Patient Information A guide to your anaesthetic
This booklet has been produced to answer your questions and to help ease your mind about the anaesthetic you are to have. Contents Page 1. What is anaesthesia? 2 2. Who is your anaesthetist? 2 3. What types of anaesthesia are available? 2 4. What should I do before the anaesthetic? 3 5. What happens before I get to the 3 operating theatre? 6. What will the anaesthetist need to know? 4 7. What will happen when I get to the 5 operating theatre? 8. What happens when I have a 5 general anaesthetic? 9. What happens when I have a 6 regional anaesthetic? 10. How will my pain relief be given after the 7 operation? 11. What are the risks and complications 8 of having anaesthesia? 12. Your questions 10 13. Further information 11 1
1. What is anaesthesia? Anaesthesia is a carefully controlled and supervised state, which allows surgery to be performed painlessly. It is more than being put to sleep. 2. Who is your anaesthetist? Your anaesthetist is a fully trained, medically qualified doctor who has chosen to specialise in anaesthesia. This involves caring for patients before, during and after operations. All consultant anaesthetists are Fellows of the Royal College of Anaesthetists (or have an equivalent qualification). Your anaesthetic doctor will be assisted by theatre staff who are also specially trained. 3. What types of anaesthesia are available? There are 2 main types of anaesthesia: General where you are unconscious and Regional which uses a local anaesthetic to numb parts of the body. In some cases, including in enhanced recovery programmes, a combination of both are often used. About general anaesthesia This is where you are put into a state of unconsciousness for the duration of your operation. This is achieved and maintained by giving drugs into a vein and/or by a mixture of gases, which you breathe. About regional anaesthesia This involves an injection of local anaesthetic, which numbs a particular region of the body therefore preventing pain sensation. Examples are injections into your back (spinal or epidural), injections into your arm or leg and local anaesthesia for the eye. You can remain awake but you will be free from pain. If you wish, you may also receive some tranquilliser or sedative. Your anaesthetist will explain more if you are having this type of anaesthesia. 2
4. What should I do before the anaesthetic? If you are a smoker you should stop smoking for as long as possible beforehand, as this will reduce chest problems after the operation. You should not drink alcohol the night before your surgery. But you should have a light meal the night before the operation. You must continue to take any prescribed medicines up to and including the day of surgery, unless you have been specifically told to stop by the surgeon or anaesthetist. EATING before the anaesthetic You should not eat for 6 hours before the anaesthetic/operation. Chocolate and milky drinks like cappuccino and latte coffee count as food. DRINKING before the anaesthetic You should not have anything to drink for 2 hours before the anaesthetic. Having a drink of a carbohydrate drink, water, clear squash, tea or coffee with a little milk until 2 hours before is fine. You can chew gum, but only until 2 hours before the anaesthetic - not after that time. If you don t follow these rules, your operation may have to be postponed for safety reasons. Staying warm keeps the chance of surgical complications down so please bring enough clothing to keep warm at all times. 5. What happens before I get to the operating theatre? Before going to the operating theatre you will normally be seen by an anaesthetist who will ask questions and may examine you. 3
6. What will the anaesthetist need to know? The anaesthetic doctor needs the best possible picture of your health so that the most suitable anaesthetic can be planned for you. The aim of this is to minimise risks. Please tell the anaesthetist about: Any medical problems you have, especially heart disease, chest disease or diabetes. Any medications you take (whether prescribed or bought at a chemist). Please bring a list of your medicines and the bottles or boxes your medicines came in. Any allergies you have (and not only to medicines). If you have had any previous problems with anaesthesia. If anyone in your family has had any problems with an anaesthetic. If you have loose teeth, dentures, capped or crowned teeth. The last time you had something to eat and drink. After this, your anaesthetist will discuss the various anaesthetic techniques available to you and the benefits and risks of each. Your anaesthetist will then explain what he/she recommends as the best type of anaesthetic technique for you. You may ask any questions you wish and you should understand and agree the plan the anaesthetist has discussed with you. You have the right to refuse a technique or anaesthetic plan, but the anaesthetic doctor may not think it safe to administer exactly the anaesthetic you may wish and may then decline to proceed. Occasionally, it may prove necessary to change this anaesthetic plan (for example if unexpected events occur). You may be given a pre-medication (a tablet or injection) before the operation to help you relax and help relieve any anxiety. You can request this if you want. Painkillers may also be given to you as part of your pain control after your operation. 4
7. What will happen when I get to the operating theatre? When the operating theatre is ready for you, you will be taken to the theatre area. Most people are taken on a trolley or a chair. Sometimes you may be asked to walk. Somebody (usually a nurse) will go with you. You can ask for a relative or friend to accompany you. Please wear sufficient clothing to keep warm. The temperature in the hospital may be lower than you are used to at home. You can wear glasses, hearing aids and dentures up until you are in the anaesthetic room. Jewellery and decorative piercing should be removed. If this is not possible then it will be covered with paper tape to protect it and your skin from damage. Theatre staff will check your identification and ask other medical details as a final check that you are having the operation you are scheduled for. A warm air blanket may be put over you to keep you warm. This air blanket may stay on for the whole operation. You will then be taken into an anaesthetic room where monitors will be attached to your chest/arm/finger to check your heart, blood pressure and blood oxygen levels. 8. What happens when I have a general anaesthetic? A plastic needle is usually inserted into a vein. If this worries you, you can request a local anaesthetic cream to numb the skin. This must be put on at least 30 minutes beforehand on the ward. You will usually be given oxygen to breathe from a mask as a routine safety measure. Drugs are then injected into the plastic needle, to start the anaesthetic. In some cases, you may be given the choice to breathe an anaesthetic gas through the mask. 5
Whichever method is used, you will soon lose consciousness. Once you are unconscious a tube may be inserted into your windpipe to help your breathing and make it safe (this tube will be removed before you wake up). You are then transferred (unconscious) into the operating theatre and the operation begins. The anaesthetist monitors your condition closely throughout the entire operation and adjusts the level of anaesthetic as needed to make sure that you remain unconscious at all times. After the operation you will wake up in the recovery room, where you will be looked after by qualified nursing staff trained in postoperative care. Many patients do not remember this. 9. What happens when I have a regional anaesthetic? A local anaesthetic injection will be given to numb the area being operated on. You may also be given some sedative if you wish. It is important to stay still while the injections are being performed. It is quite normal to experience a warm tingling feeling as the local anaesthetic begins to work. After this injection further sedation may be given to you to help you relax, which may cause you to fall asleep. If the preference is for the anaesthetist to keep you awake, he/she will check that the area to be operated upon is adequately anaesthetised. It is not unusual to be aware of some sensation. Should you feel pain you should inform your anaesthetist and you may be given a general anaesthetic. The anaesthetist will monitor your condition closely throughout the operation. You may speak to him/her whenever you want to. You can bring your own music player together with its headphones eg an ipod/cd player to listen to while the operation is going on. For larger operations you will not be able to see anything because of a large screen, but for smaller operations you may be able to watch if you want. 6
10. How will my pain relief be given after the operation? This will depend on a number of factors including how major the operation is, the site of surgery, and any underlying medical problems. Also people do vary as to how much pain relief they require. The types of pain relief vary from weaker painkillers like paracetamol and ibuprofen type drugs to stronger tablets like codeine and tramadol and to strong morphine type tablets, liquid or injections. These can be given in various ways depending on whether your stomach is likely to be able to absorb the painkillers if these are given to you by mouth. Suppositories (tablet into the back passage) may also be offered. Injections of morphine may be required if the pain is difficult to control with just tablets or syrups. Regular painkillers will be prescribed which may be delivered by mouth or injections into a drip by the nurses. To cater for different pain requirements optional extra doses of stronger, morphine type painkillers will be available. These will be offered to you or you can ask the nurse for these if needed. A patient controlled analgesia system (PCAS) may also be prescribed which allows you to control the amount of pain relief by pressing a button. More information will be provided by the anaesthetist or nurses if this technique is used. In some cases the anaesthetist may use a local anaesthetic to numb nerves, for example a nerve block or epidural. Numbing nerves can be very effective for most patients. Your anaesthetist will be able to explain the advantages and disadvantages of these techniques. For certain operations intermittent ice packs may also be used and are very effective in helping with pain control. In general, a combination of painkillers is the most effective way of controlling pain after surgery which then limits the potential sideeffects of any single drug. 7
Side-effects from painkillers such as nausea and constipation are very common and so to counteract these you will often be given anti-sickness tablets and laxatives. Your nurse will be able to explain more. Please feel free to ask any questions you may have about your planned care. You have the right to refuse the treatment suggested. 11. What are the risks and complications of having anaesthesia? Every anaesthetic has small risks and these depend on many factors such as the type of surgery and any medical conditions you may have. Modern anaesthesia is very safe, but risk cannot be removed completely. Understanding risk To understand a risk, you need to know how likely it is to happen, how serious it could be and how it can be treated. Your individual risk depends on your medical conditions, your personal factors, (such as smoking and being overweight) and the operation being performed. Deaths caused by anaesthesia are very rare and are usually caused by a combination of complications happening together. There are about 5 deaths per million anaesthetics in the UK per year. People vary in how they interpret words and numbers. This scale may help. Very common 1 in 10 Common 1 in 100 Uncommon 1 in 1000 Rare 1 in 10,000 Very rare 1 in 100,000 8
Common temporary side-effects These include bruising or pain in the area where you were injected, dizziness, blurred vision and sickness. These can generally be treated and will usually pass quickly. Uncommon/rare complications These include: temporary breathing difficulties, infections at injection sites, inflammation of the veins where the drugs were injected, muscle pains, shivering after the operation, headaches*, damage to lips, teeth and tongue, sore throat and temporary voice hoarseness, becoming conscious before the end of your operation. These complications may be uncomfortable but are rarely dangerous and the anaesthetist will ensure they are treated promptly. * Headaches that are worse on sitting, standing or coughing can occur after an epidural/spinal anaesthetic. If you get this type of headache, you should inform a nurse before you go home. Sometimes this can occur after you have been discharged. If so, you should telephone your ward for advice and treatment can then be arranged. 9
Very rare and serious complications These include: severe allergic reactions and death, brain damage, kidney and liver failure, lung damage, paralysis, permanent nerve or blood vessel damage, eye injury, damage to the voice box. 12. Your questions Please ask your anaesthetist any questions you may have. You may find it helpful to use this space to write down any questions you want to ask your anaesthetist. 10
13. Further information Further information is available from the Anaesthetic Department: 01332 785549. More detailed leaflets and the booklet Anaesthesia Explained can be requested or viewed on the Royal College of Anaesthetists website: www.rcoa.ac.uk P3282/0211/02.2018/VERSION8: Last reviewed 02.2018 Copyright. Any external organisations and websites included here do not necessarily reflect the views of the Trust, nor does their inclusion constitute a recommendation. www.derbyhospitals.nhs.uk