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Anesthesiology

Anesthesiology
The Department of Anesthesiology at City of Hope provides a full spectrum of perioperative services aimed at delivering compassionate, evidence-based care of the highest quality. Our anesthesiologists serve as key members of a patient’s surgical team. They play a vital role in and out of the operating room, helping to make decisions to protect and regulate a patient’s critical life functions (consciousness, breathing, heart rate, respiration and blood pressure) before, during and after surgical procedures.
 
The role of anesthesia in cancer treatment at City of Hope is evolving to care for the whole patient – from pre-anesthesia testing to surgery and interventional pain medicine.

Our care begins in the Pre-anesthesia Testing Clinic (PATC), where patients are seen and have their medical conditions optimized prior to surgery. 
 
The goal of our PATC is to maximize patient safety while minimizing delay to surgical therapy.   Once in the operating room, our patients receive state-of-the-art care from our team of compassionate and experienced anesthesiologists utilizing the most current techniques and technologies.  Our team has extensive experience in providing anesthesia for patients undergoing minimally invasive and robotically assisted procedures. 

The Department of Anesthesiology at City of Hope also includes specialists in pain medicine to help improve the quality of life of patients dealing with chronic pain.  In addition, our team actively pursues innovative patient-centered research aimed at identifying the most advanced anesthetic techniques for surgical oncology patients.

 
The goal of the City of Hope Department of Anesthesiology
is to deliver the safest and most compassionate
perioperative care to surgical oncology patients
while utilizing the most advanced
evidence-based techniques.

Anesthesiology Team

Our team consists of experienced anesthesiologists certified by the American Board of Anesthesiology. All of our anesthesiologists are doctors of medicine who have completed four years of medical school and an additional four years of residency training in anesthesiology.  We have vast experience and exposure to oncologic anesthesia, which ensures that you are provided with the best anesthetic care possible.

About Anesthesia

 
What is anesthesia?
Anesthesia is the use of medicine to keep you safe, comfortable and as pain free as possible during surgery.
 
Can I choose my anesthesia?
Yes, in certain situations.  Some procedures can be done using different anesthetic methods.  After the anesthesiologist reviews your individual situation, you can discuss your options with him or her.
 
What are the types of anesthesia?
 
  • Local anesthesia numbs only the part of the body where you will have surgery.  Anesthetic medicines are injected or applied topically to temporarily block nerves in the surgical area. This type of anesthesia is used for minor (simple) procedures. Because local anesthesia affects just the nerves in the surgical area and not your brain, you will be awake during the procedure.
  • Regional anesthesia involves injecting anesthetic drugs near nerves and results in numbing larger portions of the body, so pain signals cannot reach the brain. This type of anesthesia is used for certain procedures to the abdomen, pelvis, arms or legs. The common types of regional anesthesia are spinal anesthesia, epidural anesthesia, and nerve block anesthesia. You may be awake during the procedure, but you may be given medication that will make you feel relaxed or sleepy. There is always a possibility that a local or regional anesthetic may have to be converted to a general anesthetic if it wears off sooner than expected or there are any other problems during surgery.
  • Monitored anesthesia care (MAC) is intravenous (through the vein) sedation. You may still be awake during the procedure, but you will be in a more relaxed state. This type of anesthesia may be used for less invasive (not deep into the body) surgery. 
  • General anesthesia temporarily produces unconsciousness and is needed for major operations, so your brain does not perceive any pain signals. It involves both intravenous and inhalational agents. With this type of anesthesia, you will be completely unconscious during a surgery, with no sensations, feeling of pain, awareness, movement, or memory of the surgery. Most of our procedures at City of Hope involve a general anesthesia.

Why do you ask about my medical history?
The anesthesiologist is responsible not only for the anesthesia, but also for your medical care during the entire course of surgery.  Therefore, the anesthesiologist must be very familiar with your medical condition.

Why do you ask about drinking and smoking?
Tobacco and alcohol affect your lungs, heart, liver and blood and can change the way an anesthetic drug will work during surgery.  Alcohol interacts with all medicines used for anesthesia.  In addition, smoking may delay or prevent tissue or wound healing after surgery.

Why do you ask about herbal preparations?
Many herbal products on the market are considered safe, but others may be potentially harmful.  Some of these products can cause side effects or react with your other medicines.  They may intensify the effect of the anesthetic, interfere with blood pressure or cause bleeding.  It is essential that you tell your doctor if you are using herbal preparations and which ones you use.  Your doctor will discuss this with you and may make recommendations about continuing, changing or stopping them before surgery.

Why does the anesthesiologist ask me all these same questions again?
Asking you the same question again serves several purposes.  First, the pre-operative interview serves as an additional means to verify your identity.  Second, it is not unusual for patients to recall significant events or details during the interview that were left out of written responses.  Third, it gives you one more opportunity to ask questions that you may not have thought of or not had a chance to ask.

Can I get addicted to the drugs you give me?
There is no evidence that any drug given during anesthesia may cause addiction.

Why can I not eat or drink before surgery?
Your doctor may tell you to fast (no food or liquids) before surgery so there is less chance of vomiting and aspirating (inhaling into the lungs) any undigested food or liquids during the procedure.  This can cause pneumonia or even death.

Will I be completely asleep during the procedure?  Will I wake up in the middle of my operation?
If you are having a general anesthetic, you will be completely asleep and will not wake up in the middle of a procedure.  There are reports of awareness under anesthesia, but they are extremely rare.  If this issue concerns you, ask your anesthesiologist more details before surgery. If you are having a local or regional anesthetic, with or without intravenous sedation, you may be more or less aware of what is going on, as your surgeon requires and as your medical condition allows. Sometimes surgeons want the patient to be able to follow commands and answer questions; in that case, the patient needs to be more awake.

How do you adjust the duration of anesthesia?
The anesthesiologist will give an initial dose of anesthetic based on the patient's weight and general health condition.  The patient is then given the medicine continuously until the end of the surgery.  Once the anesthetic is stopped, most patients generally wake up within 10 to 20 minutes.  Most anesthetic drugs in use today have a very short duration.

Why do people sometimes have a sore throat after general anesthesia?
During general anesthesia your breathing is controlled through a tube inserted in your throat.  Sometimes this tube causes irritation and a sore throat.  This is temporary and will go away in a day or two without further treatment.

How will my nausea be controlled after my procedure?
This is a common side effect after surgery and can range from none or mild to severe.  Your doctor will order medication to lessen nausea as you recover.  Your doctor or nurse may suggest other nondrug methods to help control your nausea.

I have had many anesthetics; will that make me lose my mental abilities? 
No, there are many patients who have received multiple anesthetics and never had any effects on their mental abilities.
 
 

Before Surgery

 
Pre-anesthesia Testing Clinic (PATC)
Before you have anesthesia for surgery at City of Hope, your surgeon or doctor will schedule an appointment for you at the Pre-anesthesia Testing Clinic.  This is a service provided by the Department of Anesthesiology.  The clinic is located on the second floor of Helford Clinical Research Hospital at City of Hope. 
 
Making your operation safer
The primary goal of the PATC is patient safety, that is, to minimize anesthetic risk by assuring that any issues relating to a patient’s coexisting conditions are addressed. Optimizing your health before surgery not only maximizes your safety, but also reduces your time to surgical therapy. 
 
The PATC visit gives you an opportunity to ask questions, and it helps our anesthesiologists create the ideal anesthetic plan for you.  After your PATC visit, you should know what to expect both in the time leading up to your surgery and during your recovery. 

If you are scheduled for a PATC visit, you will undergo a history and physical examination by the PATC provider, an advanced practice nurse, with special emphasis on aspects of your health that are pertinent to the administration of anesthesia.  The decision to obtain further tests will be based on your individual health, relative to your upcoming surgical procedure.  Preparing a patient for surgery often requires collaboration between a primary care physician, anesthesiologist, surgeon and specialty consultants such as cardiologists or pulmonologists.
 
Ensuring successful outcomes for our patients is a team effort
At City of Hope, we have a variety of consulting specialists available for our patients.  For those who require further testing, we coordinate this aspect of your care during the PATC appointment. 
 
To expedite the PATC visit, many patients find it helpful to have completed the PATC Intake form prior to arrival. The form is also available in Spanish. The PATC intake questionnaire reviews past medical/surgical history, current medications and allergies, and it asks questions pertinent to potential medical issues that may not have been previously evaluated.  

As part of your PATC visit, we will perform a pre-anesthetic medical evaluation and give you instructions about when to stop taking certain medications and when to stop eating and drinking before surgery. It is important to coordinate medication changes with your primary doctor, your surgeon and your anesthesiologist.   For example, it is important to inform the PATC if you are taking blood thinners (Plavix, Aspirin, Coumadin, or Lovenox), antibiotics, and diabetes or heart medications.  Some of these medications may need to be continued through surgery, while others may need to be stopped several days in advance.
 
If you have a pacemaker or a Automatic Implantable Cardioverter Defibrillator (AICD) you will need to bring your device identification card and the details of its latest checkup so that the appropriate evaluation may occur.  These devices are managed differently depending upon the medical reason for the device and type of surgery. 

Frequently asked questions about the PATC

What can I expect during my appointment at the PATC?

During your appointment, the PATC staff will:
 
  • Take your medical history
  • Perform a physical examination
  • Review pertinent tests ordered by your doctors
  • Discuss what medications you should or should not take before your surgery
  • Order any additional tests that may be necessary to make sure it is safe to proceed with surgery
  • Perform an EKG and, possibly, basic blood work
     
If I need additional testing, can this be done the same day as my visit to the PATC?
All blood testing can be done the same day.  However, if a consultation with another specialist is needed, this may need to be scheduled another day, when there is an available appointment.
 
Will you have enough information to know if I am ready for surgery?
In most cases, if your medical records are complete and up to date, your visit will supply your PATC provider with enough information to know if you are ready for surgery. 
 
However, sometimes a previously unknown underlying problem might be identified that needs to be addressed before surgery.  When this occurs, arrangements will be made for further evaluation.
 
Will my surgery be delayed or postponed for any reason?
Generally, your surgery will not be delayed.  However, even a simple problem like a common cold can make surgery less safe.  Other times, tests may show that an existing medical condition such as high blood pressure or diabetes is less than optimally controlled.

If you have a condition in need of further optimization, your PATC provider may send you to your primary care doctor or the appropriate consulting specialist to start treatment to improve your health and reevaluate your condition before surgery.  The PATC clinic will inform you and your surgeon about any conditions that require further attention before surgery.
 
What do I need to bring to my visit to the PATC?
It is important to get as complete a picture of your medical history as possible.  Therefore, in order to save you time during your visit, please bring all the information you have about the following:
 
  • All your relevant medical records  and details of your past medical history
  • All of your medications or a clear, printed list with their complete names, dosages and how often you take them
  • A list of the operations you have had, including the hospitals at which they took place
  • The name and phone number of your family doctor and any other doctors who take care of you regularly (like your heart doctor or your lung doctor)
  • Copies of the reports of any recent tests that you may have had, particularly stress tests, echocardiograms, cardiac catheterizations or lung function tests.  If you do not have the results of any of these tests, information regarding when and where they were performed would be helpful, including any phone numbers to which you may have access
  • If you have a pacemaker, Automatic Implantable Cardioverter Defibrillator (AICD)  or coronary stent, the card that goes with that device
  • Any recent laboratory studies you may have had outside of City of Hope
  • Preoperative Medical Questionnaire (to be completed before your clinic visit)
 

During Surgery

 
Once you are in the operating room, the anesthesiologist will place a variety of monitors on you to measure your blood pressure, heart function, breathing and the oxygen content in your blood. You will be given oxygen to breathe through a mask.
 
Then, you will be given anesthetic drugs through your IV (intravenous) line, or you will be given anesthetic gases to inhale. The anesthesiologist adjusts your medications to keep you asleep and pain free for the entire procedure. During surgery, your condition is carefully monitored, evaluated and controlled.  A member of the anesthesia team is with you throughout the surgical procedure.
 
At the end of the surgical procedure, the anesthetic agents are stopped and medications may be given to reverse the effects of earlier medications. You will then be transferred to the Post-anesthesia Care Unit for recovery.
 
During your surgery and recovery time, your family and friends can stay in a special waiting area where the surgeon will meet with them at the end of the procedure.
 

After Surgery

The Post-anesthesia Care Unit (PACU)

When your surgery is over, you will be observed for a period of time in an area known as the PACU, also known as the Recovery Room. There, the nursing staff will watch you closely. You should tell the nurse if you are having any pain, nausea or any other discomfort. Once your condition has met certain criteria, you will be discharged from the PACU.
 
Admission to the Inpatient Unit

Depending on your type of surgery and condition, you may need to stay overnight or longer in the hospital. If this is the case, you will be taken from the PACU to your hospital room. Your family and friends can join you in your room. Any personal belongings stored by hospital staff will be brought to your room.
 
Outpatient Surgery

If your procedure does not require an overnight stay, you may go directly home. If you need additional observation before being discharged from the hospital, you will be brought to a special room for a short period of time. There, your nurse will watch you closely until you are ready to go home. Before going home, you will be given instructions on how to take care of yourself. Instructions should include use of any equipment, any special care or procedure you need to do, medications, any activity restrictions, diet, a follow-up appointment plan, any signs to watch for and to report, and a contact number for your doctor or nurse. If you do not receive this information, do not understand the instructions, or have any questions, please speak with your doctor or nurse.

Important information for outpatient surgery patients:
  • You must have someone drive you home after surgery
  • Make arrangements for someone to stay with you for the rest of the day or for 24 hours after your procedure if you had general anesthesia.
  • Stay at home the remainder of the day and rest. If you do not feel recovered the next day, continue to rest for another day or two. Even minor surgery may be taxing on your physical strength and resistance.
  • If you have small children, make arrangements for someone else to care for them.
  • Do not operate a vehicle or dangerous equipment, sign contracts or make important decisions for 48 hours after surgery.
 

Information about driving and conducting business after your surgery

Even though you will probably feel well after the first day, your reflexes are depressed and can take up to 48 hours to return to normal. Therefore, we recommend that you do not drive, operate heavy machinery, sign contracts or make important decisions for 48 hours after surgery.

What are common side effects?
Common side effects such as headache, sleepiness, nausea, vomiting, thirst and shivering can occur in a greater or lesser degree with all types of anesthesia. However, you may experience other, more specific, side effects, depending on the type of anesthesia you were given.There may be other side effects the anesthesiologist will tell you about. It is important to tell your doctor or nurse if you are having any of these side effects. Your doctor anticipates these situations and may be able to provide some relief.

Transportation
If you will be going home after surgery, arrange for someone to drive you and stay with you for the rest of the day. Make transportation and personal arrangements in advance. Provide the admitting nurse with your driver’s name and contact number or location.
 

Interventional Pain Management

Chronic pain is the leading cause of disability in the United States and more than half of patients in chronic pain report significant anxiety, depression, insomnia, and dissatisfaction with their quality of life.
 
The Interventional Pain Program, under the Department of Anesthesia, provides comprehensive pain management for both cancer and non-cancer related pain.Our goal is to properly diagnose and treat chronic pain and overall suffering with a multidisciplinary approach. This entails a responsible prescribing of pain medications, safe practice of procedures and help for the patient coping with the impact that chronic pain has had on his or her life and relationships.
 
Patients with pain are seen in the outpatient clinic, where a detailed pain history and examination are used to tailor a regimen focused on each patient’s specific needs and goals.
 
Interventions such as minimally invasive nerve blocks, joint injections, radiofrequency ablation of nerves, intrathecal pain pumps, or neurostimulators are used in conjunction with medications, psychotherapy, physical rehabilitation, and even hypnosis to reduce pain and improve quality of life for each patient.

Support This Program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

 
 
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