Cosmetic surgery at Sibley is performed at the Sibley Ambulatory Surgery Center, where all anesthesia is administered by board-certified anesthesiologists and nurse anesthetists. Prior to your operation, your anesthesiologist will discuss the procedure with you. During your procedure, he or she will make sure you receive fluids for hydration, antibiotics if needed and medications to minimize pain, inflammation and nausea. He or she will work with your surgeon and nurses until you are awake and comfortable in the recovery room.

Anesthesia for cosmetic surgery cannot typically be billed to your health insurance carrier. Therefore, the Department of Anesthesiology has agreed to provide anesthesia to all cosmetic surgery patients at a discounted rate. Your plastic surgeon’s office will be able to help estimate what your anesthesia fee will be, but if your actual surgery takes longer than planned, your fee may be higher than originally estimated. On the day of surgery, you will need to present a credit card for payment and possible overtime charges. We accept Visa, MasterCard and American Express. If you have any questions regarding cosmetic surgery billing, please contact the Department of Anesthesiology practice administrator at (202) 243-2280.

If you have a significant medical condition, extreme anxiety or have had trouble with anesthetics in the past, you may have a consultation with one of the anesthesiologists prior to your surgery date. Have your plastic surgeon write you a prescription for a “pre-op consultation” with the Department of Anesthesiology. You may then call to make an appointment at 202-537-4437 to discuss and plan your care as appropriate.

You may request a specific anesthesiologist by speaking with your surgeon or by calling the Anesthesia Office at 202-537-4141 several days prior to your surgery.

Most patients undergoing endoscopic procedures receive pain medicines and/or sedatives to allow them to tolerate the planned procedure. In many cases, an endoscopy nurse, under the direction of the gastroenterologist, will give sedation in the form of small doses of medications to help calm the patient and alleviate any discomfort. Some patients require deeper sedation or general anesthesia, in which case an anesthesiologist is present to deliver stronger medications that allow the patient to safely undergo the planned procedure. Specifically, patients who are obese or very anxious, or those with sleep apnea or multiple medical problems, may benefit from having an anesthesia provider’s care. If you have any questions about sedation or anesthesia, ask your gastroenterologist which he or she will be requesting.

If you have sleep apnea, multiple medical conditions or have had trouble with an endoscopy in the past, you may have a consultation with an anesthesiologist prior to your endoscopy date. Have your gastroenterologist write you a prescription for a “pre-op consultation” with the Department of Anesthesiology. You may then call to make an appointment at 202-537-4955 to discuss and plan your care as appropriate. The appointment MUST take place at least two days before your scheduled procedure.

You may request a specific anesthesiologist by speaking with your gastroenterologist or by calling the Anesthesia Office at 202-243-2280 several days prior to your procedure.

Learn more about endoscopies at Sibley.

Board-certified anesthesiologists and nurse anesthetists are available 24 hours a day to provide pain relief for women delivering babies. Some common procedures include the following:

Epidural Anesthesia for Labor

Epidural analgesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your body, yet allows you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. An epidural block is given in the lower back into a small area (the epidural space) outside the spinal cord. You will be asked to sit with your back curved outward while the needle is being placed.

After the epidural needle is placed, a small tube (catheter) is inserted through it, and the needle is withdrawn. A continuous dose of medication can then be given through the tubing, and you will be given a button to self-administer extra doses. The catheter is soft and flexible and can be safely laid on. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You will be able to move following an epidural block, but won’t immediately be able to walk.

An epidural block with more or stronger medications can be used for a cesarean delivery. Using an epidural allows your delivery team flexibility during birth — in the case of an unplanned cesarean delivery, the epidural can be “strengthened” quickly and safely. Patients with indwelling epidural catheters rarely require general anesthesia for their cesarean section.

Out of all the options for pain control, epidurals provide the best and most reliable level of pain relief and patient satisfaction.

Anesthesia for Elective Cesarean Section

Cesarean births require anesthesia — either via an epidural, a combined spinal/epidural or rarely, a general anesthetic. Your anesthesia provider will discuss the options available to you and remain with you throughout the surgery.

Discussing the Use of Anesthesia

If you have a significant medical condition, prior spinal surgery or trouble with an anesthetic in the past, you may have a consultation with one of the anesthesiologists prior to your delivery date. Have your obstetrician write you a prescription for a “pre-op consultation” with the Department of Anesthesiology. You may then call to make an appointment at 202-537-4437 to discuss and plan your care as appropriate. The appointment MUST take place at least two days before your scheduled delivery.

You may request a specific anesthesiologist by speaking with your obstetrician or by calling the Anesthesia Office at 202-243-2280 several days prior to your delivery.

Learn more about delivering your baby at Sibley.

Learn more about anesthesia for childbirth, including misconceptions about pain management in labor and delivery, on the Certified Anesthesia Services website.

Prior to your admission, you will be asked to complete a nursing interview. This will enable our anesthesiologists from Certified Anesthesia Services to provide appropriate services. The anesthesiologist will determine the type of anesthesia after consulting with you and your surgeon. Your anesthesiologist will administer the anesthesia and remain with you throughout the procedure until you are in the recovery room.

General and Regional Anesthesia for Orthopaedic Surgeries

Many types of anesthesia can be used for orthopaedic procedures. The type of anesthesia chosen depends on the nature and duration of the surgery, the patient’s health and medical conditions and the preferences of the patient, surgeon and anesthesiologist.

Very large or long operations usually require general anesthesia. This is frequently combined with regional anesthesia. Small, short procedures on the hand or foot can be done with local anesthesia alone or with a combination of local anesthesia provided by the surgeon and some sedation provided by the anesthesiologist (also known as MAC). Occasionally, neuraxial (epidural or spinal) anesthesia is chosen for hip or lower extremity surgery.

Nerve Blocks

For knee replacement surgery, we are able to provide peripheral nerve blocks for relief of postoperative pain. Nerve blocks often substantially reduce the amount of pain a patient has in the first few days after surgery. Also, patients with nerve blocks usually require less anesthesia during the surgery itself, so they tend to wake up faster after surgery. If you or your surgeon are interested in a nerve block, please discuss it with your anesthesiologist to determine if you are an appropriate candidate for this type of anesthesia.

Types of Nerve Blocks

Supraclavicular block: The numbing medicine is injected above the collarbone, shallow to the lung and outside of the great vessels. This block is more widely used than in the past because newer technologies have made it safer. It provides anesthesia to the upper arm, elbow, wrist and hand.

Axillary block: The numbing medicine is injected under the armpit (the axilla). This generally provides good anesthesia for hand, wrist, forearm and elbow surgery.

Interscalene block: The numbing medication is injected toward the brachial plexus below the collarbone (clavicle). This type of regional anesthesia provides good anesthesia for wrist, forearm, upper arm and often shoulder surgery.

Infraclavicular block: The numbing medication is injected toward the brachial plexus below the collarbone (clavicle). This generally provides good anesthesia for wrist, forearm and elbow surgery.

Bier block: The numbing medicine is injected through an IV line in the arm being operated on, with a tourniquet around the upper part of the arm to hold the medicine in, preventing it from leaking out to the rest of the body. This type of block is useful for short procedures such as carpal tunnel surgery.

Rescue block: The numbing medicine is injected after surgery to make you more comfortable, or after one of the blocks above has been performed in order to complete your anesthesia.

Consultations before Surgery

If you have a complex medical condition or trouble with an anesthetic in the past, you may have a consultation with one of the anesthesiologists prior to your surgery date. Have your surgeon write you a prescription for a “pre-op consultation” with the Department of Anesthesiology. You may then call to make an appointment 202-537-4955 to discuss and plan your care as appropriate. The appointment MUST take place at least two days before your scheduled surgery or procedure. Anyone who wishes to schedule an appointment less than two days in advance of surgery will be directed to wait until the procedure date.

You may request a specific anesthesiologist by speaking with your surgeon or by calling the Anesthesia Office at 202-243-2280 several days prior to your surgery.

Anesthesia is a very important part of the surgical experience. At Sibley Memorial Hospital, anesthesia services are provided by board-certified anesthesiologists and nurse anesthetists. The Department of Anesthesiology assigns an anesthesia provider to each patient scheduled for surgery. You may request a specific anesthesiologist by speaking with your surgeon or by calling the Anesthesia Office at 202-537-4141 several days prior to your surgery.

Prior to your admission, you will be asked to complete a nursing interview. This will enable our anesthesiologists to provide appropriate services. The anesthesiologist will determine the type of anesthesia after consulting with you and your surgeon. Your anesthesiologist will administer the anesthesia and remain with you throughout the procedure until you are in the recovery room.

Before surgery, we will discuss the anesthetic procedure with you. This interview will help you understand the anesthetic process and will help in planning the appropriate anesthetic. It is essential that you cooperate fully by providing a good medical history and the information necessary to determine the type of anesthetic to be administered.

You will be asked to provide the following information:

• Use of prescription and nonprescription medications
• Use of alcohol and recreational drugs (failure to report use of drugs can have dangerous consequences due to drug interactions with anesthetics)
• Personal experience with previous anesthetics and/or how family members react to anesthetics
• Diet, exercise and smoking habits
• Allergic reactions to food and drugs

The type of anesthesia used is based on several factors, including your physical condition, the type of surgery to be performed, your previous anesthesia history, your reactions to medications, your and your surgeon’s preferences and information provided during the preoperative interview.

Sibley Memorial Hospital’s operating rooms are equipped with the most current anesthesia and monitoring equipment, which will continuously capture your electrocardiogram, blood pressure, pulse rate, oxygen saturation, exhaled carbon dioxide, respiratory rate, body temperature, neuromuscular function and administered oxygen concentration. In complicated surgical procedures, prior to the operation, the anesthesiologist or surgeon may institute invasive monitoring. Should this be necessary, the anesthesiologist or surgeon will explain these procedures prior to surgery.

If you have a significant medical condition, extreme anxiety or have had trouble with an anesthetic in the past, you may have a consultation with one of the anesthesiologists prior to your surgery date. Have your plastic surgeon write you a prescription for a “pre-op consultation” with the Department of Anesthesiology. You may then call to make an appointment at 202-537-4955 to discuss and plan your care as appropriate.

You may request a specific anesthesiologist by speaking with your surgeon or by calling the Anesthesia Office at 202-243-2280 several days prior to your surgery.