PATIENT INFORMATION Having an Anaesthetic Your Questions Answered This leaflet explains what you can expect when having an anaesthetic for a planned operation. What is anaesthesia? Anaesthesia means loss of sensation, and is needed for most surgical procedures. There are three main types of anaesthesia: General anaesthesia involves putting a patient to sleep. Regional anaesthesia involves numbing an area of the body, such as an arm or leg. Local anaesthesia involves numbing a small part of the body. Often a combination of these is used. Anaesthetists Anaesthetists are doctors who have undergone further specialist training in anaesthesia. They are also experienced in intensive care medicine and pain relieving techniques, such as epidurals and nerve blocks. Your anaesthetist will see you before your operation to discuss the type of anaesthetic suitable for you, to answer any of your queries and ask for your consent. This will include plans for pain control after the operation. What can I do to prepare for the operation before coming to hospital? Stop smoking. This helps reduce the risk of breathing problems during and after an anaesthetic. If you have loose teeth or crowns, see your dentist. The anaesthetist may need to place a device between your teeth while you are asleep as there is more risk of damage to them if they are loose. If you have long-standing problems such as diabetes, high blood pressure, asthma, or epilepsy, you may be asked to see your GP to ensure things are under control before you come for your operation. If you are overweight, many risks of anaesthesia and surgery are increased. Get advice from your GP about reducing your weight. Please bring a list of all the pills, medicines and herbal remedies that you are taking to the pre-assessment clinic, and to the hospital when you come in for your operation. Page: 1 of 5
What should I do on the day of the operation? You should follow instructions given at the pre-assessment clinic. You will be told to stop eating and you must not chew gum or suck sweets for six hours before your anaesthetic. If there is food or acid in your stomach during the anaesthetic, it could rise into the back of your throat while you are asleep and contaminate your lungs. (This can cause life-threatening problems and is why an operation is delayed if a patient has eaten.) Water is allowed until two hours before your operation. If you are taking medicines, you should continue them as usual unless your anaesthetist or surgeon has asked you not to. If you take drugs to thin the blood, you will be given specific instructions about when you should stop these before surgery in the pre-assessment clinic. If you feel unwell when you are due to come in to hospital for your operation, (if you have a stomach upset or a flu-like illness, for example), please telephone the ward for advice. What is a premed? These are drugs that are sometimes given before an anaesthetic. Some premeds help you to relax, but can make you feel drowsy for longer after the operation. Your anaesthetist will decide with you whether you should have a premed. What will happen when it is time for my operation? You will be asked to change into a hospital gown. You can wear glasses, hearing aids and dentures though these may need to be removed in the anaesthetic room. Jewellery and decorative piercing should be removed or, if this is difficult, may be covered with tape. Tongue studs must be removed. Please remove nail varnish and make-up before you come to the operating theatre as these can interfere with monitoring of your oxygen levels. Most patients come to theatre on a bed or trolley. One parent can usually stay with their child until the child is asleep. Where will I have my anaesthetic? Most anaesthetics are given in the anaesthetic room. You will be attached to monitors, which will measure your heart rate, blood pressure and oxygen levels. A drip is placed in a vein in your arm and your anaesthetist will give the anaesthetic that has been discussed with you. You will then be taken into the operating theatre. Page: 2 of 5
What happens after my operation? You will be taken to the recovery room. Recovery staff will be with you at all times and will continue to monitor your heart rate, blood pressure and oxygen levels. Oxygen will be given through a clear plastic mask that covers your mouth and nose. This may be removed when you are fully awake. If you are feeling uncomfortable or sick, you will be given drugs into your drip to help you feel better. When you are fully awake and all observations are satisfactory, you will be taken back to the ward. If you have had a major operation, you may be taken to the intensive care unit afterwards. Tell me about a general anaesthetic This is a state of controlled unconsciousness during which you will be asleep, pain free and unaware of the surroundings. To start a general anaesthetic, your anaesthetist may inject a drug through a small plastic tube that has been put into a vein in the back of your hand, or you may be asked to breathe the anaesthetic gases through a mask (this method is often used in children). To keep you asleep, your anaesthetist will continue to give anaesthetic drugs either into the drip or as gases to breathe. When these are discontinued at the end of the operation, you will gradually wake up. Tell me about a regional anaesthetic A general anaesthetic is not always necessary or advisable. Some operations, for example joint replacement surgery, can be done by numbing a specific part of the body. There are three main types of regional anaesthetic: Spinal anaesthesia involves an injection of anaesthetic drugs into the fluid that surrounds the nerves in the lower part of the spine. Your lower body becomes completely numb, and you are unable to move your legs. The effects wear off over a few hours. Epidural anaesthesia involves placement of a fine plastic tube near the nerves in your back. The effects are similar to the spinal injection, but because the tube can be left in your back for a few days, this is a useful way of giving pain relief both during and after a major operation. Nerve blocks involve the injection of anaesthetic around a specific nerve, usually in the groin (to numb the leg) or in the armpit (to numb the arm). These are put in using a nerve stimulator to help deliver the anaesthetic to the most effective spot. The stimulator can make your arm or leg twitch, but most people do not find it painful. The nerve block makes your arm or leg numb and heavy and this can last from a few hours to a few days. Page: 3 of 5
Nerve blocks are often used in hip and knee surgery to keep the leg comfortable after surgery. How will pain be controlled after my operation? Simple painkillers, including paracetamol will be given regularly after your operation. They can be given as tablets or into your drip. Stronger painkillers such as morphine may be needed. Morphine can be given as syrup or by injection, by the nursing staff. Morphine can also be given by a pump that you are able to control yourself by pressing a button when you need a dose. This system is called PCA (patient-controlled analgesia). Epidurals and nerve blocks may also be used to provide pain relief after surgery. Often a combination of methods is used, and your anaesthetist will advise you on what is best for you. There is also an acute pain team who are available to help with pain control on the ward after your operation. You may like to read the leaflet Pain and Nausea Management After Surgery for further information about PCA and epidurals. What are the risks and complications of an anaesthetic? Although serious complications are uncommon with modern equipment, drugs and training, there will be a risk of complications when undergoing any procedure. Common side effects (one in about ten patients may be affected) Feeling sick and vomiting after surgery Sore throat Dizziness, blurred vision Headache Itching Aches, pains and backache Confusion Uncommon complications (one in several thousand patients may be affected) Chest infection Bladder problems Muscle pains Page: 4 of 5
Damage to teeth, lips or tongue An existing medical condition getting worse Awareness (having some memories of your operation afterwards) Rare complications (less than one in 100,000 patients will be affected) Damage to eyes Serious allergy to drugs Nerve damage Death Deaths caused by anaesthesia are very rare and are usually caused by a combination of four or five complications occurring together. There are only about five deaths for every million anaesthetics given in the UK, mostly occurring in patients who are already very unwell and who need an emergency operation. More information is available on the website of the Royal College of Anaesthetists. Go to www.rcoa.ac.uk and click on Patient Information. West Suffolk NHS Foundation Trust Page: 5 of 5