This is the time to learn about your options for anesthesia and to ask questions. The interview can be done by telephone, but usually, you will meet with an anesthesiologist who focuses on your medical history, especially as it pertains to the surgical procedure you are to have. Other things we need to know about you are whether you, or other members of your family, have had anesthesia previously and if there were any adverse reactions. Your height, weight, medication you are taking and social habits are also noted. You should refrain from smoking before surgery and it is important to inform the anesthesiologist if there is a possibility that you are pregnant. A limited physical exam is also performed with special emphasis on your airway.

You should know that the anesthesiologist at the preoperative interview may not be the same person performing your anesthesia on the day of the surgery. A particular anesthesiologist can be requested for your case, but this should be done well in advance of the surgery to avoid scheduling conflicts.

There are three options with your anesthesia and most depend on the surgery at hand. The options are general anesthesia, regional anesthesia and monitored anesthesia care.

General anesthesia is usually required for major surgery. You will have an intravenous started and through it, you will receive medication that will make you unconscious. While you are asleep the anesthesiologist may help you breath or control your breathing with a ventilator. To do this, you will have a flexible breathing tube placed into your windpipe, or what we call intubation. Although infrequent, there is a possibility of teeth being damaged or dislodged during this procedure. This is why we ask you to open your mouth and about the condition of your teeth. It gives us an idea of how easy the intubation will be. You won't remember any of this because you will be asleep. After the breathing tube is secure, the surgery proceeds. Once the procedure is completed, the breathing tube is removed, usually before you wake up. The only time the breathing tube remains in place, is if you have had major heart or lung surgery or if you have really bad lung disease to begin with.

Regional anesthesia or a regional block, is a procedure done to anesthetize a part or region of your body. This can be a finger, a hand, an arm, a foot, a leg, an eye, a tooth etc. This is done by placing a small needle or catheter near the appropriate nerves and numbing them with medications known as local anesthetics e.g., Novocain. Spinals and epidurals can numb you from the chest down and are also examples of regional anesthesia. All the nerves in your body come from the brain and spinal cord and surrounding these structures is a sac containing cerebral spinal fluid (CSF). CSF is fluid the body produces which bathes the brain and the spinal cord. When placing a spinal, a small needle is passed into this sac of fluid and local anesthetic is deposited. This local anesthetic then bathes the nerves and makes you numb in the areas they supply. The extent and duration of numbness can last from one to several hours depending on what kind and how much medication is used.

In contrast to a spinal, an epidural is a tiny catheter the size of a guitar string ( 1-2 mm) which is placed near, but not into, the sac containing CSF. Local anesthetic agents given through the catheter diffuse to the nerves and have the same effect as local anesthetics given for a spinal. The difference is that additional medication can be given through the catheter, making the pain relief last as long as needed, even days after the procedure.

The risks with any regional technique are bleeding, infection and nerve injury. Bleeding is a complication seen especially in patients with clotting disorders and because of this, regional anesthesia may not be performed on such patients. The risk of infection is very small since all the procedures are done in a sterile manner. Nerve damage is also rare but because a needle is placed near a nerve, the risk must also be mentioned.

A common difficulty with regional anesthesia is failure of the block to work completely or quickly enough. We are placing a small needle or catheter near a nerve and sometimes do not get close enough. If this were to occur, it would be noticed preoperatively and the procedure redone to establish adequate anesthesia.

With a spinal, there is about a 1% chance of developing a headache. This is treated with bed rest, drinking a lot of fluids with caffeine, and pain relievers. The reason for the headache is that the tiny hole in the sac containing CSF does not close quickly enough causing a change in CSF pressure. Headaches occur most often with young females and the incidence decreases with age. Should the headache persist, other therapies are available e.g., a blood patch. A blood patch is exactly what it sounds like. Blood is drawn from your vein and placed in a sterile manner at the site where you had the spinal. This blood will then clot and form a patch over the tiny hole in the sac containing CSF. Headaches usually resolve within minutes after a blood patch but you should still stay in bed for a few hours to avoid any disruption of the clot.

Both spinals and epidurals can be placed with you either in a sitting position or lying on your side. You will be asked to curl your back like a shrimp or the letter 'C'  to better expose your spine to the anesthesiologist. A soapy solution will then be used to sterilize your back and local anesthetic agents, through a very small needle, will numb the area where the procedure is to be performed. Anesthesiologists like to use a lot of numbing medicine and feel there is no need for pain with any procedure. The numbing medicine will feel warm as it goes in but should not be too painful.

Local anesthetics are used for all regional techniques. Dentists use local anesthesia all the time e.g. Novocain. There are two groups of local anesthetics and one group is broken down by the body into PABA, a chemical found in many sunscreens and makeup. If you are allergic or sensitive to PABA, it is important to let your anesthesiologist know so that he or she can use a local anesthetic from the other group. A true allergy to local anesthesia is rare. Most patients are allergic to the preservative in it or the PABA breakdown product, both of which can be easily tested for. Many patients are told that they are allergic to a local anesthetic but most reactions are the result of accidental injection into the bloodstream. If you were ever told you were allergic to local anesthetic agents, it is probably best to have skin testing done by an allergy doctor.

The last option for surgery is monitored anesthesia care (MAC) and it means exactly what it sounds like. Many procedures are accomplished with very little anesthesia or with local anesthesia given by the surgeon directly into the tissue to be operated on, for instance a breast biopsy. Under MAC, the anesthesiologist can provide some sedation while the procedure is performed. You may be awake the entire time and since most procedures are minor, they should be painless as well. If you do experience pain, the anesthesiologist can also give you some medication through your intravenous to make you comfortable.

For many procedures a flexible tube, or Foley catheter, is placed in the bladder to drain any urine made by the kidneys. The Foley catheter is usually placed after induction of anesthesia whether it be regional or general. Postoperatively, it is not uncommon for the catheter to give the sensation of having to void even if the bladder is empty.

If you have a regional anesthetic or MAC, don't be surprised if the surgeon has some background music playing. This is a work environment like any other and anything that makes someone more relaxed also improves performance. You may even be allowed to choose the selection!