What to Ask About Anesthesia Before Surgery in St. Louis

Revised August 21, 2026

Imagine it’s a Thursday afternoon in Des Peres and the surgery scheduler has just called. Date, arrival time, nothing to eat after midnight, bring your insurance card. You wrote it on the back of an envelope. Then you hung up and realized the part you are actually nervous about — the going-under part — never came up at all.

Maybe you’re in Bellefontaine Neighbors getting a knee done. Maybe it’s a colonoscopy in Granite City, or a shoulder in Creve Coeur, or you’re driving your daughter to Wildwood for ear tubes. Same gap every time. The surgeon explained the surgery in detail. Anesthesia gets a phone call from somebody you have never met, sometimes the evening before.

So here is the part nobody walked you through: the kinds of anesthesia and what each feels like, who is actually standing behind your head while you’re under, what to tell them even when it’s embarrassing, and why anesthesia so often shows up as its own separate bill weeks later. None of this is a decision you make alone. Every choice below gets made with the clinician who has read your chart. What follows is how to be a useful part of that conversation.

What should you ask about anesthesia before surgery?

Six questions cover almost all of it. Which type of anesthesia am I getting, and why that one? Who will personally be with me — a physician anesthesiologist, a CRNA, or a care team? How will pain be handled after I wake up? What medications do I stop, and when? When exactly do I stop eating and drinking? And is the anesthesia group in my insurance network?

Write them on the envelope. The preoperative call is brief and it is not scheduled around your day, so having the list in front of you is the difference between getting answers and remembering three of the questions in the car afterward. If you get a pre-op clinic visit — common for joint replacements and anything cardiac — that is the better venue for the long version.

One thing surprises people: at many hospitals nobody can name your anesthesia professional until the morning of the case, because the assignment board is built the day before. That is normal, and it is not evasion. The useful question is not who your anesthesiologist is but what the staffing model is and who you will meet before anything starts. You will meet someone, and you get to ask everything again.

What are the four kinds of anesthesia, and what does each one feel like?

Four broad categories: general, regional, sedation, and local. General means you are fully unconscious with your breathing supported. Regional numbs an entire region through a spinal, an epidural, or a nerve block. Sedation ranges from pleasantly drowsy to nearly asleep. Local numbs one small area and nothing else.

General anesthesia is what most people picture. Medication goes into an IV, you take a few breaths of oxygen, and the next thing you are aware of is a recovery bay and someone saying your name. There is no sensation of time passing. Your airway and breathing are managed for you, and your heart rhythm, blood pressure, oxygen and exhaled carbon dioxide are monitored continuously the whole time.

Regional anesthesia numbs a whole territory while you stay awake or lightly sedated. A spinal or epidural handles everything below a certain level, which is why it is common for cesarean delivery and for hip and knee replacement. A peripheral nerve block targets one limb — a shoulder block for a rotator cuff repair — and often keeps working for hours after you go home, which is the point. Blocks are frequently combined with general anesthesia rather than replacing it, so you sleep through surgery and wake with the arm already numb.

Sedation has the widest range, which is why it confuses people. Light sedation leaves you drowsy and able to answer. Deeper sedation, often called monitored anesthesia care on your paperwork, leaves most people with no memory of the procedure even though they were never under general anesthesia. Endoscopy, many dental procedures and cataract surgery run this way. Local is the simplest: a numbing injection at the site, you are entirely awake, and often no anesthesia professional is involved. Which one you get follows the procedure first and your history second, but there is often a real choice inside that. Say your preference out loud early rather than the morning of.

Who is actually in the room during your anesthesia?

One of three arrangements. A physician anesthesiologist personally administering your anesthetic. A certified registered nurse anesthetist, or CRNA. Or an anesthesia care team, where a physician anesthesiologist directs CRNAs, certified anesthesiologist assistants, or anesthesiology residents across more than one room. The care team is the arrangement patients most often misread, and it is the most common one in American hospitals.

The American Society of Anesthesiologists describes the Anesthesia Care Team as directed by an anesthesiologist, with selected tasks delegated to qualified team members while overall responsibility for the team’s actions and for patient safety rests with the physician anesthesiologist. If you meet a CRNA in the pre-op bay and never see a physician, it does not mean no physician is involved — but it is entirely fair to ask who that physician is.

Medicare’s billing rules put hard edges on the model. Under the medical direction requirements CMS finalized in the 1998 TEFRA final rule, an anesthesiologist may medically direct no more than four concurrent cases, and must do seven specific things to bill that way: perform a pre-anesthetic exam and evaluation, prescribe the anesthesia plan, personally participate in the most demanding portions including induction and emergence, ensure qualified personnel handle the rest, monitor the course at frequent intervals, remain physically present and immediately available for emergencies, and provide post-anesthesia care.

You may also meet a resident, if your surgery is at a teaching hospital — a physician in training supervised by an attending anesthesiologist, which is how every anesthesiologist you have ever had was made. The fair question is never who is better. It is what the model is here, who the responsible physician is, and how you reach them.

Does the anesthesiologist stay in the operating room?

Someone qualified in anesthesia stays with you continuously, from the moment the anesthetic begins until you are handed off to the recovery nurse. That is a standard of care, not a courtesy, and it does not vary. Whether the physician anesthesiologist is personally in the room for every minute depends on the staffing model at your facility.

If a physician anesthesiologist is personally performing your case, they are in the room the entire time. In a medically directed care team, the anesthesiologist personally participates in the most demanding portions — induction and emergence, the two ends where things move fastest — and remains physically present and immediately available while a CRNA, anesthesiologist assistant or resident stays continuously at your side. The room is never empty of anesthesia personnel while you are anesthetized. If knowing matters to you, ask in exactly those words on the morning of surgery. Anesthesia professionals field that question constantly.

What does Missouri or Illinois law say about who supervises anesthesia?

The two sides of the river word it differently, and in this metro you may well have surgery in both states over a lifetime. Missouri writes a supervision standard. Illinois writes a participation-and-presence standard. Both mean a physician is attached to your anesthetic, and the wording is what governs your case.

In Missouri, section 334.104 of the Revised Statutes provides that a certified registered nurse anesthetist shall be permitted to provide anesthesia services without a collaborative practice arrangement, provided that he or she is under the supervision of an anesthesiologist or other physician, dentist, or podiatrist who is immediately available if needed. Note that the supervising clinician does not have to be an anesthesiologist under that language — in some settings it is the physician, dentist or podiatrist performing your procedure.

In Illinois, the Nurse Practice Act at 225 ILCS 65/65-35 goes further on presence. For anesthesia provided by a CRNA, an anesthesiologist, physician, dentist or podiatric physician must participate through discussion of and agreement with the anesthesia plan, and must remain physically present and available on the premises during the delivery of anesthesia services. Illinois also requires a written collaborative agreement when a CRNA provides anesthesia outside a hospital or ambulatory surgical treatment center — a freestanding dental or podiatry office in Edwardsville or O’Fallon, say. Either way, you are allowed to know who the responsible clinician is. Ask at the surgery center, not only at the hospital, because small freestanding facilities are where arrangements vary most.

Wildly off-topic — the metro’s veterinarians are worth finding before you need one.

What do you have to tell them, even if it feels awkward?

Five things people leave out: every medication and supplement you take, including GLP-1 drugs; snoring or diagnosed sleep apnea; how much you actually drink; any bad reaction you or a blood relative has had to anesthesia; and recreational drug use, cannabis included. None of it is a moral conversation. All of it changes the plan.

Medications first, and bring the bottles or a photo of the labels rather than trusting memory. Blood thinners, diabetes medication and anything for weight loss all carry specific instructions, and they are not the same for everyone. GLP-1 drugs got their own guidance: in October 2024 the American Society of Anesthesiologists issued multisociety clinical guidance with the American Gastroenterological Association and three other societies saying most patients should continue their GLP-1 receptor agonist before elective surgery, and that patients without significant gastrointestinal symptoms should avoid solid food for 24 hours and take clear liquids before a procedure requiring anesthesia. Do not stop the drug on your own and do not hide that you take it.

Sleep apnea is the disclosure people skip because they assume it is unrelated. Loud snoring, gasping at night, or a diagnosed apnea changes how your airway is managed, which sedatives are chosen, and how long you are watched in recovery. If you use CPAP, say so and ask whether to bring the machine and your settings. If you have never been tested but your partner has complained for years, say that too.

Alcohol is the honest-number question. Regular heavy drinking changes how much anesthetic you need and raises the possibility of withdrawal during a hospital stay, which is far easier to manage when the team expects it than when it surprises them on day two. Nobody is recording it to shame you. Same for cannabis, legal for adults in both Missouri and Illinois and still relevant to your anesthetic.

Then the history. Have you had anesthesia before, and did anything go badly — severe nausea and vomiting, a rough or prolonged wake-up, someone mentioning afterward that your airway was difficult? Write down what you were told. And ask your relatives one specific question: has anyone in the family ever had a serious problem, a very high fever, or a death during or right after anesthesia? The Malignant Hyperthermia Association of the United States notes that anyone with a family history of malignant hyperthermia is potentially at risk, and that someone with a first-degree relative — parent, sibling or child — who has had an MH reaction is considered susceptible. It is manageable when known in advance, because the team plans an anesthetic without the triggering agents. MHAUS also runs a 24-hour hotline for clinicians managing a crisis, at 1-800-644-9737. Family history is one of the few genuinely important things a patient brings that no chart will supply.

When do you have to stop eating and drinking before surgery?

American Society of Anesthesiologists fasting guidance for healthy patients having elective procedures is often shortened to 2-4-6: two hours for clear liquids, four hours for breast milk, six hours for infant formula, non-human milk or a light meal, and eight hours after fried or fatty food or a meal containing meat. The ASA’s 2023 modular update, published in Anesthesiology in February 2023, reaffirmed clear liquids up to two hours before an elective procedure.

Clear liquids means you can see through them: water, pulp-free juice, black coffee, black tea. No milk, no cream, no smoothie. The guideline is not automatically your instruction, though. Plenty of facilities still say nothing after midnight, which is more conservative, and some patients get a longer window for a specific reason. Follow the written instruction you were handed, and call the number on it if the instruction and the internet disagree.

Ask two follow-ups people forget. Can I have clear liquids up to a stated hour, or truly nothing? And which of my morning pills do I take, with how much water? Skipping a blood pressure medication because you were told nothing by mouth is common and entirely avoidable. If the patient is a child, the whole conversation shifts, and the clinician who knows that child best is worth looping in — our guides on choosing a pediatrician in St. Louis and on what a pediatric dentist does cover neighboring ground, since dental sedation for young kids raises exactly these questions.

Why does anesthesia arrive as a separate bill?

Because it is a separate professional service, billed by a separate group, on a separate claim. The hospital bills the facility charge. The surgeon bills the surgery. The anesthesia group bills its own work, and almost never as a flat fee. The standard method is base units plus time units plus modifier units, multiplied by a conversion factor.

Base units are fixed values assigned to each anesthesia procedure code by complexity and risk. Time units are counted in 15-minute increments. Modifier units reflect things like your overall physical status. The conversion factor is the dollar value per unit and it is set by the payer, which is why the same anesthetic produces different numbers under different insurance. For a public reference point: Medicare’s national anesthesia conversion factor for calendar year 2026 is $20.4976 per unit, under the CMS Physician Fee Schedule final rule published October 31, 2025. Commercial contracts are negotiated separately and run considerably higher.

Two things follow. Anesthesia time is generally counted from when the anesthesia professional starts preparing you until they hand you off to post-anesthesia care, so it runs longer than incision to close. And there is no honest flat answer to what an hour costs, because an hour on a low base-unit procedure and an hour of open-heart surgery are not the same bill. Ask for an estimate in writing, and ask what it does and does not include.

Can you be balance billed for anesthesia at an in-network hospital?

For a scheduled procedure at an in-network facility, no. The federal No Surprises Act, in effect since January 1, 2022, bans balance billing by out-of-network providers of ancillary services at in-network facilities, and anesthesiology is specifically named as one of those ancillary services. Your cost sharing has to be calculated as though the provider were in network.

Here is the mechanism, because it is the most useful thing on this page. In a narrow set of situations an out-of-network provider at an in-network facility may hand you a notice-and-consent form asking you to waive the protection. Anesthesiology is on the list where that waiver is not permitted at all. If someone asks you to sign away balance-billing protections for anesthesia before a scheduled surgery, that is the moment to stop and ask questions rather than sign. You still owe your normal in-network deductible, copay and coinsurance. The provider and your health plan settle the difference between themselves, through negotiation and, failing that, a federal independent dispute resolution process you are not a party to.

Illinois adds a state layer. Section 356z.3a of the Illinois Insurance Code defines a facility-based provider to include anesthesiology delivered at a participating hospital or ambulatory surgical treatment center, and the Illinois Department of Insurance has continued enforcing those balance-billing protections, including for calculating the recognized amount or out-of-network rate used under the federal law. If your surgery is in Belleville, Edwardsville or Granite City on an Illinois-regulated policy, both sets of rules are in play.

Missouri’s own statute is narrower than people assume. Section 376.690 covers unanticipated out-of-network care, but defines it as care received in an in-network facility from an out-of-network professional from the time the patient presents with an emergency medical condition until discharge. For a scheduled elective operation in Chesterfield or Creve Coeur, the federal No Surprises Act is the protection doing the work, not the Missouri statute. Where the Missouri law does apply, it bars billing you the difference and sends unresolved disputes to arbitration.

Uninsured or paying cash? You have a different right: a good faith estimate in advance. If the final bill lands $400 or more above that estimate, you can dispute it through patient-provider dispute resolution, generally within 120 days of the bill. If you believe the rules were not followed, the federal No Surprises Help Desk is at 1-800-985-3059, seven days a week, with a complaint form at cms.gov/medical-bill-rights.

Two caveats. Ground ambulance rides are not covered by the federal law, which is where people still get surprised. And the protection attaches to the facility being in network, so an elective procedure at a facility you already knew was out of network is a different conversation. Before surgery, make two calls: the number on your insurance card, asking whether the anesthesia group at that specific facility is contracted, and the facility, asking which group staffs its operating rooms.

What this looks like from the other side of the OR door

Anesthesia is one of the few specialties whose revenue is measured literally in minutes: base units for the procedure, time units in 15-minute increments, times a conversion factor. Medicare’s CY 2026 national anesthesia conversion factor of $20.4976 a unit sits well below commercial rates, so payer mix decides whether a group can cover its own call schedule. The hours that generate no units are the ones that hurt — obstetric epidural coverage at three in the morning, trauma call, a room staffed and ready for a case that cancels. That is why so many groups now negotiate a stipend from the facility. VMG Health found the share of ambulatory surgery centers expecting to pay an anesthesia stipend rose from 28 percent in 2024 to 44 percent in 2025, and 60 percent of ASC leaders ranked anesthesia coverage among their top three financial challenges heading into 2026. A canceled case is the loss nobody recovers, which is exactly why that pre-op phone call is not a formality. Patients and referring offices do look for the group behind their surgery by name, and keeping a complete, current listing is how a practice gets found when they do.

What should you do in the week before your procedure?

Make one page and put everything on it. Your medication and supplement list with doses. Your allergies and how you reacted. Your history with previous anesthetics, including anything a relative has told you about theirs. Your CPAP settings if you use one. And the six questions from the top of this page. That single page answers most of the pre-op call before it is asked.

Then handle the insurance side while there is still time to act on it. Confirm the facility is in network, confirm the anesthesia group is contracted, and if you are self-pay, request the good faith estimate in writing. Arrange your ride, because you will not be permitted to drive yourself home after sedation or general anesthesia. On the morning itself, expect to answer the same questions several times — your name, your date of birth, what you are having done, which side. That repetition is the safety check working. Say the awkward things out loud one last time, then let the team do the rest.

Frequently asked questions

Is there a difference between an anaesthetist and an anaesthesiologist?

In the United States the two words are not interchangeable. An anesthesiologist is a physician — an MD or DO who completed medical school and a four-year anesthesiology residency. A nurse anesthetist, or CRNA, is an advanced practice registered nurse. In the UK, Australia and much of the Commonwealth, the spelling with the extra vowel is the ordinary word for the physician, which is why the term shifts depending on which country’s website you landed on.

Do anesthesiologists get called doctors?

Yes. An anesthesiologist holds an MD or a DO, completed medical school, and finished a four-year anesthesiology residency, often followed by a fellowship in pain medicine, cardiac, pediatric, obstetric or critical care anesthesia. Many practices now use the phrase physician anesthesiologist specifically so patients can tell the roles apart. If you are not sure who you are speaking with in the pre-op bay, just ask. It is a normal question.

Which is harder, a CRNA or anesthesiologist?

The paths differ more than they rank, and both are selective. Physician anesthesiologists complete four years of medical school plus a four-year residency, roughly twelve years after high school. CRNAs complete a nursing degree, then at least one year of full-time critical care experience required by the Council on Accreditation, then a doctoral nurse anesthesia program of at least 36 months. They train for different roles rather than competing for the same one.

Does it take 12 years to become an anesthesiologist?

Roughly, counting from the first day of college: four years of undergraduate study, four years of medical school, and a four-year anesthesiology residency that opens with an intern year and continues with three clinical anesthesia years. A subspecialty fellowship in cardiac, pediatric, obstetric, critical care or pain medicine adds another year. That is the training standing behind whoever writes and signs your anesthetic plan.

Do anesthesiologists stay during surgery?

Qualified anesthesia personnel stay with you continuously, from the start of the anesthetic until you are handed off in recovery. Whether the physician anesthesiologist is personally in the room for the entire case depends on the staffing model. In a medically directed anesthesia care team, the anesthesiologist personally participates in the most demanding portions, including induction and emergence, and remains physically present and immediately available throughout.

What is the 2 4 6 rule for anesthesia?

It is shorthand for preoperative fasting: two hours for clear liquids, four hours for breast milk, six hours for infant formula, non-human milk or a light meal. American Society of Anesthesiologists guidance adds eight hours after fried or fatty food or a meal containing meat. Your facility’s written instruction may be stricter for a specific reason, so follow the instruction you were handed and call if anything is unclear.

What is a typical anesthesiologist fee?

There is no single fee, because anesthesia is not billed as a flat charge. The standard method is base units for the specific procedure code, plus time units counted in 15-minute increments, plus modifier units, multiplied by a conversion factor set by the payer. Medicare’s national anesthesia conversion factor for calendar year 2026 is $20.4976 per unit; commercial contracts are negotiated separately and run higher.

How much is anesthesia for 1 hour?

It depends on the procedure, not only the clock. One hour equals four time units, but base units differ by procedure code and the conversion factor differs by payer and contract, so an hour of anesthesia for a hernia repair and an hour for cardiac surgery bill differently. Ask the anesthesia group for a written estimate tied to your actual procedure code, and confirm the group is contracted with your plan.

What are the pros and cons of an anesthesiologist?

Read as a patient question rather than a career one: a physician anesthesiologist brings medical school and residency training in diagnosing and treating problems that surface mid-procedure, which matters most when your medical history is complicated. An anesthesiologist-led care team is the standard arrangement at many hospitals and lets one physician oversee several rooms. Neither is a downgrade. Ask which model your facility uses and who is responsible for your case.

About the Author: The St Louis Near Me Directory Team
Written by a dedicated team of St. Louis locals who live, work, and play right here in the St. Louis metro. Founder Lane Forman and team are committed to building the region’s most trusted directory by verifying listings and connecting local businesses with loyal customers across Missouri and Illinois.

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