Pre-Anesthesia Clinic (Surgical Services Center)

Directions

The Madigan Surgical Services Center is located in Madigan Army Medical Center and can be reached by taking I-5 Exit 122, traveling straight on Jackson Avenue and then turning right onto Madigan Avenue to enter the Hospital Tower East Yellow Parking Lot. The Surgical Services Center is located on the second floor of the hospital tower.

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About Us

The Surgical Services Center offers a pre-anesthesia evaluation, which prepares patients for surgery after consultation with their surgeon. This appointment takes place before your surgery and may either be an in-person appointment or a telephone appointment, dependent on your procedure and medical history. Appointments are made either through the Puget Sound Military Appointment Center listed above or by the assistance of the appropriate surgical clinic. Patients can expect a series of interviews, patient teaching instructions, and diagnostic testing such as electrocardiograms, and lab work. The goals of the pre-anesthetic consultation include the following:

• identification of clinical problems which may modify perioperative care
• evaluation of a known medical problem which may alter anesthesia care
• formulation of specific plans and alternatives for anesthesia care

Thank you for choosing Madigan Army Medical Center for your upcoming procedure. No matter how extensive your procedure, we know surgery is a significant event for anyone, and we want to assure you that your multidisciplinary team of providers will care for you at all times. In addition to improving your health in the safest of environments, our goal is to ensure that your surgical experience at Madigan is a positive one. We encourage open communication with our patients, so if you have questions or feedback that would improve your experience with us, please let us know! MHS Patient Satisfaction Surveys
 

What should I expect?

Once your surgeon has determined your candidacy for surgery, you will be directed to Surgical Services for an initial appointment for evaluation and teaching by the nursing and anesthesia staff. These appointments usually take 60 minutes to complete, but the duration will depend on the procedure you are having and your unique medical history. Your participation in this appointment is important as it:

• Allows us to complete paperwork and any tests necessary for your procedure
• Helps us to be fully prepared to serve you on the day of your surgery

At this appointment, you will have your vital signs taken, your medications reviewed, be instructed on preparation for surgery and any additional required pre-operative testing will be completed. This is an excellent opportunity to have any questions about surgical preparation answered. Please bring your Surgical Passport along with any medical consultation documents that your surgeon may have requested at your pre-operative appointment.

Our team will also provide you with a brochure to guide you through the Surgery experience and maximize your comfort. The surgery team here at Madigan wants to provide you with a truly patient centered surgical experience and get you on the road to recovery swiftly and comfortably.
 

What should I bring to the Pre-Anesthesia appointment?

It is important to bring all documents listed below to your Surgical Services appointment in order to address any areas of concern relevant to your perioperative anesthesia care:

• The Surgical Passport (if applicable, your care team will provide)
• List of all current medications complete with dose and frequency to include all supplements and over-the-counter medications
• You may choose to expedite your Surgical Services appointment by filling out the required health history paperwork before your appointment time. Please print the Health History and Attendant/Escort material and bring completed paperwork on the day of your appointment. These documents can also be found in your Surgical Passport. Escort form
• Please bring any recent medical consult documentation your surgeon ordered at your pre-operative appointment. (Internal Medicine, Cardiology, etc.) * As a result of this medical review your anesthesia provider may wish to consult with other physicians to clarify any areas of concern or obtain information or specialized tests to ensure a safe and successful surgery.
• Please note that your pre-operative appointment with your surgeon and all medical consultations need to happen before your pre-anesthesia appointment in Surgical Services.

What to expect from your Anesthesia Care Team:

An Anesthesia Care Team, led by physician anesthesiologists will guide you throughout your entire surgical experience, including helping you prepare, during the procedure and after it is over as you recover.

Before surgery — In the days or weeks before your surgery, your physician anesthesiologist will be sure you are fit for surgery and prepare you for the procedure by asking detailed questions about your health, examining you, reviewing tests, and answering your questions about surgery and anesthesia. Be sure to let your anesthesia care team know about any medical problems you have, such as heart disease, diabetes or asthma, what medications you are taking (prescription, over-the-counter and herbal supplements) and whether you’ve had problems or concerns while having anesthesia in the past. Use this time to ask questions. Understanding your care will make you feel more comfortable and confident as you prepare for surgery. Your Anesthesia Care Team will create an anesthesia plan specifically developed for you to ensure a safe and successful procedure.

During surgery — The physician anesthesiologist manages your pain control and closely monitors your anesthesia and vital body functions during the procedure, working alone or with an Anesthesia Care Team. Your physician anesthesiologist will manage medical problems if they occur during surgery, as well as any chronic conditions you have such as asthma, diabetes, high blood pressure and heart problems.

After surgery — In the recovery room, the physician anesthesiologist supervises the nurse and others who care for you and monitor your recovery – including your breathing, circulation, consciousness and level of oxygen – and is immediately available if there are questions or concerns. The physician anesthesiologist typically is the person to decide when you are recovered from the effects of anesthesia and ready to go home or be moved to a regular room in the hospital or the intensive care unit. The physician anesthesiologist also creates a plan for your recovery and may be involved in pain management after you go home.

What Types of Anesthesia Are Available?

The three types of anesthesia used during surgery are:

Monitored anesthesia care or (MAC) — With MAC anesthesia, IV sedatives and pain medicines are administered by your anesthesia provider, and used in combination with a local anesthetic injected by your surgeon at the operative site. The level of sedation may range from minimal, making you drowsy but able to talk, to deep, meaning you probably won’t remember much of the procedure. MAC anesthesia often is used for minor procedures such as colonoscopies or cataract surgery.

Regional anesthesia — Local anesthetics may be administered by your anesthesia provider to numb larger parts of the body, such as the area below the waist (with spinal or epidural anesthesia), or an arm, hand or leg (with other regional anesthetic techniques). You may be sedated during the procedure, as required for your comfort, but unable to feel pain in the numbed area. This type of anesthesia is often used for childbirth and for surgeries of the arm, leg or abdomen.

General anesthesia — General anesthesia is administered by your anesthesia provider, and renders you unconscious throughout the surgical procedure. It may be administered through an IV, or inhaled through a breathing device, or a combination of both. General anesthesia is more likely, but not always, the anesthetic of choice for major surgical procedures.

The type of anesthesia you receive will depend on a variety of factors, including the type of procedure you are having, your health and in some cases, your preference.

Are there any side effects from anesthesia?

If you have general anesthesia, you will likely feel a little groggy or confused for a short time after waking up.

Other side effects can include:
Feeling sick to your stomach (nausea) and throwing up (vomiting) – Your Anesthesia Care Team can give you medicines for this problem. Please mention any history of nausea with anesthesia to your anesthesia provider. A sore throat – This can happen if you had a breathing tube. It usually gets better soon after surgery, rarely lasting longer than 24 hours.

People who have certain medical conditions or certain types of surgery can have trouble breathing after surgery and general anesthesia. People who have this problem sometimes need to keep the breathing tube and stay connected to the machine that helps with breathing for a while after surgery. They stay sedated for the entire time that the breathing tube is in place. Before surgery, your anesthesiologist will explain whether you are likely to have breathing problems.

Will I wake up during my surgery?

If you’re having a major surgery, such as a knee replacement or back surgery, you most likely will receive general anesthesia and be unconscious during the procedure. Very rarely, patients who have general anesthesia become aware or conscious during the procedure when the intention was for the patient to be unconscious. This is called anesthesia awareness, and it happens in only one or two out of every 1,000 medical cases involving general anesthesia in adults. Although it can be very unsettling, patients who experience awareness generally do not feel pain.

Anesthesia awareness is not the same thing as remembering some activities surrounding your procedure, such as just before the anesthesia starts working, or when its effects begin wearing off after the surgery. These are expected and normal. You might even dream during surgery, and only think you have experienced awareness.

The Morning of Surgery

• Follow the skin preparation guide provided by your surgery team. Do not shower the morning of surgery unless instructed to do so by your surgeon. Do not apply any lotions, creams, deodorant, cosmetics, colognes, nail polish, or personal products the morning of surgery.
• Plan to arrive early for check-in to allow time for parking and walking to your check-in location. All patients will report to the Day of Surgery Check-in Desk, located on the 2nd floor of the hospital tower. If you have any questions about when and where you should report the morning of surgery please call (253) 968-3015 (option# 2) during normal business hours. Please note that your check-in time is not the time your surgery will begin; it is the time necessary to prepare you for your procedure, this process can take up to two hours.
• We ask that you limit your adult escort to 1 person as space is limited. In most situations, you may have 1 adult escort stay with you until it is time to go to the Operating Room. Your family and friends may wait in the Surgery/Recovery Waiting area, and your adult escort may join them when you go to the Operating Room.
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At The Hospital

• Upon your arrival, you will be asked for your Military identification, and when you last ate or drank. It is very important to follow the eating and drinking guidelines outlined by your surgeon or Anesthesia provider. Failure to do so may result in cancellation, and will result in an 8 hour delay at a minimum at the discretion of the Anesthesia provider.
• After Check-in you can expect a visit from your Surgeon, Nurse, and Anesthesia provider who will go over your Surgical Plan, and address any last minute questions or concerns you may have. We encourage dialog and want to ensure you have all of your questions answered and understand your plan of care.
• An IV may be started at this time to provide a secure route for medication delivery during your procedure. At this time, the final preparations for surgery will occur, such as contact lens, denture, hearing aid, or eyeglass removal. These items will be returned to you following surgery.

After Surgery

• Following surgery, you will arrive in the Post Anesthesia Care Unit, also called the PACU. There you will be carefully monitored and a team of doctors, nurses, and support staff will ensure your pain is controlled and you are ready to be released. Your length of stay in the PACU will depend on the type of Anesthesia and type of surgery you had. The doctor will decide when you are ready to be released from the hospital or taken to an inpatient room where you will spend the night.