General anesthesia means you will go sleep. The anesthesiologist gives you some medicine through the intravenous line, you drift off to sleep, and then he puts a tube down your throat to help you breathe. During your bariatric surgery, he will also give you a muscle relaxant so that the weight loss surgeon doesn’t have to fight you.

When the weight loss surgeon is through with his work…

…and you are all sewn up, the anesthesiologist lets the medicine wear off and you wake up. A good anesthesiologist has a “flight plan,” or a “sleep plan,” for the medications he or she will use during every step of the procedure.

 

You will wake up!

Okay, so you heard the horror stories of people who wake up during a procedure and can’t move—oh, you didn’t hear that one? Good. Ah, Dr. Simpson found another way to frighten his readers. Such events usually only happen under very special circumstances, typically during heart or brain surgery.

The greatest fear of anesthesia is unfounded—that you won’t wake up.Perhaps it is a control issue. For a period, your life is totally in the hands of a skilled anesthesiologist and a surgical team. During that time there are monitors checking every vital function you can imagine, from the quantity of anesthetic in your system, to your heart rate and blood pressure, to a catheter to see if you make pee. Of all the risks of weight loss surgery, not waking up isn’t in the top 10,000. But, all humans, even anesthesiologists, worry about waking up—or rather, not waking up—after an operation.

Epidural and general anesthetics

With an Epidural, a catheter is placed next to your spinal cord. Through this catheter, either local anesthetics, or narcotics, are placed to decrease your postoperative pain. This catheter is used after weight loss surgery too, to help decrease pain. There are some good things about epidurals—bariatric patients like it a lot—but not every anesthesiologist is skilled with it. If your anesthesiologist wishes to use an epidural technique, he or she will probably insert the catheter in you before you arrive in the operating room. Also, most of us who do this weight loss surgery use some agents to thin the blood a bit, and many anesthesiologists will not place an epidural catheter in you when you have these agents on board.

Many women have had epidurals during childbirth, and fathers who have been in the obstetrical area are thankful for its work. They are great tools, but they are not for everyone. If we have epidurals, you might wonder—what is this Lamaze stuff? Epidurals are rarely used for these operations without a general anesthetic. There are a lot of reasons for it. You may be drowsy from the pain medication, but epidurals do not put you to sleep. A general anesthetic really is needed for this operation, and you really do want to be asleep while someone like me is rearranging your guts. I had an epidural for my knee operation—great stuff. You might want to be awake for a knee operation or to watch the birth of your baby, but do you really want to watch me rearrange your guts?

Once you are all set, wearing that stylish gown, donning the great blue hat, and ready to roll into the operating room, you will meet a couple of characters— although you may not remember them. They are the circulating nurse and the scrub technician.

The circulating nurses are a combination of go-fers and quarterbacks

They get items needed for weight loss surgery as well as make certain that the room runs smoothly. If something happens, they are expected to pitch in quickly. Their job is a little like an airline pilot’s—most of the time the job is a bit boring, but the take offs and landings can be quite exciting. Before you go into the operating room, they will re-ask all the questions. They will ask if you understand the procedure you are having, they will check your name and make certain you are the person who is suppose to have this procedure. They will also check over your consent for weight loss surgery. If it doesn’t say the right thing, they will call the weight loss surgeon to modify the consent, and ask you to initial or re-sign the consent. This seems like a terribly redundant step, but remember that people have gone into the operating room for one procedure and ended up getting another. They will again ask you about any allergies to medication, latex, to solutions used to prepare your skin such as iodine or alcohol, or to surgical tape or dressings. They will go over your medication list with you and again ask when you last took certain medications. They really want to know when you ate your last meal, took medication, and a host of other things. They will check your blood type in case you need blood and will ask if you have a religious objection to receiving blood. They will also make certain that, if blood was ordered, it is present before your weight loss surgery starts. These nurses understand that you are a bit afraid. They have seen more than their share of weight loss surgery patients. They will re-assure you and make you feel better.

The scrub technician is the person who hands the instruments to the bariatric surgeon

You may not meet this person or you may meet him briefly if he helps you get from your hospital gurney to the operating room table, but these folks are critical to successful weight loss surgery. A good scrub technician is wonderful. When a weight loss surgeon and a good scrub tech have worked together for a while, the operation unfolds like a fine ballet. As the weight loss surgeon puts his hand out for the next instrument, the scrub technician places it there. A bad scrub technician will break your rhythm. In weight loss surgery, we want things to go as routinely as possible. We don’t want to have to wait for some instrument or suture that we use all the time. A good scrub technician anticipates and reacts quickly. I have worked with some scrub techs for years that I keep hoping will retire before I do. Others have my routine down pat after working with them only once. They are an important part of the team and if you have a good team, the weight loss surgery goes very smoothly.