Anaesthesia And What To Expect On The Day Of Surgery
Anaesthesia is the state of a person not feeling anything, but it has come to mean the provision of a service of unconsciousness to allow surgery to proceed, with a multi-modal approach to the care of patients when ‘asleep’, including provision of pain relief (analgesia) and the care of patients until they have woken up after their surgery, and their management into the post-operative period.
Anaesthesia is a speciality which encompasses provision of anaesthesia for all types of surgery, sedation for other procedures, intensive care medicine, critical care and the support of any other departments in the hospital which find themselves unable to look after very ill or deteriorating patients and support of all emergencies
In the U.K. your Consultant Anaesthetist is a doctor who goes through exactly the same training as any other specialist Consultant, but choses to specialise in anaesthesia, has post-graduate fellowships and has been appointed to a Consultant post in a NHS hospital.
Safety in medicine has been led by anaesthetists for many years, and your safety is central to everything that we do. Safety of anaesthetised patients – at their most vulnerable – justifies the years of training as a doctor, and the years of hospital training afterwards with some of the most wide-reaching examinations for fellowship to be found in the Royal Colleges of Medicine.
The various steps that follow contribute to ensuring your safety throughout your stay in hospital.
This is usually run as an independent service by the hospital you have chosen for your surgery, and the pre-operative nurses and doctors should contact your anaesthetist regarding any abnormalities found in your pre-operative tests. Full engagement in this process will permit the planning of your surgery and anaesthesia, allowing it to proceed smoothly.
In all but the healthiest people, there is frequently a lot of background information to be collected from your G.P. and any other hospitals you may have visited for medical problems in the past, so please attend as soon as possible after your surgery has been booked.
The tests you undergo will usually involve a few blood tests, and sometimes an ECG (electrocardiogram) which records the electricity generated by your heart when it is beating.
Sometimes there are unexpected findings which require further investigation, and so early assessment will allow this to happen in a timely fashion, and not delay your surgery.
Detailed information about you is what allows us to mitigate any risks, so this is a crucial part of the process.
Your Admission to Hospital
Please make sure that you have read the admission instructions carefully and follow them exactly. Of particular note are the instructions for starvation prior to your procedure.
Please make sure that any advice given to you in pre-operative assessment clinic regarding your medications has also been followed
When you are on the ward, you will be seen by one of the nurses who will complete your admission. This involves checking your blood pressure, temperature and pulse, asking for a urine sample which will be tested, and checking of other details.
You will also be seen by your surgeon and anaesthetist. Although the process of consent has been completed prior to your admission, this is the point at which you sign (or countersign and date) a form to agree to the surgery specified on the form.
This is usually your first contact with your anaesthetist. I will have a lot of questions for you in a short space of time, I will assess your airway, check that you have observed the pre-operative instructions exactly, discuss your anaesthetic with you and any special aspects (such as nerve blocks, differing techniques) and plan your post-operative pain relief with you.
Many of the checks will be repeated at every stage of your journey and this is done with the intention of improving the safety of the process. Please make sure that the wristband that is attached to you has exactly the right details on it as it will be used to continue with safety checks even when you are under your anaesthetic.
The Start of your Anaesthetic
When the time for surgery approaches, a nurse will bring you down to the operating theatres and into the anaesthetic room. Here you will get onto a trolley and then another set of checks is conducted, including checking your consent form and making sure that it matches the operative site marked.
Monitoring is attached, a needle is put into one of your veins (usually on the back of your hand) to allow the administration of drugs, and while you are breathing oxygen through a face-mask, you will gently drift off to sleep. Anything happening at this stage, even though previously explained, will be talked through as it happens.
Your anaesthetist is with you all the time you are anaesthetised as you require constant monitoring and modulation of the various components of your anaesthetic. When the surgery is finished, the anaesthetic is switched off and you will start to wake up.
You wake up quite quickly after modern anaesthetics, and this happens in a dedicated area of the theatre complex staffed by specialised ‘Recovery’ nurses skilled in post-anaesthetic care. Although the anaesthetic wears of quickly, the pain relief medication you will have had can leave you feeling sleepy. There is no rush, just wake up gently!
You will continue to be monitored closely, your anaesthetist is still looking after you, and as you become more aware we will make sure that you feel as comfortable as possible while you are with us in theatres
Pain Relief (analgesia)
Analgesia is a central pillar of your peri-operative care. Different modalities of pain relief are used during your surgery, and the pain relief you will be prescribed afterwards will be discussed with you on the morning of surgery.
Pain relief that you buy yourself (paracetamol, ibuprofen) is very effective, and may be sufficient for your post-operative recovery. These tablets may also form part of your post-operative plan, so please make sure that you have some at home if you are not prohibited from taking them for other reasons.
Stronger pain relief tablets that may be prescribed sometimes include paracetamol, so please be careful not to take more than eight tablets of any paracetamol-containing tablets within any twenty-four hour period.
Any painkillers stronger that those mentioned above will contain some form of opiate (morphine-like substance). These may make you feel sleepy, so sometimes one of the stronger tablets rather than two may be enough for your needs, so please adjust the number of tablets that you take as you feel necessary. Another side effect of opiate-based pain relief is that your intestinal tract (guts) slows its activity, and this results in constipation. Please make sure that you increase the fibre in your diet considerably, and drink enough fluids, as constipation can become more uncomfortable that the operative site…
Please contact us with any further questions and I will be happy to help.
Dr Andrew Costello-Cortes FRCA, FFICM