• Your comfort and well-being is our goal.
• We tailor the anesthesia to your needs.
  • General Anesthesia
  • Regional Anesthesia
  • Monitored Anesthesia Care (MAC)
  • Local Anesthesia
• We strive to minimize your risks of complications. 
  
• What questions can we answer for you?  Medications, tests, foods, etc.
  • What can you eat and drink before surgery?
  • What tests do you need to have before surgery?
  • When do you need to have pre-operative testing?
  • What medications should you STOP before surgery?
  • What medications may you take on the day of surgery?
  • What if you use a CPAP machine at home for sleep apnea?
  • What if you have a pacemaker or internal defibrillator?
  • What else do you need to know?  Forms, directions, etc?
  • How do you get in touch with the hospital or surgery center?
  • Do you have a question about your anesthesia bill?
• Help us make your experience better.

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Your comfort and well-being is our goal.

Around the time of surgery, a variety of factors impose stress on you and your body.  Anxiety, pain, discomfort, and illness may cause stress before surgery.  During surgery, your body responds by activating the autonomic nervous system, releasing stress hormones and factors, and causing inflammation.  After surgery, pain and discomfort again induce stress. 

Allied Anesthesia is committed to relieving you and your body of these stresses.  We will provide you with state-of-the art medications, procedures, and equipment.  In addition, we will help you through this difficult process with the utmost support and care.   We are down-to-earth people who can relate well to you and your family’s members.  We take pride in caring for the people of Orange County when you need to have surgery and anesthesia.   We are neighbors taking care of neighbors. 

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We tailor the anesthesia to your needs.

In consultation with your physicians, we will offer you anesthetic plans that will be tailored to meet your unique, individual needs.  They may consist of general anesthesia, regional anesthesia, monitored anesthesia care, local anesthesia, or a combination of thereof.

General Anesthesia
(Administration of Intravenous Anesthetic Medications and Respiratory Gases)

1. Endotracheal Anesthesia
   Anesthetic and breathing gases are passed through a soft plastic tube placed in the windpipe (trachea) via the nose or mouth.
2. Mask Anesthesia
   Anesthetic and breathing gases are passed through a facemask, which covers the nose and mouth, or through a Laryngeal Mask Airway (LMA), which is inserted inside the mouth and covers the windpipe’s opening (larynx).
3. Other forms of anesthesia with gases as indicated.

Regional Anesthesia

1. Epidural Anesthesia
   A small tube (catheter) is inserted into the epidural (outside of the spinal) space so that anesthetizing medications may be given to produce loss of sensation.
2. Spinal Anesthesia
   The anesthetic medications are injected directly into the spinal space to produce a loss of sensation. 
3. Nerve Blocks
   Local anesthetizing medications are injected into specific areas to produce a loss of sensation.

Monitored Anesthesia Care (MAC)
We will monitor your blood pressure, heart rate, oxygen level, and mental status, while giving you sedation and pain relief as needed.

Local Anesthesia

1. Local Anesthesia
   Anesthetic medications are injected or infiltrated directly into a small area of the body like the surgical site.
2. Topical Anesthesia
   Surface anesthesia is produced by direct application of anesthetizing medications on the skin or mucous membrane.

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We strive to minimize your risks of complications. 

Thanks to the advances in knowledge, skill, and technology, anesthesia today is safer than ever.  As the anesthesia provider for the third busiest hospital in California (St. Joseph Hospital) and the largest children’s hospital in Orange County (Children’s Hospital of Orange County), we aptly apply these advances to provide the best possible anesthetic care for our patients.  While the risks of complications from anesthesia will never be completely eliminated, we do everything we can to minimize them.

These risks may include but are not limited to:  allergic and adverse reaction to medications, nausea, vomiting, pain, sore throat, backache, headache, muscle aches, localized swelling and redness, dental injury, eye injury, positional nerve injury, aspiration, pneumonia, infection, wrong site for injection of anesthesia, inability to reverse the effects of anesthesia, recall of sound/noise/speech made by other people, seizure, paralysis, brain damage, coma, and death.

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What questions can we answer for you?  Medications, tests, foods, etc.

What can you eat and drink before surgery?

For Adults:

• No solid food and/or non-clear, full liquids up to eight (8) hours before surgery.
• Only clear liquids up to four (4) hours before surgery.
• Nothing by mouth for the four (4) hour period immediately before surgery.
• Solid Food and/or Non-Clear, Full liquid = foods, milk, juice, nectar, vegetable juice, Jell-O, gum, and candy mints.
• Clear Liquids = clear apple juice, sugar water, water, 7-up, balanced salt solution (Gatorade type solution).

For Children:

• Less than 6 months of age,
• No clear liquids up to three (3) hours before surgery.
• No breast milk up to four (4) hours before surgery.
• No formula milk up to six (6) hours before surgery.
• No solid food up to eight (8) hours before surgery.
• 6 months of age or older,
• No clear liquids up to three (3) hours before surgery.
• No breast milk up to six (6) hours before surgery.
• No formula milk up to eight (8) hours before surgery.
• No solid food up to eight (8) hours before surgery.
• Solid Food = foods, non-human milk, juice, nectar, vegetable juice, Jell-O, gum, and candy mints.
• Clear Liquids = clear apple juice, sugar water, water, 7-up, balanced salt solution (Gatorade type solution).

Caution:  Undigested foods and drinks could cause problems and may require rescheduling of your surgery.

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What tests do you need to have before surgery?

In 2002, a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation gave the following Practice Advisory:

Electrocardiogram (ECG)

Important clinical characteristics to consider may include cardiocirculatory disease, respiratory disease, and type or invasiveness of surgery. Electrocardiogram abnormalities may be higher in older patients and in patients with multiple cardiac risk factors.  Age alone may not be an indication for an electrocardiogram. An electrocardiogram may be indicated for patients with known cardiovascular risk factors or for patients with risk factors identified in the course of a preanesthesia evaluation.

Cardiac Evaluation (other than Electrocardiogram).

Clinical characteristics to consider include cardiovascular risk factors and type of surgery.

Chest Radiographs (X-ray).

Chest radiographic abnormalities may be higher in patients with extremes of age, smoking, stable COPD, stable cardiac disease, or resolved recent upper respiratory infection, but there is no unequivocal indication for chest radiography for patients.

Pulmonary Evaluation (other than Chest X-ray).

Clinical characteristics that should be considered include the type and invasiveness of the surgical procedure, interval from prior evaluation, treated or symptomatic asthma, symptomatic COPD, and scoliosis with restrictive function.

Hemoglobin or Hematocrit.

Routine hemoglobin or hematocrit is not indicated. Clinical characteristics to consider as indications for such tests include the type and invasiveness of the procedure, patients with liver disease, extremes of age, history of anemia, bleeding, and other hematologic disorders.

Coagulation Studies (e.g., INR, PT, PTT, platelets).

Clinical characteristics to consider for ordering selected coagulation studies include bleeding disorders, renal dysfunction, liver dysfunction, and type and invasiveness of procedure. Anticoagulant medications and alternative therapies may present an additional perioperative risk. There are not enough data to comment on the advisability of coagulation tests before regional anesthesia.

Serum Chemistries (i.e., Potassium, Glucose, Sodium, Renal and Liver Function Studies).

Clinical characteristics to consider before ordering such tests include likely perioperative therapies, endocrine disorders, risk of renal and liver dysfunction, and use of certain medications or alternative therapies.

Urinalysis.

Urinalysis is not indicated except for specific procedures (e.g., prosthesis implantation, urologic procedures) or when urinary tract symptoms are present.

Pregnancy Testing.

A history and physical examination may be insufficient for identification of early pregnancy. Pregnancy testing may be considered for all female patients of childbearing age. Clinical characteristics to consider include an uncertain pregnancy history or a history suggestive of current pregnancy.

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When do you need to have pre-operative testing?

In 2002, a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation gave the following Practice Advisory:

Test results obtained from the medical record within 6 months of surgery are generally acceptable if the patient's medical history has not changed substantially. More recent test results may be desirable when the medical history has changed, or when test results may play a role in the selection of a specific anesthetic technique (e.g., regional anesthesia in the setting of anticoagulation therapy).

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What medications should you STOP before surgery?

Some medications may need to be stopped before surgery. Please discuss the medications that you are currently taking with your surgeons and physicians to see if you need to stop taking any of them prior to your surgery.  Below is a list of medications that you will want to talk about.

Warfarin (Coumadin)
If you take Coumadin, please discuss this with your surgeons and physicians at least seven (7) days before your operation. You need to obtain special instructions about when to stop this medication.
Enoxaparin (Lovenox)
If you take Lovenox, please discuss this with your surgeons and physicians as soon as possible. You need to obtain special instructions about when to stop this medication.
Clopidogrel (Plavix)
If you take Plavix, please discuss this with your surgeons and physicians as soon as possible. Follow your surgeon's instructions whether to continue taking your Plavix or whether to stop taking it before your operation.
Ticlopidine (Ticlid)
If you take Ticlid, please discuss this with your surgeons and physicians as soon as possible. Follow your surgeon's instructions whether to continue taking your Ticlid or whether to stop taking it before your operation.
Persantine
If you take Persantine, please discuss this with your surgeons and physicians as soon as possible. Follow your surgeon's instructions whether to continue taking your Persantine or whether to stop taking it before your operation.
Fosamax
If you take Fosamax, please discuss this with your surgeons and physicians as soon as possible. Follow your surgeon's instructions whether to continue taking your Fosamax or whether to stop taking it before your operation.
Aspirin Drugs
If you take products containing Aspirin, please discuss this with your surgeons and physicians at least ten (10) days before your operation. You need to obtain special instructions about when to stop this medication.
Examples of aspirin products are:

Alka-Seltzer Anacin Anodynos Arthritis Pain Formula Arthritis Strength BC Powder Arthritis Strength Bufferin Asa Enseals Asa Suppositories Ascriptin Aspercin/Extra Aspergum Aspermin/Extra Aspirin Aspirtab/Maxumum Azdone Tablets Back-Quell Bayer Aspirin BC Arthritis Strength Powder BC Cold Powder Multi-Symptom Formula/Non-Drowsy Formula BC Powder/Tablets Buffaprin/Extra Buffasal/Maximum Buffects II Bufferin Buffex Buffinol/Extra Cama Arthritis Pain Reliever Damason-p Darvon Compound Dasin Doan's Pills Easprin Ecotrin Emagrin Empirin

Equagesic Excedrin Fiorinal Gensan Goody's Tablets/Powder Halfprin Heartline Lortab Magnaprin Measurin Mefenamic Acid Momentum Norgesic Norwich P-A-C Analgesic Tablets Pepto-bismol Percodan Ponstel Regiprin Robaxisal Saleto Salocol Sine-Off Sinus Soma Stanback Supac Synalgos-DC Talwin Compound Tri-Pain Trigesic Ursinus Inlay-Tabs Valesin Vanquish Verin Wesprin Zorprin

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
If you take NSAIDS, please discuss this with your surgeons and physicians at least three (3) days before your operation. You need to obtain special instructions about when to stop this medication.
Examples of NSAIDS are:

Actron Acetnol Advil Aleve Anaprox Ansaid Butazolodin Cataflam Celecoxib Celebrex Clinoril Daypro Diclofenac Potassium/Sodium Disalcid Dolobid Etodolac Evista Feldene Fenoprofen Flurbiproben Ibuprofen Indocin Indomethacin Ketoprofen Ketorolac Lodine Meclofenamate Meclomen Medipren

Meloxicam Mobic Monogesic Motrin Motrin-IB Nabumetone Nalfon Naprelan Naprosyn Naproxen Nuprin Orudis Oruvail Osoxicam Oxaprozin Pamprin-IB Piroxicam Relafen Rufen Salflex Sulindac Suprol Tenoxicam Tolectin Tolmetin Toradol Trilisate Vioxx Voltaren

 
Monoamine Oxidase Inhibitors (MAOI)
If you take tranylcypromine (Parnate, Sicoton), phenelzine (Nardil, Nardelzine), Isocarboxazid, Marplan, Deprenyl, rasagiline (Azilect), or selegiline hydrochloride, please discuss this with your surgeons and physicians at least fourteen (14) days before your operation. You need to obtain special instructions about when to stop this medication.

Dietary Supplements: Vitamins, Minerals, Herbal Supplements, And Holistic Supplements
Dietary supplements listed below should be stopped fourteen (14) days before your operation.

Aristolochia fangchi Barberry Bilberry Borage Bromelian Cayenne Charmomile Chaparral Coleus Forskolin Coltsfoot Comfrey Dong quai Echinacea Ephedra or Ma Huang Feverfew Flaxseed Oil

Fuel Garlic Ginseng Germander Ginger Ginsent, American Ginko biloba Green Tea Iron compound Hawthorn Herbalife Horse Chestnut Kava kava Licorice Life root Pennyroyal

Meadowsweet Melatonin Meridia Metabolife Motherwort Poplar Oregon Grape Root Red Clover Rippede Shepherd’s Purse St. John’s Wort Vitamin E Willow Xenadrine Yohimbe

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What medications may you take on the day of surgery?

• You may take any of these if they are currently prescribed to you:
  • Heart Medication
  • Blood Pressure Medication
  • Anti-Seizure Medication
  • Insulin (please only take HALF of your normal dose though)
  • Tylenol, if needed, for pain up until the day of your operation.
• If you have asthma, use your inhalers the morning of surgery and BRING them with you.
• DO NOT take Water Pills, Diabetic Pills... in addition to anything you have previously stopped taking in preparation for surgery (remember this includes Aspirin, Motrin, Coumadin, Warfarin).

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What if you use a CPAP machine at home for sleep apnea?

Bring your CPAP machine with you the day of surgery.

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What if you have a pacemaker or internal defibrillator?

Inform the nurse that you have a pacemaker or internal defibrillator during your phone interview and in the pre-operative holding area on the day of surgery. 

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What else do you need to know?  Forms, directions, etc?

Please click below to find out the answers to all of your questions.

For Inpatient Surgery, click here.

For Outpatient Surgery - Adult, click here.
For Spanish, click here.

For Outpatient Surgery -Pediatric, click here.
For Spanish, click here.

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How do you get in touch with the hospital or surgery center?

If you have any questions or concerns about your upcoming inpatient surgery, please contact the St. Joseph Hospital Surgical Pre-op Assessment office between the hours of 9 a.m. to 8 p.m., Monday through Friday (except holidays) at 714-771-8920.

If you have any questions or concerns about your upcoming outpatient surgery, please contact the St. Joseph Surgery Center Outpatient Pavilion between the hours of 2 p.m. to 6 p.m., Monday through Friday (except holidays) at 714-744-8732. If you have an urgent question and it is the day before your outpatient surgery, please call the Pre-op Staff at 714-744-8734.

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Do you have a question about your anesthesia bill?

Please contact our billing company,

Pasadena Billing Associates
500 South Main Street
Suite 1210
Orange, CA 92868
Phone (714) 560 - 1580

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Help us make your experience better.

In order for us to continue to provide the best possible care for you, we need to maintain two-way communication with you.  We want to provide you with answers that you want in exactly the way that you want it.  Please fill out our Contact Us form and tell us:

• What was the circumstance that started you on the path to choosing Allied Anesthesia for your anesthetic care?
• What services, improvements, and information you would like to see from Allied Anesthesia?
• How can our web site be more useful to you?