Howard County Anesthesia Associates, PA (formerly known as John C. Payne, PA) has been providing high quality anesthesia services for patients since 1973 here at Howard County General Hospital (HCGH).
Howard County Anesthesia Associates, PA is comprised of 20 board-certified anesthesiologists and nurse anesthetists providing a variety of anesthetics for our impressive volume of surgical cases. Last year, more than 13,000 surgical cases were performed and we helped deliver more than 3,000 babies.
Although our anesthesia services assist almost all hospital departments, the bulk of Anesthesia care is seen in:
- The main Operating Rooms
- The Health Care and Surgery Center (TCAS/Same Day Surgery)
- Labor and Delivery Suite
- Interventional Radiology/Cath Lab
- Intensive Care Unit
- Emergency Department
What do anesthesiologists/nurse anesthetists do?
Anesthesiologists play a critical role before, during, and after surgery. They monitor and treat patients’ acute pain from the time surgery begins, while they are asleep, and until they have recovered and left the post anesthesia care unit (PACU). They diagnose and treat any medical problems that may arise during surgery or recovery and make informed medical decisions to protect and regulate critical life functions that may be affected by surgery.
Howard County Anesthesia Associates, PA also employs nurse anesthetists who assist with anesthesia care. Your safety and comfort during your surgical procedure are our primary goals and we do everything possible to help facilitate your recovery.
- Anesthesia Options, Risks & Side Effects
- Obstetrics - Epidural & Spinal Anesthesia
- Pediatric Anesthesia
- Joint Replacement Anesthesia
Anesthesia Options, Risks, and Side Effects
What are your options for anesthesia?
Depending on the type of procedure and your health status, you may have a number of options for anesthesia.
- Local anesthesia: only the surgical area will be anesthetized.
- Regional anesthesia: a larger part or portion of the body is anesthetized. Epidurals and spinals are both forms of regional anesthesia that involve precise injections of anesthesia in appropriate areas of the back.
- Epidurals, where anesthesia is given below the level of the spinal cord through a special needle, are often used for childbirth, but are also an option for many orthopedic procedures because they can provide extended pain relief.
- Regional anesthesia for extremity surgery involves injecting anesthetics into an area where there is a concentration of nerves for that particular extremity in order to block pain. This allows the patient to be awake for surgery and provides pain relief for a time after surgery.
- General anesthesia: IV medications and anesthetic gases induce temporary unconsciousness so you cannot feel pain during the operation. Our operating rooms are equipped with the latest technology to monitor’s a patient’s level of consciousness which can help determine the amount of medication or anesthetic agent needed to meet the needs of each individual patient.
- Sedation anesthesia: pain relievers and sedatives are given to minimize pain and discomfort during a procedure. You are able to communicate during the procedure, but there is often little memory of the procedure afterwards.
What are the risks of anesthesia?
While usually very safe, no procedure is without some degree of risk and your anesthesiologist will discuss this with you prior to your surgery. Many factors contribute to the increased safety of general anesthesia, including safer drugs, more extensive training of anesthesiologists, and national standards of care. You should discuss any concerns with your anesthesia professional. What are possible side effects of anesthesia?
Nausea and vomiting are more likely with general anesthesia and lengthy procedures. In most cases, nausea does not last long and can be treated with anti-emetic medicines.
Hypothermia (low body temperature) may cause you to feel cold and shiver when you are waking up due to a mild drop in body temperature that is common during general anesthesia. Special measures are taken during surgery to keep your body temperature from dropping too much.
Impaired coordination or judgment can result due to the effect general anesthetics can have on the central nervous system. You may feel drowsy, weak or tired for several days and have blurred vision and fuzzy thinking. You should not drive, operate machinery, or perform other activities that could endanger yourself or others for 24 hours or longer.
Obstetrics - Epidural & Spinal Anesthesia
Howard County Anesthesia Associates, PA will work closely with your obstetrician to help you through the birthing process by offering pain relief to make the labor and delivery of your baby as safe and comfortable as possible.
We want you to make informed decisions about the care you will receive during the delivery of your baby, including the kind of anesthesia you choose. The following information about the state-of-the-art pain relief techniques we routinely use here at Howard County General Hospital will help you decide how you want to manage your labor pain.
The benefits of epidural and spinal anesthesia over systemic narcotics
There are two basic approaches for using medication to manage labor pain. One method uses systemic narcotics, such as Nubain®, which acts throughout your “system” or body by traveling through the bloodstream to the brain to “numb” the pain. The other methods – epidurals and spinals – are called regional anesthesia because the medication is administered into a specific region of the body to numb pain.
Systemic medications produce drowsiness and sedation in addition to pain relief while the epidural or spinal medication acts only locally, so you will be comfortable, alert and able to fully participate in the birthing process. Epidurals and spinals also require a smaller dose of medication to relieve the pain, resulting in less medication being transferred to your baby than with use of systemic narcotics.
Having an epidural catheter in place also provides “insurance” against the need for general anesthesia in the event of an emergency Cesarean section. Your anesthesiologist will simply administer a stronger local anesthetic through your epidural catheter. (read more)
Epidural versus spinal or combined spinal-epidural techniques
Both epidural and spinal anesthesia involve blocking the transmission of pain signals close to their point of origin and each technique has its particular advantages and disadvantages. One advantage of the epidural is that medication can be administered continuously through an epidural catheter (a thin plastic tube inserted into the space next to the spinal cord), providing pain relief throughout labor and delivery or after surgery should a cesarean be necessary.
Spinal and combined spinal/epidural techniques have their own distinct advantages. Because spinals involve injecting a numbing medication directly into the spinal fluid, they take effect more quickly than epidurals and produce a more pronounced pain relief.
The type of pain relief technique you will receive will be tailored to suit your needs.
Epidural frequently asked questions
Cesarean section (C-section) anesthesia
FAQs - Epidural Analgesia
Q: Am I required to have an epidural?
A: No. An epidural is one option for pain relief during labor, but is usually done at your request and with your consent.
Q: What other methods of pain relief are available?
A: For some women, massage and breathing techniques may be adequate, and narcotic drugs are also available, although they might not provide as effective pain relief as an epidural. Your doctor may also inject a local anesthetic to the birth canal at the time of delivery.
Q: Are there patients who cannot have an epidural?
A: Certain medical conditions such as bleeding disorders, infections at the site of epidural, spine surgery or disease of the nervous system might make an epidural unadvisable. You should discuss any concerns with your anesthesiologist.
Q: Is an epidural painful?
A: A local anesthetic, which stings for a few seconds, is injected under the skin before insertion of the epidural to make you more comfortable. You may experience a feeling of pressure in the back during insertion. View an animated demonstration of an epidural insertion.
Q: Will the epidural slow my labor?
A: The dose and timing of an epidural are carefully tailored to your needs during labor. In fact, an epidural can improve the descent of your baby by relieving pain and relaxing the pelvic muscles.
There is controversy about whether epidurals and spinals will slow labor. This is not normally an issue during the first stage of labor (from the onset of regular contractions to full dilation of the cervix). However, it is possible that these techniques may prolong the duration of the second stage of labor (from full cervical dilation until delivery of the baby) by a few minutes.
The challenge of obstetric anesthesia is to make you as comfortable as possible without compromising your ability to push out your baby. To prevent this, we may slow or stop the infusion of epidural medication to enable you to regain some sensation of pushing and/or muscle strength. Because the epidural catheter remains in place, we can always administer additional doses if needed. Every woman is unique, and we will customize your pain relief to make you as comfortable as possible during the entire labor and delivery process.
Q: When should I have my epidural?
A: Most patients are able to receive an epidural once they are in adequate or active labor. Your provider will help you determine the best time for you, depending on your specific circumstance. An anesthesiologist is available for laboring patients around the clock to provide this service.
Q: How long does it take the epidural to work?
A: Normally, it takes 10 to 15 minutes for the epidural to take full effect. For women who receive the epidural in the active stage of labor, analgesia can take up to 20 minutes.
Q: Will I be numb?
A: The goal of epidural anesthesia is pain relief rather than total numbness, which can lead to decreased ability to push the baby out. Most patients experience numbness or tingling after the initial dose of medication, then gradually less numbness but continued pain relief. Patients are often aware of their contractions, but they should not be painful. As labor progresses, especially close to delivery, you may experience more pressure; this is difficult to alleviate and attempts to do so can lead to ineffective pushing, which can delay delivery.
Q: Will the epidural/spinal last long enough?
A: Yes. Epidural catheters are connected to a continuous infusion of medication that is stopped only after the baby is delivered. Except in rare circumstances, spinal anesthetics greatly exceed the time required for a Cesarean section.
Q: What if the epidural does not work?
A: The anesthesia team will assess the patient's response to the initial dose of medication. If the relief is not satisfactory, the epidural is reassessed. Options include administering additional medication, adjusting the catheter, or replacing the catheter.
Q: What if I need a C-Section?
A: Various factors influence the choice of anesthesia for a Caesarean section, but they are usually done under epidural or spinal anesthesia. You are numb from the level of the nipple line down, but will remain awake during the birth of your baby and your partner may be present.If your baby needs to be delivered quickly due to an emergency situation or if epidural or spinal anesthesia is not adequate, general anesthesia may be necessary. (read more)
Q: Will any of these the medication affect my baby?
A: Medications used for labor and delivery are safe and normally do not affect the baby. Spinal and epidurals can cause the mother's blood pressure to decrease in the first few minutes, but your vital signs will be followed more frequently during this period and your anesthesiologist and nurse will closely monitor you and your baby throughout your labor and delivery.
Q: What are the risks and side effects of an epidural (or spinal)?
A: Some women experience a persistent headache. Other complications include incomplete anesthesia, low blood pressure, shivering and nausea. Recent studies have ruled out long-term back pain as a side effect of epidural anesthesia.
Q: What is a bolus?
A: A bolus is the administration of additional medication(s) through an epidural to alleviate pain.
Q: What is a PCEA?
A: PCEA stands for Patient Controlled Epidural Anesthesia and is a method that allows you to administer your own "extra" dose of medication if the pain intensifies.
Cesarean Anesthesia (C-Section)
Various factors influence the choice of anesthesia for a Caesarean section, but they are usually done under epidural or spinal anesthesia. You are numb from the level of the nipple line down, but will remain awake during the birth of your baby and your partner may be present.
If your baby needs to be delivered quickly due to an emergency situation or if epidural or spinal anesthesia is not adequate, general anesthesia may be necessary.
If an epidural catheter is already in place and you require a Cesarean section, you will simply receive a stronger dose of local anesthetic through your catheter. If you are scheduled for an elective Cesarean delivery or if a Cesarean delivery becomes necessary before you have epidural or spinal pain relief, four options are available:
- epidural anesthesia
- spinal anesthesia
- combined spinal-epidural anesthesia or
- general anesthesia (read more)
We usually do not use spinal anesthesia alone, because it is advantageous to have an epidural catheter in place to deliver pain medication after the surgery. General anesthesia is normally used only in emergency situations when there is insufficient time to perform regional anesthesia or if you have a condition that prevents use of a spinal or epidural anesthetic.
After a Cesarean you will routinely receive a medication called Duramorph through your epidural catheter that will give you pain relief for more than 24 hours. You may also get medication to control your pain through your IV or by mouth.
Pediatric Anesthesia
Pediatric anesthesia for ambulatory and same-day procedures
Having a surgical procedure can be a scary time for a child and stressful for his or her parents. Howard County Anesthesia Associates, PA wants to alleviate your concerns by helping you better understand the anesthesia process from start to finish and what is required of you before, during and after your child’s hospital visit.
Frequently Asked Questions:
Q: Why must my child fast before surgery?
A: Fasting prior to surgery is required to reduce the risk of your child breathing in any food or liquid while under anesthesia. While rare, this is very serious complication and parents need to strictly follow our recommendations and very specific policies regarding children’s ages and time periods for fasting, which are based on safety standards. We will recommend a fasting time that is as short as possible.
The following guidelines for fasting times prior to surgery apply to healthy patients who are having elective surgery. A history of diabetes or reflux may require longer fasting times:
- Clear liquids – two hours
- Breast milk – four hours
- Infant formula – six hours
- Nonhuman milk – six hours
- Light meal – six hours
Q: What if my child becomes ill prior to surgery?
A: Please let your doctor know before the scheduled day of surgery if your child is coming down with an illness or has any nausea or vomiting. Even minor illnesses, such as the sniffles, may cause problems during surgery in small children, and your doctor and anesthesiologist may recommend postponing surgery. Please call (410) 740-7795 and ask for the anesthesiologist on call if you have any concerns.
Q: How can I help alleviate my child’s fears?
A: Talk with your child and make a plan for what to do if he or she feels nervous. Some things that might help are reading a book, telling a story, taking deep breaths or talking about something fun you like to do together.
Stay calm - your child will take cues from you. Comfort and encourage your child, stay close, hold hands, respect his or her feelings and let your child know he or she is doing a good job.
Q: Who will provide anesthesia?
A: A team consisting of our anesthesiologists working with a certified nurse anesthetist will care for your child.
Q: Will my child receive any sedatives before surgery?A: Many children need less sedation when their parents can help them through the stress of a procedure. Some children, however, may require medicine, given by mouth or injection, to calm them before a procedure. Your anesthesiologist will determine the time and type of such premedication if required.
Q: May I enter the operating room with my child?
A: Depending upon the circumstances, you may be permitted to be in the operating room. Please feel free to discuss the options with your anesthesiologist.
Q: How will my child receive anesthesia?
A: Most children under the age of ten initially receive anesthesia by breathing a combination of anesthetic medications and oxygen through a mask. After they are asleep, they may require an intravenous line (IV) for fluid and additional anesthetic medications. Older children, like adults, often receive anesthesia through an IV. Your anesthesiologist will discuss these options with you and your child.
Q: What will happen as my child falls asleep?
A: Your child’s breathing may become heavier or louder and his body limp and relaxed with deeper sleep. Sometimes there is an “excitement phase” when you may notice subtle or active movement, but your child will be unaware of this and it will pass quickly. Your child’s eyes may be only partially closed. All of this is completely normal and your anesthesiologist will let you know when your child is asleep and it is time for you to leave.
Q: How Long Will It Take for My Child to Go to Sleep?
A: It takes approximately 30 to 60 seconds to go to sleep when breathing through a mask; when a child receives anesthesia through an IV, it takes less than 10 seconds.
Once your child is asleep, a nurse will escort you from the OR to the surgical waiting area so that the staff can focus on taking care of your child. We recommend that you eat something while your child is in surgery as you will need energy to help your child during recovery.
Q: When will I see my child after surgery?
A: Anesthesiologists frequently allow parents to be with their child in the Post Anesthesia Care Unit (PACU) but sometimes this may not be possible. We will make every effort to reunite you with your child as soon as possible.
Q: What Can Parents Expect in the (PACU)?
A: Each child wakes up differently – some more quickly than others. How quickly children wake up is affected by the length of surgery and the types of medications used.
Frequently children wake up disoriented, crying and restless with their eyes open even though they may not be fully awake. This is very common and does not always mean your child is experiencing pain. Most children do not remember this transition period.
As the anesthesia continues to wear off after several minutes, your child should begin to relax. Sometimes children receive pain or sedative medications to help calm them even when they are not experiencing pain. The staff will carefully monitor your child to assess pain and will let you know what is happening.
Q: How long will my child remain in the PACU?
A: This depends on the type of surgery your child has, how much anesthesia was required, how quickly he or she wakes up, and what medications are given in the PACU. The average recovery time is 90 minutes, but with shorter surgeries, such as ear tube insertion, the stay is usually between 30 and 60 minutes.
Please call (410) 884-4501 if you would like to schedule a preoperative tour.
Joint Replacement Anesthesia
By this time, you already have visited your orthopedic surgeon and decided to have your total joint replacement at Howard County General Hospital.
You’ve also have seen your primary care physician, who completed your history and physical examination, ordered routine lab tests and possibly a chest X-ray and EKG. These tests must be completed prior to your surgery.
Many patients choose to donate blood prior to surgery. Feel free to discuss this option with your orthopedic surgeon.
Next, you should meet with one the anesthesiologists at Howard County Anesthesia Associates, PA prior to your surgery. At your preoperative meeting, the anesthesiologist will review your medical history and discuss all available options with you. Our goal is to provide you with the anesthetic approach that will control your postoperative pain to get you up and moving and able to follow through with your physical therapy shortly after surgery.
Frequently asked questions about joint replacement anesthesia
- Q: What are my anesthesia choices for my total joint replacement?
- A: Typically there are four options for anesthesia:
- Femoral nerve block catheter placement plus general anesthesia
- Epidural/spinal neuroaxial technique plus sedation
- Femoral/nerve block and epidural/spinal technique with sedation
- General anesthesia
Q: How is my post operative joint pain controlled?
A: With a nerve block and/or patient-controlled analgesia (PCA), which allows you to self-administer pain medicine through an IV by pushing a button. If you have a PCA, your doctor will order the machine set to dispense the appropriate narcotic at the appropriate dosage. These settings are based on your height and weight and your level of pain. By the second day, you will take your pain medicine orally.
Q: How does the nursing staff know how much pain I am in?
A: Our staff will do its best to stay ahead of your pain by keeping an open line of communication with you. You may be asked to rate pain on a scale of 0-10, where 0 means no pain and 1 or 2 means discomfort. It is important to get relief for your pain when it reaches 5 or 6. If you allow it to reach 9, it could take two to three hours to get relief. Different medication delivery systems take different times to have an effect: approximately three minutes for PCA or IV medication, 10-15 minutes for a shot in the muscle and about an hour for an oral pain pill.
Q: What is a nerve block?
A: A regional nerve block is a general term used to refer to the injection of local anesthesia near nerves for temporary control of pain. Nerve blocks are sterile procedures that are usually performed with the help of an ultrasound machine, which enables the anesthesiologist to view needle placement.
Q: Are there any risks with getting a nerve block?
A: Nerve blocks, like other medical procedures, are not risk free. There is a possibility of side effects and complications from the procedure, needle puncture, and medications used. The most critical factor in the efficacy of a nerve block is the proper location of the target nerve, which is why we use an ultrasound machine.
Complications may include:
- Infection
- Allergic reaction
- Nerve injury
- Intravascular injection of the local anesthesia
- Bleeding
Q: What specific type of nerve block will I get for my knee replacement?
A: A femoral nerve block, which is an injection of local anesthesia into the groin and close to the nerve to provide pain relief to the front of the thigh and the knee. The groin is the fold at the top of your leg where the abdomen meets either thigh. After cleaning the groin under sterile technique, an ultrasound machine is used to locate the femoral nerve. After the injection, a catheter is left behind close to the proximity of the nerve which connects to a pump and will continue providing pain relief for 48-72 hours after the operation.
Q: What is the advantage of a continuous femoral nerve block?
A: The nerve block will provide pain relief during surgery and for days after the operation. This reduces the amount of strong painkillers, such as morphine, fentanyl, and Dilaudid during and after the surgery. Knee surgery can be very painful, and our goal is that you feel as little pain as possible.
Q: Who is a not a candidate for a femoral nerve block?
A. In the presence of the following specific medical situations, a femoral nerve block should not be performed:
- Taking medication that prevents your blood from clotting, such as Warfarin, which would lead to more bleeding than normal. Bleeding around the nerves in the leg is a serious problem that must be avoided.
- An illness that prevents your blood from clotting, such as hemophilia, which would also lead to more bleeding around the nerves in the leg.
- Infection of the skin over the site where the needle needs to be put could lead to further infection in the deeper tissues and possibly introduce the infection into the blood stream. This could also cause infection around the nerves.
- Any systemic infections
- Any baseline neurological deficits already present, such as neuropathy secondary to diabetes or other conditions
- Previous injury affecting your femoral nerve