Anaesthesia

Before you come into hospital

Here are some things that you can do to prepare yourself and reduce the likelihood of difficulties with the anaesthetic. If you have asthma, emphysema, any heart condition or other chronic disease, you will be evaluated by an anaesthetist or specialist prior to surgery.

If you have loose or broken teeth, or crowns that are not secure, you may want to visit your dentist for treatment. The anaesthetist may need to put a tube in your throat to help you breathe, and if your teeth are not secure, they may be damaged.

Pills, medicines, herbal remedies and allergies

If you are taking any pills, medicines, herbal remedies or supplements, it is important to bring these with you. A written list of everything you are taking, whether they have been prescribed or whether you have bought them over the counter, would be helpful. If you have any allergies, a note of these will also be helpful.

Please note that the use of blood-thinning medication is dangerous if not stopped in time before surgery due to the decreased clotting that blood-thinning medication causes.

This can lead to uncontrollable bleeding during surgery. It is important to stop taking aspirin at least 10 days prior to surgery. If you are taking Warfarin, this should be stopped according to instructions from your specialist or anaesthetist. If you are taking other chronic medication it is important that you check with your specialist whether you should be taking these on the morning of surgery or not. If you are not sure, your anaesthetist will advise you.

On the day of your operation

You will be asked to come in well in advance of your scheduled operating time to allow enough time for your admission to the ward, and for the nurses to go through the anaesthetic check-list with you. Unfortunately it is not possible to give you an exact time that you would be going to theatre, and it may be that you have to wait a long time before you go to theatre, since operating times can be very unpredictable.

The anaesthetist will consult with you before your anaesthetic to ensure that the safest and most appropriate anaesthetic is administered.

Nothing to eat or drink - fasting ('Nil by mouth')

If there is any food or liquid in your stomach during your anaesthetic, it could come up into the back of your throat and then go into your lungs. This could cause serious damage to your lungs. You should not eat or drink anything for at least six hours prior to surgery. If, for instance, you have been told to arrive at 10h00, you may usually have some clear fluids at 06h00 the morning of your surgery. It is important to check with your specialist about this.

Premedication

Premedication (a 'premed') is the name for drugs (tablet) that are sometimes given before an anaesthetic, although today they are not always used. They are used to sedate and calm you before your operation.

The theatre

When you are taken into the operating theatre, your anaesthetist will prepare you for your anaesthetic. Several people will be there, including your anaesthetist and the anaesthetic assistant. All the checks you have just been through will be repeated once again.

To monitor you during your operation, your anaesthetist will attach you to machines to monitor:
Your heart: self-adhesive patches will be placed on your chest (electrocardiogram or ECG).
Your blood pressure: a blood pressure cuff will be placed on your arm.
The oxygen level in your blood: a soft rubber hood will be placed on your finger (pulse oximeter).

Setting up your cannula

Your anaesthetist will need to administer drugs into a vein. A needle will be used to put a thin plastic tube (a cannula) into a vein in the back of your hand or arm. This is taped down to prevent it from slipping out. A special bag of sterile water with added salt or sugar (a drip) will be connected to the cannula.

What happens during a general anaesthetic?

Before starting the anaesthetic, you may be given oxygen through a face mask. This will be the last thing you remember before waking up. For some operations the anaesthetist will place a breathing tube down your windpipe (trachea) once you are unconscious. You will not be aware of this tube being used.

You will wake up in the recovery room where you will be looked after by trained staff. You may have an oxygen mask on at first.

How will I feel afterwards?

Most people feel fine, but occasionally you may find yourself shaking as though you are very cold. This is quite common and soon stops. Some patients may have a painful throat and dry lips, possibly because of the presence of the breathing tube during anaesthesia. This usually clears up after a day or two. Rarely you may experience some muscle aches. These are most common across the shoulders and neck and may last for a few days. Ways of treating pain is discussed elsewhere on this page.
 
You may feel nauseous or vomit after operations, although this is less likely with modern anaesthetics. Please inform the anaesthetist if this has been a problem for you before so that steps can be taken to reduce the chances of it happening, or treat it if it occurs.
 
Some people experience tiredness after an anaesthetic that may last several days. Your anaesthetist will try to relieve any discomfort you may have. You might be repositioned before the onset of surgery. We take great care with positioning, and use padding for all pressure points. However, on occasion patients have body aches from being in the same position for a long time.

After the operation

After the operation you will be moved to a recovery room where your condition will be monitored. The drip is not usually needed for any longer than about 24 hours after the operation. Your operation site may be quite painful at first and initially you may be given injections to ease the pain (or a PCA - see the section on this page); when the pain has lessened, tablets can be given. Your surgery may be discussed with you in the ward by the surgical team.

What are the risks?

Anaesthesia is safer than it ever has been before, but all medical treatments carry some risk. Some nerves are at risk of being compressed due to the position you lie in when unconscious. Very rarely, numbness and weakness may persist for several weeks. There is a small risk to your life with every anaesthetic performed; these risks are, however, extremely small. There is a large number of very rare complications that may occur with even the most routine of procedures and you should always have a frank and open discussion about these with your anaesthetist.  

If you or anyone in your family has had a problem with an anaesthetic, you must discuss this with the anaesthetist. If you have any worries or if you have any side-effects after your operation, please inform a member of the nursing staff who can refer you to an anaesthetist.

How long am I going to stay in hospital?

One of the main reasons for staying on in hospital is to control post-operative pain. You may go home as soon as the specialist is satisfied and you are comfortable enough, sooner for minor operations than for major operations.

You will be given painkillers to take home. Do not drive a motor vehicle, operate dangerous equipment, use any alcohol or make any important decisions for 24 hours after surgery.

Pain relief after your back operation

There are various forms of pain relief after surgery. Depending on your operation and individual circumstances, the anaesthetist may recommend one particular method of pain relief for you.

Am I going to have a lot of pain afterwards?

Certain back and neck operations are known to cause a fair amount of pain. There are three options available after these operations: intramuscular or intravenous painkillers and oral tablets for less severe pain.

How often will I need painkillers?

The anaesthetist will prescribe painkillers to be taken orally, or intramuscular injections. As soon as you start feeling uncomfortable, you should ask the nursing staff to give you tablets or an injection.

You are in the hospital after your back or neck operation partly to control your pain, and there is no need to have severe pain. In some cases we will use a PCA (see below), which allow you to control the amount of painkiller you receive.

Patient Controlled Analgesia (PCA)

This is a method of pain relief (usually with morphine) which allows you to control the amount of painkiller you receive.

Why is this better than the nurse or specialist controlling it?

Because patients vary enormously in how much painkiller they need. We use either an electronic PCA machine, which has a button similar to a bell, or a special PCA syringe, which has a simple lever, which is pressed.

The PCA machine (or PCA syringe) allows you control over the amount of painkiller administered. You do this by pressing the button (or lever) on the handset, if you have pain.

How does it work?

As soon as you feel pain, you press the button (or the lever) on the handset. This is connected to the PCA machine (or PCA syringe) and you will hear a bleep (with the electronic PCA) to confirm that the machine is working. It will then deliver a small amount of painkiller into your drip. This acts quickly and also avoids the need for painful injections.

Does the machine always give painkiller when I press the lever?

No. It only gives painkiller every few minutes (usually seven), however many times you press the button. This is to ensure that one dose has had time to take effect before another dose is given and to avoid complications such as suppression of your breathing.

Can I have an overdose of the painkiller?

PCA is generally very safe and can provide good pain relief, which is beneficial to your recovery. You will be regularly observed while you are on the PCA. It is important that only you (not relatives or friends) press the button (or lever) and only for pain from your operation site.

Will I get addicted?

No. Addiction does not happen when you are taking painkillers for a few days to treat pain from an operation, no matter how much you need.

How often should I press the lever?

You need to press the lever as often as you require to keep yourself comfortable. You should use as much painkiller as necessary to allow you to move around comfortably, take a deep breath and cough (this is important to clear secretions from your lungs). There is no need to refrain from using the PCA analgesia, as it is completely safe.

Are there any side effects to PCA?

Side-effects are sometimes encountered. It is normal to feel drowsy, however, if this is excessive you may need to be treated for it.

It is not uncommon to experience some nausea or even vomiting after having had an operation and there are many reasons for this. If you experience nausea, please tell a member of staff and an injection can be administered to treat this. If nausea is an ongoing problem then further changes can be made to treat it.

Itchiness is a common complication of PCA. Often this is only mild, but it can be treated with medication or altering the analgesic medication.  

Modern anaesthesia is safe, efficient and usually associated with much less discomfort and side-effects than used to be the case. The most important thing to do is to follow your specialist’s orders and convey as much information to your anaesthetist about yourself and any illnesses as you can.

 

 
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