Q: What is an anaesthetist? Edit
An anaesthetist is a doctor who has specialised in anaesthesia after finishing a university medical degree. Overall it takes at least 13 years of training and many examinations to become a specialist anaesthetist. As part of their training they become experts in pain management, resuscitation, care of the critically ill patient as well as other specialist areas such as obstetrics and paediatrics.
Without anaesthesia many procedures would not be able to be performed and many advances in surgery would not have occurred. To achieve the situation where the surgeon can perform your procedure your anaesthetist uses several different medications. These medications while being necessary can have significant impacts on your body. A specialist anaesthetist has extensive knowledge of these medications and how they interact with your body. It is because of this extensive knowledge that complications from anaesthesia are rare. When complications do occur your anaesthetist has the skills and knowledge to manage these. Your anaesthetist will stay with you for the duration of the operation and monitor you closely.
Ultimately your well-being during and immediately following surgery is the responsibility of your anaesthetist.
Further information regarding anaesthesia and the role of anaesthetists can be found at the Australian and New Zealand College of Anaesthetists website.
Back to top ^
Q: When do I meet my anaesthetist and what information do they need? Edit
You will meet your anaesthetist before your operation to discuss your anaesthetic and to perform a relevant examination. This may occur in our consultation rooms or in the hospital on the day of surgery.
Important information to tell your anaesthetist include:
- Previous operations and whether there were any problems with anaesthesia.
- Any serious complications experienced by family (blood relatives) during anaesthesia.
- Abnormal reactions to medications and any allergies.
- Medical problems or any recent illnesses.
- List any medications that you are taking including herbal medications
- If you suffer from acid reflux or heartburn.
- If you have had a Laparoscopic Gastric Band (Lap Band) or other weight loss surgery.
- Loose teeth, capped teeth, dentures, veneers or bonding.
- Any other concerns.
Back to top ^
Q: What is a Pre-Anaesthetic Consultation and why is it important? Edit
Your anaesthetist needs to ensure that you are fit for the surgery and determine the safest method of anaesthesia based on your planned operation, your physical health and your preferences. Traditionally this would be determined in hospital the night before the operation but now most patients are admitted to hospital on the day of their operation. This limits the amount of time for these decisions to be made and increases the chances that your surgery may be cancelled.
Wide Bay Anaesthesia therefore attempts to see all patients who may require general anaesthesia in their rooms at either the Friendly Society Private Hospital or Mater Hospital in the weeks leading up to your surgery. This consultation is the best opportunity for your anaesthetist to provide information, answer any questions and reduce any anxieties you may have about your procedure. Your anaesthetist may also order tests if necessary and refer patients to other specialists for an opinion. Your anaesthetist may even advise not to proceed with surgery or recommend that you have your surgery in a major metropolitan hospital.
Some patients having minor procedures will see their anaesthetist on the day of their surgery. However, if you would like to see your anaesthetist prior to your procedure day please call our rooms to arrange a consultation.
There may be a fee for a preoperative assessment. Medicare provides a rebate for this, but a gap may be charged. You will be provided with an estimate of the consultation fee prior to the appointment. If you have any questions regarding your anaesthetic fees the appropriate time to ask these questions is during the consultation.
Back to top ^
Q: How long should I fast before my operation? Edit
Fasting is important for safe anaesthesia. This is to prevent stomach contents from entering your airways causing lung damage while you are unconscious during anaesthesia. This applies for all procedures requiring sedation or general anaesthesia.
Patients must be fasted for at least 6 hours prior to their anaesthetic. That means no food, no lollies and no chewing gum. Milk should also not be consumed for 6 hours prior to your anaesthetic. Most anaesthetists will be happy for you to have sips of water up until 2 hours before your operation. This will be discussed with you at the pre-operative consultation. Prior to some major operations a sugary drink may be provided. Once again this will be discussed with you prior to your operation.
Back to top ^
Q: What do I do with my normal medication? Edit
In most instances, take your normal prescribed medications with a sip of water regardless of whether you are fasting. This is particularly important for those patients taking heart medications and blood pressure medications. If you are a diabetic, discuss a plan for managing your diabetes with your anaesthetist prior to surgery.
Sometimes surgeons will ask you to stop aspirin and other blood thinning agents (eg. Xarelto, Pradaxa, Iscover, Plavix, Co-plavix, warfarin). However, it is sometimes important to continue these medications or substitute with another medication. This is especially important if you have had procedures on your heart previously (e.g. stents, artificial heart valves). If you have any questions please contact Wide Bay Anaesthesia. In some instances your anaesthetist will need to discuss your case with your cardiologist.
Back to top ^
Q: Is anaesthesia safe? Edit
Your anaesthetist has spent many years of training to make sure that you are safe during surgery. The training and standards set by the Australian and New Zealand College of Anaesthetists that has made anaesthesia here in Australia as safe if not safer than anywhere in the world. Unfortunately despite world-best care complications can still occur.
WHAT ARE THE SIDE EFFECTS OF ANAESTHESIA?
Nausea and Vomiting
Nausea and vomiting is one of the most unpleasant complications following anaesthesia. If you are at risk of getting sick after your operation your anaesthetist will tailor your anaesthetic to minimise this risk. If you have been sick after previous anaesthetics or if you are prone to motion sickness it is important you let your anaesthetist know prior to your anaesthetic. Mild nausea and vomiting occurs in 1 in 4 patients without preventative measures with women are 3 times more likely than men to have nausea and vomiting.
Pain
Your anaesthetist will try to make sure that you wake after your operation as comfortable as possible. However, people vary greatly with their pain relief requirements for surgery and pain control techniques make need to be adjusted. If you wake with pain in recovery, you will be given extra pain relief quickly.
Sore Throat & Hoarse Voice
It is a necessity of anaesthesia that we ensure that you breath well and this generally involves placing a breathing tube in your throat once you are asleep. This may cause a small amount of throat discomfort and/or hoarseness of your voice which may last for a few days and is rarely persistent.
Skin Bruising
Commonly there may be bruises at the site of an intravenous drip or other injections.
Dental Damage
Occasionally teeth may get damaged during an anaesthetic. Let your anaesthetist know if you have loose teeth, crowns or bridgework. If you are at particular risk of dental damage your anaesthetist will often discuss this with you. Damage requiring intervention is approximately 1 in 5000.
Nerve Injury
Placing your body in special positions are sometimes required so your procedure can be performed. Some nerves can be compressed or stretched with this positioning. Your surgeon and your anaesthetist will minimise this risk by making sure these areas are well padded and that nerves are not stretched. Risk ranges from 1 in 300 to 1000.
Eye Injury
Anaesthetists take a lot of care to protect your eyes during your anaesthetic. Unfortunately when patients are waking up from an anaesthetic patients can inadvertently scratch the surface of their eye. Damage is usually mild and should improve over several days. Blindness is extremely rare but is more common in some instances such as during spinal surgery when you are lying face down for a period of time. Your anaesthetist will discuss this complication if you are having a procedure that increases you risk.
Allergic Reaction
Although uncommon, every time you are exposed to new medications there is a small chance that you may have a reaction. This risk is the same with anaesthetic medications. These reactions can vary from a rash to more serious breathing and blood pressure problems. If you have one of these reactions your anaesthetist is trained to manage this situation immediately.
Breathing problems
Anaesthesia can cause breathing problems. These problems are more common in people with pre-existing asthma or other medical problems such as emphysema or obstructive sleep apnoea. Another serious complication called aspiration can occur if stomach contents get into the lungs and damage them. This is more likely with emergency surgery or when inadequate fasting has occurred prior to your operation.
Heart Attack
Heart attacks during anaesthesia are uncommon. However, patients especially at risk are those with pre-existing heart disease, diabetes or high blood pressure.
Stroke
Strokes occur when there is an interruption of blood supply to the brain. It is uncommon in patients that are fit prior to surgery. At risk patients are those with a previous history of strokes, heart disease, diabetes and high blood pressure.
Death
Death due to anaesthetic complications is extremely rare. For a fit and well patient the risk is approximately 1 in 100 000. For older patients with multiple medical conditions the risk can be significantly higher but is still rare.
Side effects from nerve blocks and epidurals
Nerve blocks (numbing a region of your body e.g. arm, leg), spinal blocks or epidurals (e.g. numb the lower half of your body) are sometimes used as part of the anaesthetic. While these procedures are very safe, rare complications such as nerve damage due to the needle, bleeding or infection can occur. The numbness and weakness is usually temporary but may be permanent in extremely rare cases.
Back to top ^
Q: What can I do after the anaesthetic? Edit
Anaesthesia may impair your judgement and decision making skills for the first 24 hours. Therefore it is important that you:
- Do not drive
- Do not operate machinery
- Do not do any cooking
- Do not sign legal documents or make important decisions.
- Do not drink alcohol
If you are booked for day surgery, a responsible adult should take you home and stay with you for the first night. You should also have a reliable mode of transport to get back to the hospital if required and not be further than 30 minutes from the nearest hospital. If any of these requirements is not met you are not suitable for day surgery and please discuss with your surgeon and/or anaesthetist about staying in hospital overnight.
Back to top ^
Q: How is pain controlled after the anaesthetic? Edit
Your anaesthetist will play a very important role in managing your pain relief following surgery.
Adequate pain control is desirable as it will improve your recovery after surgery and will help prevent complications.
Your anaesthetist will discuss the options with you before your operation. After surgery associated with significant pain or when advanced methods of pain relief are used an anaesthetist from Wide Bay Anaesthesia will continue to see you after your anaesthetic to ensure your pain is being managed adequately.
There are many ways that pain can be controlled. Usually a combination of several methods of pain relief will be used.
- Simple Painkillers (Tablets) - includes medications such as paracetamol and anti-inflammatory drugs (eg. ibuprofen, diclofenac). While not as strong as other medications they are an important component of your pain relief regime after most operations.
- Opioid Medications - e.g. tramadol, codeine, oxycodone, morphine. Stronger pain relief either given on a regular basis or when you request more pain relief from your nurse. These medications can either be given by tablet form or through an injection.
- Patient Controlled Analgesia - is a very safe method of delivering stronger pain medications such as morphine and fentanyl. Your drip is connected to a machine and when you would like more pain relief you simply press a button and the medication is administered. For safety reasons it is important that only you press the button. More information regarding patient controlled analgesia will be provided if your anaesthetist prescribes you this form of pain relief.
- Epidural Anaesthetic - an epidural is a small tube (catheter) placed near to the nerves that transmit pain as they emerge from your spinal cord. Small amounts of pain relief medication can be delivered through the epidural catheter close to these nerves. The epidural catheter can be left for several days. For some operations it provides the best form of pain relief and may reduce complications after your surgery. If your anaesthetist believes you may benefit from an epidural they will discuss the risks and benefits of this option with you prior to your surgery.
- Nerve Blocks - your anaesthetist can use local anaesthetic (e.g. numbing medication) to numb specific areas of your body (e.g. arms, shoulders, knees, hips). For a period of time ranging from 6-24 hrs the area will be numb and possibly weak. If your anaesthetist recommends a nerve block he or she will discuss the risks and benefits with you prior to your anaesthetic.
Back to top ^