Services

Anesthesia Services

There are many types of anesthesia available to help make patients comfortable during surgery or a medical procedure. Because each person is unique, your anesthesiologist, in consultation with you, will individually tailor the treatment approach for your specific needs. Factors affecting the particular technique or approach include the type of surgery/procedure being performed, the patient’s age, physical status, lab results and medical history as well as the requirements of the surgeon.

We offers the following anesthesia services:

General Anesthesia

This is the most common type of anesthesia. You will have a total lack of awareness. Essentially you will be “completely asleep”. The anesthetic drugs and vapors administered will result in you becoming “unconscious” for the entire duration of your surgery or procedure. After you emerge or “wake up” from general anesthesia you will have no recall of any events from the time you were induced or “put to sleep” into general anesthesia. In fact, general anesthesia is a drug coma induced and controlled by your anesthesiologist during which your anesthesiologist will monitor and care for your well-being, allowing you to emerge at the appropriate time. There are 3 main components to general anesthesia:


  • Hypnosis. You are unaware of anything happening during general anesthesia.
  • Analgesia. You will be pain free from the administration of anesthesia or IV pain medications.
  • Muscle relaxation. Your muscles are sometimes relaxed to facilitate placement of your breathing tube or to help your surgeon by keeping you still, or to aid in the procedure itself.
Regional Anesthesia

This is most commonly administered for obstetric anesthesia and analgesia and orthopedic anesthesia and analgesia, although regional techniques can be used in a large number of other specialties such as general surgery and gynecologic surgery. Here a specific region of your body will be without sensation or pain.

Peripheral Nerve Blocks and Bier Blocks

The second common category of regional anesthesia encompasses all peripheral nerve blocks and Bier blocks (IV regional anesthesia). For peripheral nerve blocks, which we usually use for postoperative pain management, local anesthetic solution is injected around a nerve(s) to numb up a specific limb or region. For example for shoulder surgery, injection of local anesthetic in the neck around the nerves supplying the shoulder and arm on that side will provide excellent analgesia for 8-24 hours postoperatively. In addition for hand or arm surgery of short duration, we offer IV regional anesthesia or Bier blocks. This involves injecting local anesthetic into an IV in that hand with a tourniquet on, to numb up the entire arm. This type of regional anesthesia usually lasts for a short duration, and is therefore used for the surgery itself, and not for postoperative pain control.

TIVA (Total IV Anesthesia) or IV General

Total IV Anesthesia is a form of anesthesia where you will effectively be given a general anesthetic without the placement of a breathing tube. You will not be placed on a ventilator and will be breathing on your own. The difference between deep sedation and TIVA is you will be unconscious and not rousable to stimulation with an IV general. We use this technique for a number of procedures, but most commonly for gastroenterology procedures such as upper endoscopy and colonoscopy, performed by the gastroenterologists and tranesophageal echocardiography performed by the cardiologists. This technique is also used in conjunction with other types of anesthesia such as local anesthesia and regional anesthesia (for example spinal anesthesia for total knee replacements).

MAC or Monitored Anesthesia Care with Sedation:
Deep, Moderate, Mild

Monitored anesthesia care with sedation is usually used in conjunction with other techniques such as local anesthesia for cataract surgery and regional anesthesia such as Bier blocks. In mild sedation you will be awake but relaxed with medication. You will be able to follow commands. In moderate sedation you will be somewhat more relaxed and will be rousable to command or touch. In deep sedation you will be asleep but still rousable to deep stimulation. Very occasionally MAC without sedation is requested by your doctor. Here, an anesthesiologist will be closely monitoring your vital signs and will be immediately available should the need for sedation or other types of anesthesia arise.

Local Anesthesia

Here, the anesthetic or numbing medicine is directly infiltrated into the surgical site. A common example is local anesthesia for dental surgery or eye drops for cataract surgery. In the hospital setting, local anesthesia is usually only part of your anesthesia care, which usually also involves MAC with sedation, TIVA or General Anesthesia in addition to the local.

General Surgery

We provide anesthesia for all types of general surgery cases including laparoscopic cholecystectomy and hernia repairs. A significant number of our cases are of an outpatient nature. Therefore, our choice of anesthetic techniques and postoperative analgesics, provide our patients optimum patient comfort, with same day discharge. In addition, we aggressively attempt to prevent and treat post-operative nausea and vomiting. Our nursing colleagues in the recovery room also rapidly address post-operative nausea and vomiting, making same day discharge possible in almost all outpatients. We also provide anesthesia for more complex inpatient procedures such as exploratory laparotomy, colectomy, and Whipple procedures, often necessitating additional monitors such as arterial and central venous catheter placement. In addition, if requested by your surgeon, we are able to place epidural catheters for your postoperative pain management.

Cardiothoracic and Vascular Surgery

Our team of Anesthesiologists provide anesthesia for all open heart procedures at the Mayaguez Medical Center, such as coronary artery bypass and valvular repairs done most often under cardiopulmonary bypass (using the heart-lung machine). Our surgeons also perform minimally invasive valve repairs, TAVRs (Transcatheter Aortic Valve Replacements), In addition, our expertise in intraoperative transesophageal echocardiography (including 3D TEE) helps guide our surgical colleagues in their clinical decision making, and with valvular repairs and replacements allows us evaluate the function of the new valve prior to leaving the operating room. In addition to routine monitoring, we place arterial catheters and Swan-Ganz Cardiac catheters for intensive monitoring of your cardiovascular system during these complex open heart procedures. We also provide anesthesia for all vascular cases such as aortic aneurysm repair (open and endovascular) and carotid endarterectomy. Examples of thoracic cases done include open thoracotomy with lung resections and VATS (video assisted with smaller incisions) procedures.

Orthopedic Surgery

At Mayaguez Medical Center, our busy orthopedic anesthesia practice includes both general anesthesia, regional anesthetic techniques and peripheral nerve blocks (including interscalene, supaclavicular, axillary, fascia iliaca, adductor canal and popliteal nerve blockade) for postoperative pain management. If a block is requested by your surgeon, we will utilize the latest technology including ultrasonography and nerve stimulation to ensure that your block is safely and efficiently placed. Peripheral nerve blocks provide superior postoperative pain control, allowing lower doses of narcotic medication, with less side effects. Nerve blocks are useful for both inpatient procedures such as total knee replacements and outpatient procedures such as rotator cuff repairs of the shoulder. If requested by your surgeon, we are also able to place peripheral catheters for continuous peripheral nerve blockade.

Some of our orthopedic surgeons also specialize in spine surgery from outpatient minimally invasive discectomy to complex fusion surgery. These cases are done under general anesthesia and the lengthy fusion surgeries may necessitate the placement of additional monitors such as arterial and central venous catheters to more closely monitor your cardiovascular system. There are specific risks related to your prone (face down) position for lengthy spinal fusion procedures, which although rare, can be quite serious and require special considerations in anesthetic technique to minimize their occurrence.

Otolaryngology

Highly skilled ENT surgeons operate at Mayaguez Medical Center, performing largely outpatient procedures such as tonsillectomy and endoscopic sinus surgery. We provide our patients with appropriate analgesics (pain medication) and antiemetic’s (anti-nausea medications) making it possible for most patients to return home on the day of surgery. In addition, we also provide anesthesia for more complex inpatient procedures such as tracheostomy and radical neck dissection for cancer often requiring more specialized anesthetic techniques.

Urology

Anesthesia for urologic cases includes routine cystoscopy to radical prostatectomy. In addition we provide general, regional and IV general anesthesia for all other urologic procedures from nephrectomy to ureter cystoscopy.

Plastic Surgery

A Highly trained plastic surgeon operate at Mayaguez medical Center and mainly perform breast reconstructive procedures. These predominantly include breast reconstructive surgery following mastectomy for breast cancer including complex flap reconstructive procedures requiring vascular anastomosis (stitching minute blood vessels together) such as the DIEP procedure. For these complex lengthy procedures, sometimes taking 10-12 hours, your anesthesiologist may place arterial and central venous catheters to provide more intense monitoring.

Gynecology
Gynecological Oncology and Urogynecology

We provide anesthesia for a large number of our gynecology, gynecological oncology and urogynecology colleagues who perform open, laparoscopic, and. These patients mainly have general anesthesia or IV general anesthesia for shorter procedures such as hysteroscopy. Because gynecologic procedures are more likely to cause nausea and vomiting, we aggressively try and prevent postoperative nausea in addition to providing adequate pain relief prior to leaving the operating room.

Oral Surgery

We provide anesthesia for all oral surgery procedures. These case are almost performed under general anesthesia. Occasionally arterial and/or central venous monitoring may be indicated.

Cardiology-diagnostic, interventional and electrophysiology / structural heart

We administer mainly general anesthesia for cardiac electrophysiology (EP) procedures such as EP Ablations on a daily basis working with our colleagues from Mayaguez Medical Center Heart Specialists. In addition to routine monitoring we often place arterial catheters for these complex ablation procedures. Even though this procedure is performed through the groin, rare complications such as damage to the heart can occur rapidly, with the resultant blood around the heart causing compression of the heart and cardiac arrest. Your anesthesiologist will be carefully monitoring you throughout the procedure and will be prepared to rapidly begin resuscitation should the need arise. In addition we also provide IV general anesthesia for diagnostic cardiac procedures such as TEE (Transesophageal Echocardiography). This allows rapid sedation, wake up, and discharge from the unit. Our cardiac anesthesiologists also provide anesthesia for our Structural Heart Program including TAVR.

Gastroenterology/Pulmonology

Our gastroenterology procedures are performed at the Center for Endoscopy at Mayaguez Medical Center. Anesthesia for these procedures, which include upper endoscopy, colonoscopy, as well more complex procedures such as endoscopic ultrasound, and ERCP, are mainly performed under IV general anesthesia with the drug Propofol. This allows patients to be rapidly sedated, awakened, and discharged. In addition, patients rarely experience nausea from this anesthetic technique. Occasionally for ERCP, or upper double balloon enteroscopy procedures, general anesthesia will be required.

We also provide general anesthesia for complex bronchoscopy procedures for our pulmonology colleagues, when needed, in the endoscopy lab.

Radiology

We provide general and IV general anesthesia for both diagnostic (ex. MRI) and interventional radiology procedures which take place in the Radiology department.

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