Anesthesia is frequently a team effort consisting of the surgeon who may give a local anesthetic and/or a physician anesthesiologist and certified registered nurse anesthetist (CRNA) who may give sedation or a local, regional, spinal or general anesthetic.

• Preparation for anesthesia
  1. Pre-admission testing - the patient is evaluated by the anesthesiologist prior to surgery. The patient's heart and lungs are examined. The patient's medications are evaluated to be sure that there is no conflict with the anesthetic to be used. Any allergies are determined. To facilitate this process the patient may complete the Pre-Surgery Information Form and take it to the hospital
  2. Laboratory tests such as blood count, urine analysis and pregnancy test (between ages 12 yrs to 50 yrs) may be obtained. Other tests may include blood clotting studies, EKG (heart tracing) and chest X-ray
  3. The patient is kept without food or fluids for at least 6 hours before surgery. This assures that the stomach is empty and the patient will not aspirate stomach content should he/she vomits
  4. A needle is inserted into a vein to give fluids usually a saline and dextrose (salt and sugar) solution
• Local anesthesia - the injection of a drug into the skin or around a nerve in non-toxic concentrations to block pain impulses. (Figures 1,2) Sometimes the local anesthetic is mixed with a steroid (cortisone) to reduce inflammation. This is particularly so when used in a joint
  1. Local anesthesia is reversible with the length of the effect of the anesthetic varying depending on the drug used, the concentration of the drug and whether the drug is mixed with epinephrine
  2. Epinephrine causes the local blood vessels to constrict and thus slows the removal of the drug
  3. Some local anesthetics and their length of action when used for injecting in the skin or around a nerve are: