Reader Question: Medication Charges for OR

This reader question was asked in the comments and Kim gave a very detailed answer that I thought should be posted as well.

Susan Asks:

I have a question. I have had several surgeries, including foot surgery where a block was used. The list of medications on my bill were astounding! I understand the induction agent, narcotics and versed, but what is the anesthesia gas for? Just to keep the patient asleep? I love these posts!

Kim Says:

Hi, Susan!

Thanks for your question. One of the fascinating things about anesthesia is that there are as many different ways to give an anesthetic as there are different types of patients. Anesthesia is based on the type of surgery you are having, your own health/anesthetic surgery, preferences of the surgeon as well as the experience and preference of your anesthetist.

In the old days, you breathed in an anesthetic gas until you were asleep. If you ever had anesthesia with ether, you’d understand why we’ve continually looked for better ways to render patients insensible to pain.

Another way was to “block” the pain impulses by the use of local anesthesia either as a “field block” (blocking the area similar to what a dentist does), as a spinal or epidural, or a block of an extremity. One thing we’ve learned through the study of pain is that blocking the area with a local anesthetic decreases the over all amount of pain a person has post op. Because the nerve impulses to the brain are blocked, the brain doesn’t respond by releasing stress chemicals that cause inflammation until after the local wears off which means that less pain and inflammation happens over all.

So the “modern” way of doing an anesthetic has changed to what we call a multi-modal approach.

1) The block was to prevent pain and to keep you comfortable for a time after surgery.

2) The induction agent (versus breathing enough gas to go to sleep which isn’t especially pleasant in an adult) puts you to sleep initially, while the Versed (an amnestic) and narcotic (pain relief) provide other pieces of the anesthetic puzzle.

3) The anesthetic gas is added after you are asleep from the induction agent and also provides amnesia and pain relief. It also helps to control blood pressure changes from surgical stimulation or the use of a tourniquet in extremity surgery (used to keep the sterile field “bloodless” and expedite the surgery).

With the advent of outpatient surgery, patients no longer snooze the day away waking up from their anesthetic. They need to be deeply asleep and then awake enough to go home in a matter of hours. Using a multi-modal approach (using a combination of drugs for different reasons) is much more effective than each of those drugs by themselves.

For example, without the use of the anesthetic gas, much more narcotic is required. Without the narcotic, much more gas is required to do the same job. Every drug has side effects which increase with dosage and in the case of anesthetic gasses, time.

Using a combination of drugs allows us to keep the side effects to a minimum. It is a common misconception that we give a patient an anesthetic drug and then coast through the surgery and like magic they wake up when it is over. Even surgeons think so.

In reality, though it seems like a large number of medicines, each one has a specific purpose and one of the reasons anesthesia is safer and more pleasant than the old days.

Probably more info than you wanted, but I enjoy when people who are interested in what I do. I’ve been a CRNA for 34 years and I still find it absolutely fascinating!

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Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com

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