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Orthopedic Anesthesia PDF Print E-mail

Orthopedic anesthesia requires a great variety of techniques be possessed and offered to our patients. Our anesthesia care team routinely provides care for elderly patients with underlying medical conditions such as heart disease or severe lung disease. Your anesthesiologist is experienced in anesthetizing patients requiring total joint replacement, spine surgery, elective orthopedic trauma surgery, sports medicine and hand surgery. We also are required to anesthetize orthopedic trauma patients on an urgent or emergent basis that may have acute spinal fractures, acetabulum (hip) and pelvic fractures or multiple extremity fractures. These patients may have an unstable cervical (neck) spine requiring specialized airway management techniques and evolving fluid and blood management strategies.


Anesthesia for orthopedic surgery commonly utilizes general anesthesia for our patients. However, your surgery may be done utilizing a number of different anesthetic options such as spinal, epidural, and major nerve blocks or with combined regional/general anesthetic techniques. Not all anesthetic options are available in all patients for all procedures. Some of our anesthesiologists are trained in the delivery of state-of-the-art indwelling peripheral nerve block catheters for outpatient and inpatient procedures. Both your surgeon and your anesthesiologist may have a specific preference for your upcoming procedure, so discuss your options with these doctors


Preoperative Evaluation

American Anesthesiology's preoperative evaluation attempts to both familiarize patients with the anesthesia care team and address any concerns and/or expectations regarding your surgery. Prior to the day of your surgery, an anesthesiologist will go over your history and various tests (for example, labs, EKG, cardiac catherization results, etc.). Occasionally, we are able to leave the operating room to meet with you and explain what to expect before, during and after your surgery as it pertains to anesthesia. Occasionally we will call you to gather more information after we have reviewed your chart prior to the date of the surgery.


Day of Surgery

On the day of surgery, you will either be transported from the floor or come in from home to our same day surgery area prior to surgery. Our anesthesiologist and nurse anesthetist will visit with you and your family to review the history, assess any changes in health, examine you and discuss the proposed anesthetic plan in words that you and your family can understand. We will review American Anesthesiology's anesthesia consent and answer any questions that you may have. When your surgeon, operating room nurses, and anesthesia are ready we will transport you to the operating room. Typically, we administer a sedative called Versed through the IV. This medication will help ease your anxiety as well as may make it unlikely you will remember much from this point forward until you wake up in the PACU (also known as the recovery room). We will make every effort to try to make your transport to the operating room relaxing and as stress-free as possible. Pain medicine may be given in addition to the sedative to assure your comfort.


Intraoperative Care

Once you have been placed on the operating room bed, we will place various monitors to try to ensure your safety during your operation. If we are proceeding with a general anesthetic, then we will deliver oxygen by gently placing an oxygen mask over your mouth and nose. We will induce general anesthesia by injecting medication through your IV. It generally takes about 30-60 seconds to fall asleep after we start. We will place a breathing tube into your trachea (also known as wind pipe). We will breathe for you during the surgery until you wake up in the PACU. We keep you asleep through a combination of anesthetic gas though the breathing tube, pain medicines and more sedatives. 


Types of Anesthesia:


General Anesthesia

General anesthesia is the most commonly used anesthesia at our facilities for most major orthopedic procedures. In the operating room, the anesthesiologist will give you IV medication that lets you drift off to sleep. While sleeping, the anesthesia care team will protect your breathing by using either a breathing tube in your trachea (or windpipe) or a specialized breathing apparatus in your mouth called a LMA. Many people who prefer to be completely unaware of their surroundings prefer general anesthesia.


Spinal or Epidural Anesthesia

Most people are familiar with spinal or epidural anesthesia in the setting of childbirth. Please refer to our animated narrative that demonstrates how a spinal or an epidural would be administered to you. These types of anesthesia are a good option for many lower extremity procedures, such as hip or knee replacements. In the case of epidural anesthesia, a small catheter can remain in the back to provide pain relief both during the surgery and post-operatively. Patients who undergo epidural or spinal anesthesia will be sedated for your comfort during the your procedure. Depending on the level of sedation that you require, you may have some recall of your surroundings in the operating room. Typically, you breathe on your own with supplemental oxygen to ensure a safe amount in your body.


Regional Nerve Block

Regional nerve blocks have become more accepted in orthopedic surgery. These blocks can be done either by placement on an indwelling catheter with continuous medicine delivery or by a single injection of numbing medicine directly around the nerves or that are affected by the surgery. When an area is anesthetized, you may feel touch but no pain and the muscles around the area won’t work normally until the numbness wears off. Regional anesthesia allows you to be comfortable during the procedure and usually allows you to recover more quickly than general anesthesia. The block should provide adequate pain relief after your surgery is done. The duration of the pain control depends upon what numbing medicine we use for your procedure and how you metabolize the medicine. Some last a few hours while others can last up to 18- 24 hours. The placement of an indwelling catheter allows the medicine to be given over many days for more prolong pain relief. Please refer to our various animated narratives that demonstrate how the various blocks would be administered to you.


Monitored Anesthesia Care with Sedation

This technique involves your anesthesia team giving you IV sedation to complement local anesthesia infiltration by your surgeon or regional anesthesia techniques that your anesthesiologist has performed on you. Sedation and pain medication are given through your IV to ensure a calm, pleasant and safe experience for you during your procedure. Your will be closely monitored, as this is the same type of medication used in general anesthesia, just in lighter doses.


Local Anesthesia

Local anesthesia is a choice for select types of orthopedic surgery. Your anesthesia team is usually not involved with your procedure. Commonly, local anesthesia can be utilized for some types of hand and foot surgery, as well as certain superficial procedures on the extremities. When used properly, local anesthesia is very safe. From time to time, this technique may not provide adequate pain relief for some procedures. Discuss with your surgeon if local anesthesia would be appropriate for your upcoming surgery.


Risks of Anesthesia

As you are probably aware all medical procedures carry with them a certain degree of risk. Please refer to American Anesthesiology's anesthesia consent found on our website to review pertinent risks to regional anesthesia. Even though special precautions are taken by our physicians and crnas to minimize the risk associated with carrying out your anesthetic, there is still a minimal amount of risk to you that still remains. Complications do not occur often and rarely lead to significant problems you. Our anesthesia team will discuss these risks with you and try to answer any other questions you might have at any time.



The physicians of American Anesthesiology are always available to answer any questions you might have concerning your care. If there is time available prior to your surgery, then your surgeon can arrange a consultation with us if necessary. American Anesthesiology and its physicians look forward to helping you and your family get through what can be a difficult time for both your family and yourself.


American Anesthesiology Associates of Virginia

1001 Sam Perry Blvd
Fredericksburg, VA 22401 (view map)


Office Phone: (540) 741-7614

Fax: (540) 741-7615


Billing Inquiries:

Call (888) 280-9533*


*In order to expedite your inquiries to our billing department, please have your account number available.