White Mountain Anesthesia, PLLC

We'd like to thank you for trusting the Memorial Hospital and White Mountain Anesthesia with your health care needs. As you are about to undergo surgery we’d like you to have all the information you require to be knowledgeable and reassured regarding your procedures.

Your doctors will instruct you very thoroughly, but please also take this time to read carefully the portions of this webpage that pertain to you. As an informed patient you can have as much influence as we do to insure yourself a safe procedure and a complete and comfortable recovery.

We have and will continue to work hard to earn your confidence and trust to provide for you and your family’s health care.

Members of White Mountain Anesthesia

Anesthesia services at the Memorial Hospital are provided by White Mountain Anesthesia. We are a separate entity from the hospital and, as such, our services will be billed separately. Please feel free to call our business office with any questions you may have regarding your insurance coverage for anesthesia services.

David Esmay, CRNA

Sean O'Brien, CRNA

Hugh Cochran, CRNA

For questions regarding your anesthesia care call our info line at 603-356-5461 ext 2228. For questions regarding your billing please call Jesse Moniz, Affiliated Professional Services, at

2527 Cranberry Highway Wareham, MA 02571

800-841-5200 x3240 or 508-273-1222

(fax) 1-508-273-1351

Who we are and what we do as anesthetists.

What is an anesthetist?

An anesthetist administers anesthesia for surgery and other medical procedures requiring monitoring of vital signs and control of pain. An anesthetist is a nurse who has completed training in the specialty of Anesthesia after obtaining a Nursing degree. In addition, a written examination is required in order to become certified by the American Association of Nurse Anesthetists.

What is the role of the anesthetist at The Memorial Hospital?

Our primary role is to insure your SAFETY AND COMFORT in the “peri-operative period” — the time just before, during and immediately after your surgery. We are responsible for the safe administration of anesthetics and analgesics to patients of all ages, including infants and women in labor, who present with various types of medical and surgical conditions. We also assist in the treatment of postoperative pain. In addition, we have an active service for the treatment of chronic pain.

What you, as the patient, can expect during your visit.

How safe is anesthesia today?

Tremendous advances have been made over the last 20 years in the field of anesthesia. Modern anesthetic drugs are safer, shorter acting and have fewer side effects than those used in the past. These advances have helped make same-day surgery possible. Sophisticated, reliable monitoring and alarm systems, as well as more highly qualified and trained anesthetists, have further reduced tbe already low risk of anesthesia. Of course, as with many of our daily activities there is always some risk involved. However, objectively and statistically, modern anesthesia is extremely SAFE.

During my surgery, will there be an anesthetist present at all times?

YES! While in the operating room at the Memorial Hospital there will always be an anesthetist present whose sole responsibility is your care. Constant vigilance is necessary to insure your well being. State of the art monitoring devices are used to aid us in this task. These include a pulse oximeter to assess oxygenation, a capnography (carbon dioxide monitor) to insure proper breathing and airway management, a continuous electrocardiogram to monitor the heart rate and rhythm and a blood pressure monitor. Certain types of surgery and medical conditions require additional monitoring.

When will I meet my anesthetist?

Since the majority of surgery performed today at Memorial Hospital takes place on the same day of admission, the initial visit with your anesthetist usually takes place at that time. During the pre-operative interview, your anesthetist will review your medical history and discuss the anesthetic options available to you.

What are the different types of anesthesia?

A general anesthetic renders you unconscious and you are unaware of anything. Spinal, epidural and nerve blocks are types of regional anesthetics, which anesthetize only a portion of your body. Monitored anesthesia care (MAC) involves continuous monitoring of your vital signs along with the administration of intravenous medication to keep you relaxed and comfortable while your surgeon administers a local anesthetic. The best and safest approach depends on the type of surgery, your age and medical condition, and to the extent possible, your personal preference. During the preoperative interview our objective is to assess these factors and together with you and your surgeon and choose the safest and most suitable anesthetic option for you.

What can I expect after the surgery and anesthesia?

Immediately after surgery, your anesthetist will accompany you to the post anesthesia care unit (PACU). Under his supervision, the PACU nurses will continue to monitor your vital signs and keep you comfortable, administering pain medications and sedatives as needed. When your PACU nurse and anesthetist feel you are adequately recovered from your anesthetic, you will be transferred to your hospital room or back to the ambulatory holding area.

Today’s anesthetics are eliminated very rapidly by the body. The feeling of anesthesia “hangover” is usually minimal and may be due to the post-operative medications you receive. Other common side effects include dry or sore throat, nausea and. sometimes, vomiting. We recommend that if you are allowed to eat post-operatively, you do so lightly for the first 12-24 hours.

How can pain be controlled after the surgery?

Your anesthetist can administer analgesics intravenously both during and after surgery for the rapid prevention and control of pain.

Regional administration of analgesics is a highly effective way of minimizing pain after surgery. The regional anesthetic is performed prior to beginning the induction of anesthesia. Pain relief is often complete and may last up to 24 hours postoperatively!

Certain surgical procedures permit your surgeon to infiltrate the area being operated with local anesthesia. Others may be performed using a nerve block. In these cases the anesthesia may last well into the postoperative period.

What you can do to prepare yourself.

What can I do to prepare myself for anesthesia and surgery?

The most important thing that you can do to prepare for your surgery is to KNOW YOUR MEDICAL AND ANESTHESIA HISTORY. This includes any medical or surgical illnesses you have now or had in the past, as well as your experience with previous anesthetics. Your surgeon may refer you to your family doctor for a full medical evaluation in order to insure that you are in the optimal state of health at the time of your surgery.

Inform your anesthetist of medications that you take on a regular basis especially blood thinners. It is essential that you consult with your regular doctor, surgeon or anesthetist since certain medications can and should be continued until the time of surgery while others should be discontinued well advance.

AN EMPTY STOMACH IS EXTREMELY IMPORTANT FOR THE SAFE ADMINISTRATION OF ANESTHESIA. Therefore, all adult patients must refrain from eating or drinking anything at all for at least 6 hours before the start of anesthesia for elective surgery. However, since there may be last minute changes in the time of your scheduled surgery, ABSTAIN FROM EATING AFTER MIDNIGHT THE NIGHT BEFORE YOUR SURGERY.

Cervical, Thoracic, and Lumbosacral Epidural Injections -- Patient Information

What is an epidural injection and why is it helpful?

Your doctor has decided to treat your pain by referring you for a fluoroscopically guided selective epidural injection of corticosteroid medicine. Corticosteroids reduce inflammation around the nerves in your spine and, therefore can help reduce pain in your neck, shoulder, and arm or back, buttocks and leg. Spinal injections can also provide diagnostic information that may be helpful to your physician in making further decisions regarding your care. Cervical epidural injections are given along the neck. Thoracic and lumbosacral injections are given in the middle and lower spine.

What will happen to me during the procedure?

All injections provided by White Mountain Anesthesia PLLC under fluoroscopic (x-ray) guidance. Using fluoroscopy allows the provider performing the injection to place the medicine precisely into the epidural space near the source of your pain.

Pain medications are usually not necessary during the procedure. If needed a nurse may administer some intravenous medication to help you relax during the procedure, but you will be awake at all times as it is important for the provider to communicate with you.

Immediately prior to the procedure an IV will be started and you will be positioned on the exam table. For some cervical injections you may lie on your back during the procedure. For thoracic and lumbar procedures you will lie on your abdomen. Once you have been positioned on the exam table the nurse will clean your skin with iodine. At this point, it is important to do your best not to move because it will make the procedure safer, faster, and more comfortable for you if you hold still. After your back has been cleaned thoroughly it will be covered with a sterile drape. Then your provider will view the bones in your spine using the fluoroscope. This will allow them to identify the proper location for the injection. After viewing the bones in your spine the provider will use numbing medicine to anesthetize the skin of your back. This may sting momentarily. After the skin has been adequately anesthetized a small needle will be directed into the epidural space. When the needle is in proper position a small amount of iodine based dye will be injected. Visualization of the dye confirms that the medicine will go to the correct place. When the corticosteroid is injected you may feel a burning sensation in your back or down either your legs or arms. This is normal, and suggests that the corticosteroid has been injected in the correct location. There may be minor discomfort with the procedure, but most patients tolerate it well.

Pain relief from the epidural injection may not become noticeable until a few days or up to two weeks after the injection. Some patients experience relief for only one or two weeks while others may have good relief for many months. The relief provide by the epidural steroid injection should make it easier to participate in other aspects of pain management, including increased physical activity. The goal of the epidural steroid injection is to reduce symptoms. Treatment of chronic pain generally consists of several methods used together. Learning to use your spine safely, developing a healthy exercise program, and becoming aware of techniques for relaxation and positive thinking may help you manage your condition more effectively. Decisions regarding further care for your condition will be directed by your referring physician.

Potential Complications

With any procedure there are potential complications. You should discuss any questions or concerns you have with your medical providers before the procedure begins. We believe that in carefully selected patients the potential benefits from an epidural outweigh the potential harms. The overall serious risk rate is low. Thousands of similar procedures have been accomplished without complication. However, any injection procedure, especially one involving the neck should be taken very seriously. Potential complications or risks may include, but are not limited to:

  1. If you are a diabetic your blood sugar is likely to increase for 48 hours after the cortisone injection and you will need to monitor this and report abnormal values to your primary care physician.

  1. If the spinal needle punctures the spinal sack and spinal fluid escapes this is referred to as a “wet tap.” A wet tape is not dangerous, but it will result in postponement of the epidural. Approximately 25% of patients who have a wet tap will develop a spinal headache. This may require treatment with an “epidural blood patch” procedure. The incidence of wet taps with fluoroscopically guided procedures is less than 1%.

  1. Infection is a remote possibility whenever a needle is introduced under the skin. To prevent this complication your skin will be disinfected and carefully prepared using strict sterile technique. If an infection in the spinal canal or vertebrae occurs, this is a serious complication and it will require intensive antibiotic treatment and possibly surgery.

  1. Rarely, local bleeding can be serious and require further treatment.

  1. There is potential for nerve injury which can lead to permanent pain and/or weakness.

  1. You may have an allergic/adverse reaction to medications and substances used during the procedure. These include Betadine (contains iodine), anesthetics, contrast agents, corticosteroids. Side effects of corticosteroids include increased blood sugar, increased blood pressure, mood swings, fluid retention that can exacerbate existing heart failure, local fat atrophy, facial flushing, skin discoloration, gastritis or peptic ulcer disease, bone demineralization and necrosis of the hip.

  1. On rare occasions, there is a risk of spinal cord injury that may result in paralysis, impaired breathing, prolonged headaches, seizures, stroke, and possible death associated with the procedure.

  1. For thoracic (mid-back) procedures, there is a risk of lung puncture and collapse of the lung(s), which may require placement of a chest tube to re-expand your lungs.

  1. Risk of procedural sedation, which includes, but is not limited to allergic reactions to medications, hallucinations, over-sedation, potential breathing problems, lack of blood flow and oxygen to vital organs such as the brain and the heart, which creates the risk of major complication such as stroke, heart attack or potentially even death.

  1. Although most patients will benefit from the procedure, there is no guarantee of the desired results. Some patients will have a severe flare up in their pain for 1 – 2 weeks after an injection. In some individuals, the increase in pain can last longer, or in rare cases, even be permanent.

General Pre/Post Procedure Instructions

If you have a recent spine MRI which was performed outside the Memorial Hospital you must hand carry it with you to your visit. Failure to do so may result in rescheduling of the procedure.

You should refrain from eating for 8 hours prior to the procedure. Water is fine up to 2 hours before the procedure. Take your routine medications before the procedure (such as high blood pressure medications) except no aspirin and all anti-inflammatory medications (e.g., Motrin/Ibuprofen, Naprosyn/Naproxen, Aleve, Relafen, Daypro, Indocin, Celebrex, Vioxx, Trilisate, etc.) 7 days before the procedure. If you are taking oral (pill form) diabetes medication, DO NOT take the medication the morning of the procedure. If you are taking insulin injections, inject only HALF of the usual scheduled dose the morning of the procedure. If you are taking St. John’s Wort, Ginkgo, Ginseng, or Garlic supplements, you will need to stop these 7 days prior to the procedure. All of your routine medicines and supplements can be re-started after the procedure on the same day. You may take your regular pain medicine as needed before/after the procedure.

If you are taking Coumadin/Warfarin, heparin, Lovenox/Enoxaparin, Plavix/Clopidogrel, Ticlid/Ticlopidine, or Pletal/Cilostazol please call the physician who prescribed the medication as you will need written clearance from them to be off of the blood thinner for the appropriate time in order to have a procedure. You will need an INR (blood coagulation test) one day prior to the procedure if you are taking Coumadin/Warfarin, Heparin, Lovenox/Enoxaparin. If not normal the procedure will be cancelled. The physician who manages your blood thinner must notify our office by fax, with a clearance note, so that the timing of stopping these medicines can be explained and planned. If you are on antibiotics, please notify our office, we may postpone the procedure until you have finished the medicine. If you have an active infection or fever, we will not perform the procedure. If you are a woman of childbearing age and you know or suspect that you may be pregnant, we will not perform the procedure. If you have a known allergy – rash, hives, or anaphylaxis – to iodinated contrast agents, please contact our office 1 week prior to your procedure.

You will be in the hospital for 1 to 2 hours even though you will see the provider for only 20 to 30 minutes. You will need to bring a driver with you. Failure to do so will result in cancellation of your procedure. Plan to be off work for the day of the procedure. You may return to your current level of activities the next day, including return to work.

Steroid inhibits the body’s response to fight infection. Steroid injections should not be given if there is an active infection elsewhere in your body. This is an elective procedure. If you have fever, chills, have a cold or flu or any infection, you should call to cancel the procedure.


Discharge Instruction: Epidural Steroid Injections

You have undergone an epidural injection with regional anesthetic and corticosteroids. It is likely that the effects of this anesthetic are still present when you are discharged home. The anesthetic provides pain relief and also prevents your muscles from working at full strength. Please pay attention to the following side effects and post-injection instructions

  1. It is not uncommon to experience pain or soreness at the site of your neck or back injection, apply ice packs to the injection site for no longer than 15 – 20 minutes. You may repeat the ice pack treatment 4 to 6 times as needed. You may take pain medication prescribed by your referring doctor as needed

  1. You may also resume your usual medication after the procedure.

  1. On the day of the procedure, restrict yourself to light activity. When possible change positions throughout the day. Avoid lifting heavy objects, bending, stooping and twisting.

  1. If you are diabetic, the steroid may temporarily increase your blood sugar levels. If this occurs, please notify your personal doctor. Your diabetic medication may need to be adjusted. Other steroid effects may include water retention, insomnia, restlessness and headache.

  1. You may experience mild numbness, tingling, or weakness in your neck/arm or back/leg after your injection. This is the result of the numbing agent that was used and it will resolve within a few hours of the injection.

  1. You may not drive or operate any mechanical equipment requiring coordination for 24 hours after your procedure.

  1. The pain relief that you receive from your injection may not be immediately evident following the block. You will need to keep a log of your pain for two weeks following the injection in order to discuss the results with your primary physician. You will be issued a pain diary and instructed in how to fill it out. You should bring your completed pain diary with you during the follow up visits.

  1. If you do not have a follow up telephone or office visit scheduled with your referring physician within 2 – 3 weeks please call to schedule one.

  1. If you have any questions or concerns about your procedure please contact WHTIE MOUNTAIN ANESHESIA AT 603-356-5461 EXT 2228. If we are not available and you experience ANY of the following, please phone or visit the emergency department at (603) 356-5461 EXT 2128:

Fever, chills, severe tenderness at the injection site, weakness in the arm (for neck procedure) or leg (back procedure) that persists the next day after the procedure, unable to urinate or have new incontinence of bowel or bladder, breathing difficulty, dizziness, severe total body rash, facial or tongue swelling, chest pain.