Anaesthesia
Overview
Anaesthesia. Information to help you prepare for your anaesthetics. It has been written for patients having plastic and aesthetic surgery.
Dr Aseem Tufchi. Consultant anaesthetist
WHAT IS ANAESTHESIA?
Anaesthesia stops you feeling pain and other sensations. It can be given in various ways and does not always make you unconscious. Local anaesthesia involves injections that numb a small part of your body. You stay conscious but free from pain. This type of anaesthesia is used for minor procedures. General anaesthesia gives a state of controlled unconsciousness. It is essential for some bigger operations. You are unconscious and feel nothing. General anaesthesia is delivered by the anaesthetists.
Anaesthetists are doctors who:
discuss the type or types of anaesthetic that are suitable for your operation. If there are choices available, your anaesthetist will help you choose what is best for you
discuss the risks of anaesthesia with you
agree a plan with you for your anaesthetic and pain control
are responsible for giving your anaesthetic and for your wellbeing and safety throughout your surgery
manage any blood transfusions you may need
make your experience as calm and pain free as possible
THE PRE-ASSESSMENT CLINIC
You will usually be invited to a pre-assessment clinic a few weeks or days before your surgery.
Staff at the clinic will assess your general health. You will be asked questions and a nurse or doctor may listen to your heart and lungs. Tests will be organised if necessary. This will often include blood tests and an ECG (heart tracing).
You are likely to be checked for certain important infections – usually by using a swab on your skin, or in your nose.The staff will want to make an accurate list of the medicines you take. Please bring a list or the medicines themselves in their boxes.
If you are allergic to anything, this will be written down.
If necessary, arrangements will be made for you to see an anaesthetist.
If you know you have high blood pressure, it is a good idea to bring a list of any recent blood pressure readings. This is because blood pressure can rise in a hospital clinic, and this may not be a true picture of your usual blood pressure.
MORE INFORMATION
This is a very useful opportunity for you to ask any questions that you have about the anaesthetic and about coming into hospital generally. If the staff do not have all the answers you need, they will be able to help you find out more.
BEFORE COMING TO HOSPITAL
If you smoke, giving up for several weeks before the operation will reduce the risk of breathing problems during your anaesthetic, making your anaesthetic safer.
If you have loose teeth or crowns, treatment from your dentist may reduce the risk of damage to your teeth during the anaesthetic.
If you have a long-standing medical problem such as diabetes, asthma or bronchitis, thyroid problems, heart problems or high blood pressure, you should ask your GP if you need a check up.
ON THE DAY OF YOUR OPERATION
The hospital should give you clear instructions about eating and drinking. These instructions are important. If there is food or liquid in your stomach during your anaesthetic, it could come up into your throat and damage your lungs. You should not use chewing gums on the day of operation.
If you are a smoker you should not smoke on the day of your operation.
If you are taking medicines: most medicines should be continued before an operation, but there are some important exceptions. You will need specific instructions from the pre-assessment team about your tablets.
If you feel unwell when you are due to come into hospital, please telephone the ward for advice.
MEETING YOUR ANAESTHETIST
Your anaesthetist will meet you before your operation. They will refer to the discussion you had in the pre-assessment clinic. They will discuss the anaesthetic you could have, including benefits, risks and your preferences.
Pre-medication (a ‘pre-med’) is given before some anaesthetics. Premeds prepare your body for surgery – they may start off the pain relief, reduce acid in the stomach or help you relax. Some premeds make you more drowsy after the operation. If you think a pre-med would help you, please ask your anaesthetist.
A needle is used to start most anaesthetics in adults. If you are very worried about this, please talk to your anaesthetist.
Nothing will happen to you until you understand and agree with what has been planned. You have the right to refuse if you do not want the treatment suggested or if you want more information or more time to decide.
WHEN YOU ARE CALLED FOR YOUR OPERATION
A member of staff will go with you to the theatre.
You can wear your glasses, hearing aids and dentures until you are in the anaesthetic room. You may be able to keep them on if you are having a local anaesthetic.
Jewellery and/or any decorative piercing should ideally be removed. If you cannot remove it, the nurses will cover it with tape to prevent damage to it or to your skin.
You may walk to theatre, accompanied by a member of staff, or you may go in a wheelchair or
on a bed or trolley. If you are walking, you can wear your own dressing gown and slippers.
Final checks will be done as you arrive in the operating department, before the anaesthetic starts. You will be asked to confirm your name, the operation you are having, whether left or right side (if applicable), when you last ate or drank and your allergies.
STARTING THE ANAESTHETIC
Your anaesthetic may start in the anaesthetic room or in the operating theatre. Your anaesthetist will be working with a trained assistant. The anaesthetist or the assistant will attach machines that measure your heart rate, blood pressure and oxygen levels.
Almost all anaesthetics, including some kinds of local anaesthetic, start with a needle being used to put a cannula (thin plastic tube) into a vein in the back of your hand or arm. If needles worry you, please tell your anaesthetist. A needle cannot usually be avoided, but there are things he can do to help.
LOCAL ANAESTHETICS
It is usually administered by the surgeon in the operating theatre.
If you are having a local anaesthetic:
your surgeon will ask you to keep quite still while the injections are given. You may notice a warm tingling feeling as the anaesthetic begins to take effect
your operation will only go ahead when you and your surgeon are sure that the area is numb
you will remain alert and aware of your surroundings, unless you are having sedation. A screen shields the operating site, so you will not see the operation unless you want to
if you are having sedation, you will be sleepy and relaxed. However, you may be aware of events around you
GENERAL ANAESTHETICS:
There are two ways of starting a general anaesthetic:
anaesthetic drugs may be injected into a vein through the cannula. This is generally used for adults
you can breathe anaesthetic gases and oxygen through a mask, which you may hold if you prefer.
Once you are unconscious, an anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised.
THE RECOVERY ROOM:
After the operation, you will usually be taken to the recovery room. Recovery staff will make sure you are as comfortable and free of nausea as possible. When they are satisfied that you have recovered safely from your anaesthetic you will be taken back to the ward.
If you are having your procedure done under local anaesthetics only, you may not need to be in the recovery and can be transferred to the ward directly.
PAIN RELIEF AFTERWARDS
Good pain relief is important and some people need more pain relief than others. It is much easier to relieve pain if it is dealt with before it gets bad. Pain relief can be increased, given more often, or given in different combinations.
Occasionally, pain is a warning sign that all is not well; therefore, you should always report it to your nurses and seek their advice and help
Here are some ways of giving pain relief:
Pills, tablets or liquids to swallow – These are used for all types of pain. They take at least half an hour to work. You need to be able to eat, drink and not feel sick, for these drugs to work.
Injections – These are not often needed, and may be intravenous (through your cannula into a vein for a quicker effect) or intramuscular (into your leg or buttock muscle using a needle, taking about 20 minutes to work).
Local anaesthetics and regional blocks – These types of anaesthesia can be very useful for relieving pain after surgery.
RISK WITH ANAESTHESIA
In modern anaesthesia, serious problems are uncommon. Risk cannot be removed completely, but modern equipment, training and drugs have made it a much safer procedure in recent years.
The risk to you as an individual will depend on:
whether you have any other illness
personal factors, such as smoking or being overweight
COMMON SIDE EFFECTS
Feeling sick and vomiting after surgery
Sore throat
Damage to teeth
UNCOMMON AND RARE SIDE EFFECTS AND COMPLICATIONS
Damage to the cornea of the eye
An existing medical condition getting worse
Nerve damage to peripheral nerves
Awareness (becoming conscious during your operation)
Allergic reaction to anaesthetic medication
DEATHS CAUSED BY ANAESTHESIA ARE VERY RARE. THERE ARE PROBABLY ABOUT FIVE DEATHS FOR EVERY MILLION ANAESTHETICS IN THE UK.