anesthesia. "By utilizing extensive safeguards during surgery, we attempt to make the process as safe for people with multisystem diseases as for any other patient. We can safely put anybody to sleep. There are risks, but we try to minimize them," Dr. Dove said. It's also not uncommon for patients to express strong misgivings about regional anesthesia and the fear of being paralyzed by a spinal or epidural. "With new techniques and disposable spinal needles, that type of problem just doesn't happen anymore. Unfortunately, there are those one or two family stories that may have happened decades ago that have been handed down like folklore," Dr. Dove said.
The anesthesia interview is part of Carolinas' Care One program, which was introduced when the new hospital opened in 1998 to simplify the process of preparing patients for surgery. Most required pre-op tests can be done at this centralized location. "One complaint that we heard from patients in the past was that they had to spend all day going to various departments for tests such as EKG, lab work and x-rays. Through Care One, we have coordinated the process into one well-oiled machine and decreased the time they spend with pre-op testing," Dr. Dove said.
On the day of surgery, the reassurances provided to patients a couple weeks prior to surgery often have to be communicated again before they go into surgery. "Regardless of how much you talk to the patient beforehand, there is still going to be a certain amount of anxiety," Dr. Dove said. In some instances, medication is required to sufficiently calm a patient before heading to the operating room. Yet Dr. Dove emphasizes "that as important as the sedative drugs can be, nothing can replace exceptional care by the nurses, technicians, surgeons and anesthesiologists in making the patient's stay as comfortable as possible. At Carolinas Hospital System, we feel like we have put the pieces all together to do that," he said.
Anesthesia care at Carolinas is provided by an exceptional group of five anesthesiologists and nine certified nurse anesthetists. Dr. Dove and his partners, Drs. Coleman Floyd, Martin Evaldi, Michael Herrin and Blake Kline, are all board certified in anesthesia. Dr. Floyd is also board certified in pediatrics. "We have really put together a fantastic staff," Dr. Dove said of the group that formed the beginning of 2002. (Three of the anesthesiologists had previously worked at Carolinas Hospital System.) "Together with the nurses in the operating room, the technicians, the recovery room and Day Hospital staff, we are there to provide excellent care and service for the patients and the surgeons," he said.
Whether a patient is given general anesthesia (to put the entire body "to sleep"), or regional anesthesia (to numb a particular part of the body), the anesthesia team continually measures how the patient's body is responding to the surgery and the anesthesia. "An anesthesia provider is with the patient 100 percent of the time. Vital signs are monitored on regular intervals from the minute the patient is in the room until the minute he or she is handed to the care of the nurses in the recovery room," said Dr. Dove.
The anesthesiologist's job isn't quite complete when surgery is over. Patients that remain in the hospital receive a post-operative visit to determine if any complications arose from the anesthesia. When surgery is completed on an outpatient basis, Day Hospital nurses give patients a courtesy call at home. "This lets us know about nausea or other side effects they may be having. If need be, we can call in a prescription for them," said Dr. Dove.
While Dr. Dove explains that anesthesia care is "What makes the difference is the people administering the care. We've recruited some very good people and feel like we are providing the best care for our surgical patients in the Pee Dee."
A Space Age Experience
Youngsters may find surgery to be a little less intimidating at Carolinas Hospital System, thanks to an operating room that's recently been painted as a spaceship in orbit. The project was the brainchild of Dr. Coleman Floyd, a pediatric anesthesiologist at the hospital.
"Surgery can be scary for anybody, whether it be children or adults," said Dr. Floyd, who wanted to find a way to make children less uncomfortable in a trying situation. "The OR is just a different type of environment. Children come into a room that's cold with bright lights, where people are wearing hats and masks. It's not very warm and fuzzy," she said.
So Dr. Floyd elaborated on an idea she had picked up during her pediatric training in which the nitrous oxide mask is likened to an astronaut's mask. She had often referred to the surgical attire and the operating room lights in terms of space terminology when working with her young patients. The room's redesign took the imaginative comparison a step further. When children enter the operating room, it looks more like a space camp adventure instead of a place where their tonsils will be removed or where tubes will be inserted in their ears.
Painted by local artist and teacher, Chad Costello, the room simulates the inside of a spaceship. Costello's design includes windows that look out into outer space, where youngsters can spot Saturn and its rings, a shooting star and another spaceship on a journey. Even the various buttons, lights and pieces of medical equipment on the wall have been incorporated into the theme.
When the room was completed a couple of months ago, the response from youngsters was decidedly positive. One little girl was so taken by the prospect of "riding on a spaceship" that she waved her mother off with an excited goodbye. Putting children at ease also puts their parents at ease, which is a comfort to Dr. Floyd. Amother of three, she's sat in the waiting room when two of her own children underwent surgery. "I can look into a mother's eyes and know exactly what she's feeling. And it's quite normal to be scared," she said. As parents leave children in her charge, Dr. Floyd addresses the anxiety that she understands firsthand. "I tell them that I am going to take good care of their children," she said.
That good care has included the transformation of a small operating room to a fascinating place on the edge of the universe that takes the edge off children's fear. What's next for pediatric surgical patients at Carolinas? Hopefully, the newest addition will be a wagon outfitted like a spaceship to transport small children from their rooms to the OR. Dr. Floyd is exploring various options, and if everything works out, a sleek silver spacecraft will be another vehicle to coax smiles on little faces.
by Diane J. Epperly, Contributing Writer
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