Pre-operative Evaluation Suite

Preanesthesia Evaluation Service

The Preanesthesia Evaluation Service sees patients prior to surgery or procedures involving anesthesia care. The Preanesthesia evaluation involves taking a patient history and performing a physical examination, and it may also include gathering results of tests and evaluations previously performed or coordinating additional tests or physician consultations as needed. The Preanesthesia Evaluation Service works with surgeons and primary care physicians to ensure that the appropriate information is available on the day of your procedure and that your medical issues are properly addressed. Although you may not meet your anesthesiologist for your procedure on the day you come to the Preanesthesia Evaluation Suite, your anesthesiologist will visit with you prior to your procedure and discuss your anesthesia care, and in the Preoperative Evaluation Suite information is available on the types of anesthesia, options for pain relief, and about risks involved in anesthesia.

Patients should be sure to allow sufficient time for this comprehensive visit, particularly if laboratory or radiology procedures, specialty consultations, or special financial services arrangements are necessary.

It is our desire to make your experience with anesthesia as pleasant and as safe as possible. We have prepared this site to help you understand the nature of our services and to answer questions our patients often ask.

Important Information for Patients

All anesthesia given by the UCLA Department of Anesthesiology is administered by or under the medical direction of our Anesthesiologists. (An Anesthesiologist is a medical doctor specially trained in the administration of anesthesia care.) If you have any questions about your anesthesia, you can speak with an Anesthesiologist at (310) 825-6761, during business hours. The information below may answer some of your questions.

  1. What are the types of anesthesia?
  2. What are the risks of the different types of anesthesia?
  3. What are the options for pain relief after surgery?
  4. What else should I know about anesthesia?
1. What are the types of anesthesia?

There are three main types of anesthesia provided by an anesthesiologist: general anesthesia, regional anesthesia, and intravenous sedation (often called "monitored anesthesia care"). Each type of anesthesia has many forms and uses. Your anesthesiologist, in consultation with you and your surgeon, will determine the best type of anesthesia for you, taking your desires into consideration whenever possible./p>

General anesthesia produces total loss of consciousness. If you have general anesthesia, you will be so deeply asleep that pain of surgery cannot be felt, and normal breathing may be affected, so it is common that under general anesthesia breathing is assisted. This may be done with the use of a tube or device inserted into the mouth after you go to sleep and possibly with a mechanical breathing machine.

Regional anesthesia means numbing part of the body. This can include procedures done on the back, such as spinal block or epidural block. These types of regional anesthesia may be done for surgery on the legs, back, or abdomen, and epidural block is sometimes done for pain relief after surgery. Regional anesthesia also can involve peripheral nerve block procedures, such as numbing an arm or a leg. If you have regional anesthesia, your anesthesiologist injects medication near a cluster of nerves to numb the area of your body that requires surgery. Usually sedation is also given. With regional anesthesia, you may remain awake, or you may be sleeping through part or all of surgery, depending in part on your particular medical conditions and preferences. Sometimes regional anesthesia is combined with general anesthesia. This is usually done when general anesthesia is indicated but when regional anesthesia can help with pain control after surgery.

Monitored anesthesia care usually involves the use of intravenous medication(s) during a procedure to relieve anxiety (sedatives) or pain (analgesics). Intravenous sedation may be combined with local anesthesia given by a surgeon. Monitored anesthesia care, or “MAC,” may also be termed “twilight” anesthesia. During monitored anesthesia care with intravenous sedation, you may be aware during the surgery. It is possible to be asleep some of the time under intravenous sedation, depending in part on your particular medical conditions and preferences.

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2. What are the risks of the different types of anesthesia?

Complications, if they occur, are usually minor; rarely serious complications can occur. Before undergoing your procedure, understanding the associated risks is essential. No procedure is completely risk-free.

The following risks of sedation and analgesia are well recognized, but there may also be risks not included in this list that are unforeseen by your doctors.

  1. You may experience respiratory depression. Your breathing could slow to an alarming level or even stop (respiratory arrest). This could require that a breathing tube be temporarily inserted while the medication wears off, or longer, if necessary.
  2. You may develop decreased blood pressure, requiring treatment that may consist of administering intravenous fluid or medication. Either of these treatments may require that you be transferred to an intensive care unit (ICU) until you are stable.
  3. You may develop adverse reaction(s) to the sedatives/analgesics that may result in nausea, vomiting, seizures, hallucinations, allergic reaction, skin rash, fever, cardiac arrhythmias requiring drug treatment, cardiac arrest, coma, or death.
  4. Reversal of sedation may be required. In some cases, it may be prudent to administer medication to counteract the effects of a sedative or narcotic pain reliever. This would cause you to be more awake during the procedure.

In addition to the above, risks of regional anesthesia include, but are not limited to:

  1. You may develop headache or backache; these symptoms usually subside in a short time, but in some cases they may persist.
  2. There may be nerve damage, necessitating further treatment that may or may not correct the problem.
  3. There may be failure to achieve an adequate nerve block, which may require that the block be repeated or that general anesthesia be given.

In addition, risks of general anesthesia include, but are not limited to:

  1. There may be dental damage.
  2. You may develop a sore throat or hoarseness; there may be injury to the skin, lip or eye(s).
  3. You may experience itching, aspiration / pneumonia, bleeding, infection, lung collapse, injury to blood vessels, heart attack, or stroke.
  4. The anesthesia could fail to sedate you completely and you may remain aware of your surroundings.
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3. What are the options for pain relief after surgery

Basic pain relief after inpatient surgery may involve medications given intravenously such as opioid, or narcotic, medications. When you can take medications by mouth after surgery, you may be given pills for pain relief. Narcotic medications can be given intravenously with a pump that you help to control. This is known as patient-controlled analgesia, or PCA. Your surgeon usually prescribes these types of pain relief.

An anesthesiologist can perform regional nerve block procedures for pain relief after some operations. Regional nerve block options for pain relief include epidural medications delivered through a small catheter in the back and peripheral nerve block procedures of the arm or leg, which can be done either as a one-time block or by continuing an infusion through a catheter.

Epidural pain relief is often done for surgery involving incisions of the abdomen or chest area. Epidural pain relief may also help speed up the return of bowel function after certain operations that can cause bowel function to slow down and delay patients’ ability to take food by mouth. Both epidural pain relief and peripheral nerve block procedures are done for surgery on the lower extremities. Peripheral nerve block pain relief may also be used for surgery involving the arm or shoulder. For some surgical patients, regional nerve block procedures may provide better relief of pain than can be accomplished otherwise, especially when it comes to pain with movement.

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4. What else should I know about anesthesia?

Many people are apprehensive about surgery or anesthesia. If you are well informed and know what to expect, you will be better prepared and more relaxed. Talk with your anesthesiologist. Ask questions. Discuss any concerns you might have about your planned anesthetic care. Your anesthesiologist is not only your advocate but also the physician uniquely qualified and experienced to make your surgery and recovery as safe and comfortable as possible.

For more information, see the "Additional Information" links at the bottom of the Preanesthesia Evaluation Home Page.

Some of the above information was adapted with permission from the online document “Patient Info” available on the website of the American Society of Regional Anesthesia and Pain Medicine at www.asra.com. © 2006 ASRA 520 N. Northwest Highway - Park Ridge, IL 60068-2573

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Financial Information

At the time of the preoperative evaluation visit, patients who are scheduled for inpatient admission following their procedure are directed to Patient Financial Services to ensure satisfactory resolution of any outstanding financial issues regarding the upcoming hospitalization in advance of the procedure.

The personnel providing your anesthesia are associated with the UCLA Department of Anesthesiology. You will receive a bill from UCLA Department of Anesthesiology for the services of these Anesthesiology specialists. This fee is based on several considerations such as the type of surgical procedure, the time required for your care, your health condition, and your age. This total charge includes preoperative evaluation, administration of your anesthesia, and management of your recovery room stay.

Your hospital bill will contain an item listed as "ANESTHESIA EQUIP. AND SUPPLIES". This represents charges for the hospital equipment and drugs used during your anesthesia. This is separate from the Anesthesiologist's fee.

Most health insurance plans will pay some or all of our fees. The UCLA Department of Anesthesiology are not necessarily contracted with the same insurance carriers as the Medical Center or hospital. Please note, we will file your insurance claims for you to assist you in any way possible, but we are not responsible for collecting from your insurance company. Payment is ultimately your responsibility.

If you have questions about our fees for professional services, please don't hesitate to call our Patient Service at (310) 825-1391. We welcome the opportunity to assist you.

Additional Information

  • Awareness under Anesthesia
  • Frequently Asked Questions - Information from the American Society of Anesthesiologists
  • Information Handouts for Patients Scheduled for Anesthesia Care

Awareness under general anesthesia is a very rare event, but it is possible. In addition, patients are sometimes aware of their surroundings when receiving regional anesthesia or intravenous sedation without general anesthesia, even if they do not experience pain. The resources listed below can help to inform patients about awareness under anesthesia.

Information Resources

  • News release about Awareness under Anesthesia from the California Society of Anesthesiologists: "Anesthesiologists Correct a Public Misperception"
  • Patient information on Awareness under Anesthesia from the American Society of Anesthesiologists
  • "Patient Awareness Under General Anesthesia - What Is It?" - Brochure in English
  • "Estado de Alerta Consciente del Paciente bajo Anesthesia General - ¿Qué Significa?" - Folleto en español (Spanish version)
  • ASA Patient Awareness under Anesthesia Video: Dial-up version Broadband version