THOMAS EINSTEIN MD
Board Certified Anesthesiologist


Patient Care Comes First

Frequent Questions

  1. What are Dr. Einstein’s qualifications?
  2. “Propofol killed Michael Jackson.” Is that true? Is propofol a safe anesthetic?
  3. I am very sensitive to medications. I have trouble coming to after surgery. How will you wake me up after my procedure?
  4. I get nauseated after surgery. How will you prevent this?
  5. Do you use twilight anesthesia?
  6. What are the risks of anesthesia?
  7. Will I be asleep throughout my procedure?
  8. Will I have a sore throat?
  9. What if I have a complication?
  10. Will you use needles? I hate needles.
  11. Will you put a mask on my face?
  12. Is it dangerous to be under anesthesia for a long time?
  13. What are the different kinds of anesthesia?
  14. Why can't I eat before surgery?
  15. I am on medication. Should I take my medicine before surgery?
  16. What is the difference between inpatient and outpatient anesthesia?
  17. How will I be able to go home so soon after surgery?
  18. Does the anesthesiologist stay with me during surgery?
  19. Where do I go after surgery?
  20. Can I take ibuprofen at the same time as vicodin or percocet?
  21. I have additional questions about anesthesia. How can I get answers?

Answers

  1. What are Dr. Einstein’s qualifications?

    Dr. Einstein is board certified by the American Board of Anesthesiology. After graduating from college at UCSC and then medical school at UCLA, he completed five years total accredited training in both emergency medicine and anesthesiology. He passed both written and oral examinations administered by the American Board of Emergency Medicine and the American Board of Anesthesiology. Since 1986, he has worked exclusively as an anesthesiologist. He has extensive experience with patients of all ages and medical conditions both inside and outside of the hospital. In 1999, he obtained a general anesthesia permit from the dental board of California, certifying him to give anesthesia in dental and oral surgery offices.

  2. “Propofol killed Michael Jackson.” Is that true? Is propofol a safe anesthetic?

    The short answer is that Propofol is safe when given properly by an anesthesiologist.

    We don’t know all the facts about Michael Jackson’s unfortunate death. We do know from Michael Jackson’s autopsy report that he had significant amounts of propofol, and lorazepam (a sedative in the same family as valium) in his blood stream. The autopsy report concludes that someone other than Michael Jackson gave the propofol intravenously, without any monitoring devices. The consulting expert anesthesiologist noted that propofol is very safe and effective given by an anesthesiologist using the appropriate monitors, and equipment. The expert consultant stated that there is no medical reason for Michael Jackson to use propofol at his home.

  3. I am very sensitive to medications. I have trouble coming to after surgery. How will you wake me up after my procedure?

    The dose of the anesthetic, propofol is individualized for every patient and every surgery throughout the procedure. Propofol acts rapidly when given through the IV, and wears off very quickly when it is stopped. Propofol is given to the patient using an electronic pump programmed with the patient's weight. Observing the effect of the medication, and using a brain monitor, Dr. Einstein uses the pump to instantly increase or decrease the dosage as needed. When the surgery area is numbed up with local anesthesia, the patient will wake up right after surgery with little or no pain.

  4. I get nauseated after surgery. How will you prevent this?

    Nausea is extremely rare for Dr. Einstein’s patients, even if they have previously had problems. Most importantly, he avoids those medicines that cause problems. Certain medications frequently cause nausea in sensitive patients; especially opiate narcotics like morphine, demerol, oxycodone (ingredient of percocet), hydrocodone (ingredient of vicodin), and codeine (ingredient of Tylenol #3). Anesthetic gases, which are frequently given by most anesthesiologists, also cause nausea and vomiting. There are excellent new anti-nausea medicines including ondansetron, which can decrease problems dramatically. Some patients have a strong history of motion sickness, and are much more likely to have nausea after surgery. The transderm scop patch is an excellent choice in these cases. However, the best way to prevent nausea is not to use nausea provoking medicines in the first place.

  5. Do you use twilight anesthesia?

    “Twilight” anesthesia is a non-medical term used to indicate a condition between totally asleep and awake. Unfortunately, personnel not trained in anesthesia have often used this technique. They usually use a hodgepodge of different drugs, and are in poor control of the patient's anesthesia. Under twilight, patients often experience some pain during surgery, and wake up slowly after surgery. Post-procedure pain and nausea is common after twilight anesthesia.

    In contrast, Dr. Einstein is a board certified anesthesiologist who uses medication in a precise manner to control the patient experience. The patients are asleep and comfortable through their operations. They wake up immediately after surgery and are comfortable and usually ready for discharge in 30 to 45 minutes. Nausea is extremely rare. In the unusual case where a patient wishes to be awake during surgery, the anesthesiologist and the surgeon can use a combination of local and regional anesthesia, and short periods of sedation as needed to minimize any discomfort.

  6. What are the risks of anesthesia?

    Modern Anesthesia is extremely safe. The risks are lowest in those with no medical problems. The risks remain low if medical conditions are mild and/or well controlled. In ambulatory surgery centers with patients whose medical problems are generally well taken care of, the incidence of death due to anesthesia has recently been quoted as one in 200,000 patients. To minimize your risk of problems, your surgeon and Dr. Einstein will evaluate you, and work with your personal physician to make sure you are in the best possible condition before surgery. Your anesthesiologist will monitor you closely during surgery to treat you for any unexpected problem. Dr. Einstein is fully trained as an emergency physician and anesthesiologist, and is a certified provider of advanced cardiac life support. He works with a full set of emergency medications and devices in all practice settings. In the rare event that hospital care is needed, Dr. Einstein would call paramedics, and continue direct patient care during ambulance transfer to the hospital.

  7. Will I be asleep throughout my procedure?

    Patients are often concerned about awareness while having surgery. Although this is a very rare event, it has received a lot of media coverage recently. The worst horror story is: “I felt everything, but I couldn't move or speak.” These unfortunate patients received paralyzing medications (also called muscle relaxants), without adequate sedative, or sleep medications. This should never occur when anesthesia is properly administered and monitored. While many anesthesiologists routinely use muscle relaxants, Dr. Einstein uses them in only certain limited cases. In addition, Dr. Einstein routinely uses a BIS brain wave monitor, which continuously assesses brain electrical activity to help insure appropriate depth of anesthesia.

  8. Will I have a sore throat?

    Patients often suffer some sore throat after surgery, because many anesthesiologists routinely place breathing tubes in the nose or the mouth during surgery. To completely avoid this complaint, Dr. Einstein does not use breathing tubes routinely. However, in selected cases an artificial airway tube is necessary for patient safety. In those cases extreme care is taken to minimize any discomfort. The smallest possible airways are selected, and topical anesthetic liquids and lubricants are always used.

  9. What if I have a complication?

    Dr. Einstein can immediately handle most problems on site. If other physicians are needed, Dr. Einstein is on staff at Santa Monica UCLA hospital, and is familiar with a wide range of medical colleagues. Although it is exceedingly unlikely, in an extreme case Dr. Einstein would coordinate and supervise safe transfer to an appropriate hospital.

  10. Will you use needles? I hate needles.

    No one likes needles! We do need to place an IV (intravenous catheter) on all patients. This is a very slender plastic tube that is threaded over an even narrower needle into a vein in the arm, forearm, or hand. We usually pick the least painful site for the IV, which is typically at the elbow crease. We routinely use buffered (less painful) local anesthetic placed with the smallest needle available to numb the IV site before we place the IV, and we generally place small IV catheters. If even this is considered too painful by the patient, we will be happy to prescribe a topical anesthetic cream that can be placed one to two hours before surgery. We will work individually with patients who are extremely phobic and work out a strategy including oral sedatives before their procedures.

  11. Will you put a mask on my face?

    In any facial procedure, it is extremely unlikely that a mask will be used. For other procedures, Dr. Einstein usually uses small gentle nasal prongs for giving supplemental oxygen. If a mask is used it only placed on the face when you are asleep.

  12. Is it dangerous to be under anesthesia for a long time?

    With the appropriate treatment and monitoring there should be little or no increased risk in a longer surgery. The rare, but most severe risk in long surgeries is blood clot formation in the legs. These clots can travel to the lungs and cause severe breathing and circulation problems. This is rare, but happens more often when the legs are immobile for long periods of time as during surgery or on a long trip. To decrease this risk, we routinely place sequential compression (SCD) stockings. These stockings squeeze the leg muscles every few minutes to mimic the normal pumping action of the legs, and prevent clot formation.

  13. What are the different kinds of anesthesia?

    There are several broad categories of anesthesia. These include local anesthesia, regional anesthesia, general anesthesia and monitored anesthesia care. A wide variety of techniques and medications can be used to accomplish each of these types of anesthesia. To give local anesthesia, we inject anesthetic medication directly into an area to rapidly numb it up before surgery.

    For regional anesthesia, we inject small amounts of local anesthetics in strategic points to numb up wide areas. Examples of regional anesthesia include spinal and epidural anesthesia, as well as forehead blocks and intercostal (between the ribs) blocks.

    General anesthesia is accomplished by giving enough medication to stop pain pathways in the brain, so that patients will no longer react to what would normally be painful stimuli. The anesthetics are given either IV (intravenously) as a liquid, or by inhalation as a gas, or by a combination of gas and IV.

    Monitored Anesthesia Care or MAC refers to a combination of anesthetic techniques. Typically the surgeon and/or anesthesiologist give local and/or regional anesthesia. In addition medication is usually given intravenously, to maintain a comfortable state throughout surgery. Patients can be kept asleep or awake as desired. In all types of anesthesia, the anesthesiologist observes the patient directly, and also uses sophisticated electronic monitors to continually assess the patient's comfort, and assure the patient's safety.

  14. Why can't I eat before surgery?

    Patients are asked to fast before surgery to minimize the risk of aspiration pneumonia (lung infection). Normally, we will not inhale food particles into the lungs, because we have a gagging or protective reflex. This protective reflex can be decreased under anesthesia. If food comes up from the stomach, it can enter the lungs and cause severe breathing problems. Although serious, this is a rare complication that can be further minimized by fasting before surgery. Patients who have stomach or esophagus problems involving acid or reflux may be at increased risk for aspiration. If you regularly take acid blocking medication, it is a good idea to take it on schedule before your procedure. If you have any questions about acid or reflux, notify your surgeon and anesthesiologist, since appropriate preoperative medication in addition to fasting can be very helpful.

  15. I am on medication. Should I take my medicine before surgery?

    Generally we prefer patients to continue their routine medications before surgery. There are some medications that should not be taken before surgery. We will discuss these with each patient before his or her procedure.

  16. What is the difference between inpatient and outpatient anesthesia?

    Outpatient anesthesia is designed to get patients awake and comfortable as soon as possible after surgery. The medications that are used for sedation will wear off quickly. Longer acting local anesthetics and other medications are used, so that our patients are comfortable when they wake up. They will be easily taken care of at home, or at an after care facility. Dr. Einstein uses similar medications for inpatients. In addition more advanced longer-term pain treatments like epidural catheters can be use on inpatients.

  17. How will I be able to go home so soon after surgery?

    The medicines we use are fast acting, and wear off quickly. We use long acting local anesthetics, and other medications to wake you up in comfort.

  18. Does the anesthesiologist stay with me during surgery?

    Proper anesthesia is a one on one experience. In the office setting, Dr. Einstein will monitor you from the IV start until the time you wake up.

  19. Where do I go after surgery?

    For the vast majority of procedures, you can go home with a responsible adult. We give patients specific instructions with 24-hour follow-up telephone numbers for any questions or problems. If some professional aftercare is needed we can coordinate with you and the facility to best fit your needs.

  20. Can I take ibuprofen at the same time as vicodin or percocet?

    Ibuprofen (Advil or Motrin are brand names) is a non-steroidal anti-inflammatory (NSAID). Vicodin is a combination of acetaminophen (Tylenol is a brand name) and the opiate narcotic hydrocodone. Percocet is a combination of acetaminophen and the opiate narcotic oxycodone. Dr. Einstein commonly recommends taking an NSAID routinely post-op, and the acetaminophen/narcotic combination only as needed. Many NSAIDS interfere with platelet function, which may increase risk of post-procedure bleeding. If this is of concern to the surgeon, a more selective NSAID like celecoxib (Celebrex is the brand name), or other pain medications may be prescribed.

    Taking Vicodin or Percocet consistently together with Tylenol can lead to acetaminophen toxicity, affecting the liver. This should be avoided!

  21. I have additional questions about anesthesia. How can I get answers?

    You can email Dr. Einstein at einstein@einsteinanesthesia.com for any other anesthesia related questions.