U.S. Air Force Fact Sheet EGLIN HOSPITAL DEPARTMENT OF ANESTHESIA Welcome: The Eglin Hospital Department of Anesthesia is dedicated to providing the highest quality and safest anesthesia for its customers. 96th Medical Group · Our Mission: To train, educate, and prepare warrior medics to deliver and deploy unsurpassed health services. · Vision: To be a Center of Medical Excellence. Number of operating suites: Seven surgical suites: five main operating rooms, one cystoscopy, and one labor and delivery surgical suite. Anesthesia staff: The Anesthesia staff consists of Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs). Surgical specialties offered: Dental, Ear Nose and Throat, General surgery, Obstetrics & Gynecology, Orthopedics, Ophthalmology, Plastic surgery, Thoracic, Urology, and Vascular. It is imperative that you follow the fasting guidelines given to you by your anesthesia provider. Failure to follow specific guidelines could result in a delay or cancellation of your procedure. For most procedures requiring anesthesia the patient must not eat or drink anything after midnight the evening prior to surgery. The anesthesia professional conducting your preoperative interview will advise you as to which medications to take the morning of surgery. If you are not scheduled a pre-operative interview prior to your scheduled surgery, you can have your surgeon setup an appointment to answer any questions or concerns that you might have.  Essential information you need to share with your anesthesia provider: · A personal or blood relative history of intra-operative and/or post-operative unexplained temperature elevation, i.e. malignant hyperthermia · Any known history of difficulty with breathing tube placement · Use of prescribed and over the counter (OTC) medications including: aspirin and aspirin containing products, non-steroidal anti-inflammatories (NSAIDS) i.e. Motrin, Alieve, etc.; herbal products such as ginger, ginkgo, ginseng, ephedra, etc.; and blood thinners. · Use of home oxygen - continuous or on an as needed basis · Use of Continuous Positive Airway Pressure (CPAP) therapy · Recent colds or coughs · Medical conditions including but not limited to: arthritis, asthma, bleeding abnormalities, bronchitis, diabetes, heart disease (heart attack, congestive heart failure, chest pains or pressures, high blood pressure), heartburn, hepatitis, illegal drug usage, pregnancy, steroid usage, stroke, seizures, etc. · Family history of anesthesia complications · Post operative nausea and vomiting · Medication, food, latex, or environmental allergies · Past surgical procedures TYPES OF ANESTHESIA: The following is a list of the types of anesthesia services offered. Your anesthesia provider will provide information regarding the most appropriate type(s) of anesthesia for your particular procedure.  Certain surgical procedures and medical conditions may limit your anesthetic options or dictate a specific type of anesthetic plan.  · Epidural: An epidural is a local anesthetic delivered through a tiny tube called a catheter placed in the small of the back, just outside the spinal canal. With the exception of labor epidurals this anesthetic option is often initiated after the administration of light sedation. Most often the lumbar region or lower back area is used. However, for certain procedures a higher thoracic or upper back area is used.  The lumbar epidural is placed below the level at which the spinal cord terminates. After the catheter is placed and placement verified, a continuous or intermittent infusion of local anesthetics with or without a narcotic is given. If the epidural is placed for a surgical procedure, the goal is to either perform the procedure with the epidural and sedation or to augment general anesthesia.  For certain procedures the catheter can be left in place to provide postoperative analgesia. The later option will be discussed with the patient if appropriate for the specific operation.  · General: 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. During anesthesia, you are carefully monitored, controlled and treated by your anesthesia provider, who uses sophisticated equipment to track all your major bodily functions.  A breathing tube may be inserted through your mouth and frequently into the windpipe to maintain proper breathing during this period. The length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesia provider will reverse the process and you will regain awareness in the recovery room.  It is imperative for the patient to notify the anesthesia provider if difficulty was encountered with previous placement of the endotracheal tube.  · Local/MAC: This type of anesthetic is achieved by administering intravenous sedation and local anesthetic injection per the surgeon. In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery, for example, hand or foot, breast, or other surgical site.  · Peripheral nerve blocks: Bier block, interscalene/brachial plexus, and femoral nerve blocks. Peripheral nerve blocks are administered after sedation to augment general anesthesia, provide surgical anesthesia and to provide post-operative analgesia. This is achieved by injection of local anesthetics in an area that contains the nerves to numb the surgical site. Often patients will have several hours of postoperative analgesia as a result of the nerve block.  · Subarachnoid block (Spinal/Intrathecal): This is often known as the spinal anesthetic. After appropriate landmarks are identified a thin needle is placed between the vertebrae and the sack, or dura, surrounding the spinal space is punctured and a local anesthetic is injected. This results in complete blockade of the motor and sensory fibers below the chest allowing for surgery to be accomplished with or without sedation. This is often used for cesarean sections, lower extremity procedures and some hernia procedures. Anesthesia Options for Labor and Delivery: The Anesthesia Department at Eglin Hospital provides 24-hour in-house anesthesia coverage. The epidural and/or intrathecal medications are usually placed after the patient is dilated 4 cm. However; under certain situations and after consultation between the patient's physician and the anesthesia department the epidural might be placed earlier. There are also certain situations when the anesthesia department might be unavailable i.e. emergency surgeries and or procedures that take priority over elective labor epidural placement. Pediatric Anesthesia: Surgery can be an emotional time. When the surgery is to be performed on your child, it is especially stressful. There are things you can do to reduce the chance that your fears and anxieties, as a parent, will be transferred to your child. Children who are less anxious and less fearful have an easier time before and after surgery. Remember your emotions and anxieties influence your child. Keep calm and in control of your emotions to help your child do the same. Follow the recommendations listed to accomplish this goal. For more information, talk with your child's physician, surgeon and nurse as well as anesthesia staff at the hospital. It is important for you to notify the anesthesia staff of any medical conditions that you child might have i.e. premature delivery, sleep apnea, genetic abnormalities, developmental delays, recent colds or coughs, asthma, complications with previous anesthetics. Other anesthesia patient education links on the web: Medline plus ASA - Patient Education American Association of Nurse Anesthetist patient education "The appearance of hyperlinks does not constitute endorsement by the U.S. Air Force nor the 96th Medical Group of these Web sites' or the information, products, or services contained herein, nor do they accept any responsibility over the content at the destination."