BEFORE YOU GO UNDER

For Submission to: AANS Neurosurgeon/BOOKSHELF

Before You Go Under:

A step by step guide to ease your

mind before going under anesthesia

By Benjamin Taimoorazy MD

Publication 2008 by AccuPress

ISBN 978-0-615-18470-78

So you are faced with more questions than you expected from a 23 year old female that you are planning to do a Chiari decompression that centers primarily around the coordination of the anesthetic delivery with the planned surgical procedure.  You are already forty-five minutes into the discussion and still need to address and hopefully alleviate concerns that she has with regards to herbal supplements she uses, and the fact that she has red hair and heard that this could possibly play a role in the duration of her surgery.  Furthermore, she has temporomandibular joint disease, an anxiety about the depth of her anesthetic knowing that her head will be fixated in a pinion device.  

A staggering thirty million medical and surgical procedures utilizing anesthetics are performed each year in the United States.  Neurosurgeons spend a great deal of their time not only explaining the benefits and risks of procedures, but must often address how and why certain anesthetic procedures may be employed during the course of a patient’s surgery in order to achieve maximum benefit and outcome.  Many patients offer challenges to both their surgeon and anesthesiologist in terms of their expressed fears in having a procedure done, and often times, the time spent with these patients may not fully allay their concerns.  

Dr. Benjamin Taimoorazy, a board certified anesthesiologist concentrating in neurosurgical procedures, has written a step by step guide that explains to patients in simple layman terms the process of anesthesia.  This manuscript details the different types of anesthetics commonly used including general, spinal, epidural, local, regional, and conscious sedation delivery choices and explains why some anesthesia types are better suited for certain types of procedures in patients than others.

Describing knowledge as a sort of empowerment to alleviate concerns toward an anesthetic delivery, Dr. Taimoorazy simplifies how an anesthetic works in an engaging form of educational material that will likely give the most apprehensive patient peace of mind.  

One of the most frequently asked questions from some of the most highly anxious patients is: “How will you know that I am adequately unconscious and won’t feel anything while you are operating?”  After all, this topic has been a favorite one from time to time among the media and has led to considerable hype.  Hence, this is an area of anesthesia that has been intensely studied and assurance to the patient is paramount. Before You Go Under underscores the role of the anesthesiologist in verifying the adequacy in depth of anesthesia explaining how brain function and memory formation are the primary targets of anesthetic medications.  The variety of monitoring devices including blood pressure, heart rate, breathing pattern, along with electroencephalogram wave patterns combined with the in depth understanding of human physiology provides the basis on which anesthesiologists render judgements on the adequacy of anesthetic delivery.  Equally important is an accurate accounting of the patient’s height, weight, medical conditions and history, medication use and herbal supplements, along with recent radiographic and laboratory test rest results, so that the anesthesiologist can accurately calculate the type, dosage and concentrations needed of an anesthetic medication.

Particularly important are conditions and situations that a patient may have that will have an impact on how they are managed in the operating room.  The author takes the time to explain how artificial implants and allergies may influence the timing, dosing and types of antibiotic delivery that may be used.  Also how smoking, weight, sleep apnea and co-existing disease may influence outcome and the precautions that should be in place to deal with these variables are dutifully reviewed.  

Besides covering the most common concerns raised by patients, less common topics that remained equally important to individual patients are also addressed, such as enduring nightmares during and after surgery, the fear of needles, headaches after anesthesia, blood transfusions, pregnancy, pediatric, and geriatric anesthesia are also addressed.

This book provides perhaps the most comprehensive review in simple everyday language to help even the most anxious patient feel prepared for a planned surgical procedure.  From start to finish, this is a quick read and should be part of armamentarium available to neurosurgeons who wish to see their patients successfully and completely prepare themselves for surgery.

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