Anaesthetic

What is anaesthesia?

Anaesthesia isn’t sleep – it is so much deeper.

Anaesthesia refers to the practice of administering medications either by injection or by inhalation (breathing in) that block the feeling of pain and other sensations, or that produce a deep state of unconsciousness that eliminates all sensations, which allows medical and surgical procedures to be undertaken without causing undue distress or discomfort.

Your Anaesthetist will discuss your anaesthesia with you prior to your operation, so that you know what technique will suit you as an individual patient. The choice of anaesthesia technique is not just based on the surgery performed, but is also very reliant on other important factors such as any pre-existing medical problems you may have, and any medications that you may be taking. Every patient, and every operation, is different and your Anaesthetist is well trained to manage all aspects of your individual care.

Depending on the exact nature of your surgery (particularly for major operations), and your general state of health, it may be advisable to visit your Anaesthetist for a consultation prior to your admission to hospital. Your surgeon may advise you to book such a consultation, or you may receive contact from your hospital, or the staff at the Wakefield Anaesthetic Group. Even if you do not receive such contact, but have matters you wish to discuss, you are welcome to book a pre-anaesthesia consultation with us by calling (08) 8232 5755.

Types of anaesthesia

General anaesthesia

You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. To keep you safe during surgery you won’t respond to sound, pain or temperature changes. While you remain unaware of what is happening around you, the Anaesthetist monitors your condition closely and constantly adjusts the level of anaesthesia. You will often be asked to breathe oxygen through a mask just before your anaesthesia starts.

Regional anaesthesia

A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anaesthesia. You may be awake or sedated (see below).

Examples of regional anaesthesia include epidurals for labour, spinal anaesthesia for caesarean section and ‘eye blocks’ for cataracts.

Local anaesthesia

A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched.

Sedation

The Anaesthetist administers drugs to make you relaxed and drowsy. Recall of events is possible with ‘sedation’, however most patients have little or no recall of events, as you are not as deeply unconscious. This is sometimes called ‘twilight sleep’, ‘neurolept’ or ‘intravenous sedation’ and may be used for gastroenterology, cardiology and radiology procedures, eye surgery, plastic surgery and dental procedures. Sedation may be used alone, or it may be combined with various local anaesthesia techniques.

What is an Anaesthetist?

Specialist Anaesthetists are fully qualified and highly trained specialist medical doctors who hold a degree in medicine and spend at least two years working in the hospital system before completing a further five years (or equivalent) of accredited training in anaesthesia culminating in being awarded a diploma of fellowship of the Australian and New Zealand College of Anaesthetists (ANZCA), which can be recognised by the initials FANZCA after their name.

The ANZCA training program includes at least two years of general medical education and training followed by five years of approved specialist training. This includes multiple assessments, both at the hospitals where trainees work and by formal examinations. When trainees are in the training program they are called registrars. After completing the five year training program, successful registrars can become Fellows of the College and can practise as Anaesthetists in Australia and New Zealand. As a result of this rigorous and demanding training program, there is no safer place in the world to have an anaesthetic, than in Australia.

People often think an Anaesthetist simply “puts people to sleep”. This is not actually true. General anaesthesia involves your Anaesthetist placing you into a carefully controlled state of unconsciousness, so that you are unaware of the surgery taking place. During general anaesthesia, the support and monitoring of your vital bodily functions, such as breathing and circulation, and the changes the surgery may cause here, are essential.

Your Anaesthetist’s skills go well beyond looking after you just during your surgery. Because of the skills gained during their training, Anaesthetists are experts in post-operative pain relief, and in other forms of analgesia, including specialised local anaesthetic techniques such as epidurals for labour analgesia. Anaesthetists are also highly skilled in airway management and resuscitation, and in fact are actively involved in training other doctors in these techniques.

You will be well looked after by your specialist Anaesthetist throughout your whole journey, from the pre-operative stage, through to the surgical procedure itself, and your recovery and post-operative care.

How does your Anaesthetist stay up to date?

After they obtain their fellowship, Anaesthetists continue to update their skills by regularly attending professional sessions. It is mandatory for Anaesthetists to participate in a continuing professional development program in order for them to continue to practise.

Each year ANZCA runs a series of scientific meetings attended by leading local and international experts, and where new techniques and technology can be presented along with research findings. There are also extensive workshop programs.

ANZCA’s Education, Training and Assessment Development Committee provides a range of services to ensure that ANZCA and its Fellows remain at the forefront of innovation and best practice in anaesthesia and pain medicine.

About anaesthesia

The word anaesthesia is coined from two Greek words: “an” meaning “without” and “aesthesis” meaning “sensation”. There are various types of anaesthesia. Throughout their lives, most people will undergo anaesthesia either during the birth of their baby or for a surgical procedure, which could range from relatively short, simple surgery on a day-stay basis through to major surgery requiring complex, rapid decisions to keep them safe. Many of today’s operations are made possible as a result of developments in anaesthesia and training of specialist anaesthetists.

Patients having anaesthesia will have an anaesthetist with them all the way from the preoperative assessment of their medical conditions and planning of their medical care, to closely monitoring their health and wellbeing throughout their procedure to ensure a smooth and comfortable recovery.

Relief of pain and suffering is central to the practice of anaesthesia. Despite an increase in the complexity of surgical operations, modern anaesthesia is relatively safe due to high standards of training that emphasise quality and safety. In addition, there have been improvements in drugs and equipment. Increased support for research to improve anaesthesia has resulted in Australia and New Zealand having one of the best patient safety records in the world.

What to expect when having an anaesthetic

Except in emergency situations patients will generally meet with their anaesthetist prior to their procedure. This is particularly important where the patient has multiple or complicated medical problems, takes medications or has had complications with previous anaesthesia. Patients who have a letter from a previous anaesthetist should tell all future anaesthetists and provide them with a copy of the letter.

During consultation, the Anaesthetist may discuss matters including the conduct of the anaesthesia or sedation, pain management, potential complications and risks, and provide an opportunity for the patient to ask questions.

As part of the preoperative assessment, the Anaesthetist will assess a patient’s medical history, review appropriate records, read letters from specialists, which patients should bring to their appointment, may order relevant investigations and tests or refer to other appropriate specialists where necessary to assist in preparing the patient for anaesthesia, and check that the patient has understood, and given consent (preferably signed) for the procedure. He or she may explain the type of anaesthesia that is most appropriate, and may discuss pain-management options.

Patients will, where relevant, receive instructions regarding the medications to be taken prior to and on the day of surgery. This is especially important in patients prescribed medicines such as aspirin (Astrix, Cartia), clopidogrel (Plavix, Iscover), and warfarin, which thin the blood and increase the risk of bleeding and bruising. Regarding stopping and re-starting these medications patients should obtain instructions their Anaesthetist prior to admission to hospital.

Other medicines that may need to be modified prior to surgery include those used to control blood sugar in diabetic patients. For further information see frequently asked questions.

Occasionally patients may be prescribed medications (such as anti-reflux medicine) to be taken the night prior and on the morning of surgery.

The anaesthetist may discuss relevant risks and complications associated with the type of anaesthesia that has been selected.

Patients who are having an anaesthetic may not be allowed to eat or drink within a specified time of their procedure. This is called fasting. Patients will be advised of fasting times for solid food and liquids and it is important to follow the instructions provided by the Anaesthetist.

Generally, the protocols below will apply, however it is essential to follow the instructions of your Anaesthetist, which may vary depending on the patient and the procedure.

For healthy adults having elective (planned) procedures, limited solid food may be taken up to six hours prior to anaesthesia and clear fluids totalling not more than 200mls per hour may be taken up to two hours prior to the patient receiving an anaesthetic.

For healthy children over six weeks of age having elective (planned) procedures, limited solid food and formula milk may be given up to six hours, breast milk may be given up to four hours and clear fluids up to two hours prior to the child receiving an anaesthetic.

For healthy infants under six weeks of age having an elective (planned) procedure, formula or breast milk may be given up to four hours and clear fluids up to two hours prior to the infant receiving an anaesthetic.

Only medications ordered by the Anaesthetist should be taken (with a little water if required) less than two hours prior to anaesthetic being given.

Patients who suffer from obstructive sleep apnoea and who use a CPAP machine at night must bring the CPAP machine with them to hospital.

Patients who expect to be discharged from hospital within 24 hours of their procedure should arrange for someone to escort them home. It is a requirement that such patients are accompanied home by a responsible adult, who should remain with them for 24 hours. Patients should arrange this prior to coming to hospital.

Patients should ensure that they arrive in hospital at their allocated time so that the admission process can be completed before their scheduled surgery time. The hospital admissions unit or day-surgery unit will notify patients when they must arrive.

Preparation for surgery commonly includes recording blood pressure, pulse rate, temperature and weight, and ensuring that the patient has followed the Anaesthetist’s instructions about fasting (when you last ate and drank). These precautions help to ensure that any immediate risks, such as the presence of an infection, a fast heart rate or very high blood pressure, are minimised.

If patients have recently developed an acute illness, they should notify the nursing staff on arrival so that the Anaesthetist can review their condition. The Anaesthetist will determine whether it is appropriate to proceed with surgery.

The hospital will provide the necessary operating theatre clothing.

Patients will meet with their Anaesthetist and will have an opportunity to speak with their surgeon, who will confirm the nature and site of the operation. Patients should use this opportunity to ask questions.

Unless you have seen your Anaesthetist prior to arrival at hospital, your Anaesthetist will perform an assessment and discuss aspects of the anaesthesia technique, relevant risks and possible complications. The patient may be told what to expect after the procedure, including pain-management options. For further information see pain relief.

Any special procedures, such as nerve blocks, epidurals or spinals, may be performed in the anaesthesia bay or room prior to entering the operating theatre. The Anaesthetist will obtain your consent before performing these procedures if this was not done pre-operatively. Explaining the procedure is part of the process of obtaining your consent.

After emerging from anaesthesia, patients are transferred to the recovery room, which is also known as the post- anaesthetic care unit (PACU), or occasionally to a high dependency unit (HDU) or intensive care unit (ICU).

A nurse will be allocated to care for each patient during their stay in the PACU. The Anaesthetist will provide the nurse with instructions and prescriptions for relieving pain, nausea or specific medical conditions.

The nurse regularly monitors and records relevant medical observations such as blood pressure, pulse rate, oxygen levels and pain levels. Patients should immediately notify nursing staff if they experience nausea or pain, so they can treat it with the relevant prescribed medication.

The length of stay in a recovery unit may last up to several hours and generally depends on the nature of the surgery performed, the patient’s health and progress in recovery.

Day-surgery patients who are discharged from a day-surgery unit will be provided with verbal and written instructions on all relevant aspects of post-anaesthesia and surgical care. Please keep these instructions handy so that you can refer to them if required. A contact place and telephone number for emergency medical care should also be provided.

Suitable pain relief should be provided for at least the first day after discharge with clear written instructions on how and when it should be used. Patients should ask their doctor how and when they should stop taking the pain medicine, and how and when they should take any other regular medications.

Post anaesthesia what to expect

After the operation

Your Anaesthetist, with recovery room staff, will continue to monitor your condition well after surgery is finished to ensure your recovery is as smooth and trouble-free as possible.

You will feel drowsy for a little while after you wake up. You may have some discomfort or pain, a sore or dry throat, feel sick or have a headache. These are temporary and usually soon pass.

To help the recovery process, you will be given oxygen to breathe, usually by a clear plastic facemask, and encouraged to take deep breaths and to cough. Only when you’re fully awake and comfortable will you be transferred either back to your room, ward or a waiting area before returning home. Don’t worry if there is some dizziness, blurred vision or short-term memory loss. It usually passes quite quickly.

If you experience any worrying after effects, you should contact your Anaesthetist.

Going home

The best part is that most people now go home on the day of surgery.

If you are having ‘day surgery’ make sure there is someone to accompany you home.

For at least 24 hours do not:

  • drive a car
  • make important decisions
  • use any dangerous equipment or tools
  • sign any legal documents
  • drink alcohol.

Patients are often concerned about pain they may experience after an operation and there are medicines and techniques to help minimise pain. Patients will not normally be discharged from the PACU until adequate pain relief has been achieved either by medications administered orally or directly into a vein.

The Anaesthetist may, where necessary, prescribe medicines to be administered by the nursing staff on the ward, of which some may be administered on a regular basis. Others may be prescribed on an “as needed” basis (known as a PRN) to be used as “rescue” analgesia for breakthrough pain, which may occur when the pain relief lasts for less time than the pain. Patients should ask the nursing staff for pain relief if they are in pain. For further information see frequently asked questions.

FAQs

As a general rule you should take your usual morning medications with a sip of water on the morning of the operation unless instructed otherwise by the anaesthetist.

It is important to cease some medicines prior to surgery, including blood-thinning drugs, also known as anti- platelet drugs (aspirin and clopidogrel), and anticoagulants such as warfarin. If a heart specialist has prescribed them, then he or she should review you prior to surgery or at least be notified that you are having surgery. The decision about ceasing medications should be made primarily by the prescribing doctor in consultation with the anaesthetist. It is vital that you do not stop taking these medications without specific instructions on when to stop and restart them and whether any other drugs such as clexane in the case of warfarin cessation needs to be taken in the period that these drugs are stopped.

Other medicines that must be adjusted or stopped include those for diabetes. These include various types of insulin or medicines taken by mouth to lower blood-sugar level including metformin (Diaformin, Diabex) and glicalizide (Diamicron). Seek instructions from your anaesthetist or diabetes specialist as to when to stop and resume taking these medicines prior to surgery. This will depend on whether you have type 1 (insulin dependent) or type 2 diabetes (non insulin-dependent diabetes). The timing of your surgery and your blood glucose is controlled.

Almost all patients are now admitted to hospital on the same day as their operation. Depending on the hospital’s requirements, you may be waiting for some hours. There will normally only be limited time available for you to talk to your anaesthetist before your procedure. If you are having a major procedure, or have concerns about your health or anaesthesia, it is beneficial to consult with your anaesthetist at a separate visit before the day of your surgery.

Make sure that you leave plenty of time to get to the hospital and the admissions area prior to your designated arrival time. There can often be a considerable waiting period at hospitals, so bring something to read or listen to and try to remain relaxed – as difficult as this may be! Your anaesthetist and the hospital staff are there to look after you.

Remember, if you have any concerns or questions please contact your anaesthetist prior to coming to hospital.

Your anaesthetist will meet with you before your operation to discuss your health, general medical condition, any previous anaesthesia and will perform a relevant examination.

Depending on the type of operation, hospital or facility, this may not occur until immediately before your procedure. The anaesthetist will want to know:

  1. How healthy you are and whether you have had any recent illnesses, with a particular focus on heart or respiratory problems.
  2. What previous operations you have had and whether there were any problems with anaesthesia.
  3. If you have had any abnormal reactions to any medications and whether you have any allergies.
  4. Whether you have a history of reflux or heartburn, asthma, bronchitis, heart problems or any other medical conditions.
  5. Whether you are currently taking any drugs, prescribed or otherwise including cigarettes and alcohol 
and whether you are taking ‘blood thinners’, otherwise known as ‘antiplatelet drugs’ or ‘anticoagulants’. These include aspirin, clopidogrel [Plavix], warfarin, Pradaxa and Xarelto. Please bring all your current 
medications in their original packaging.
  6. If you have any loose, capped or crowned teeth or implants, have ‘veneers’ or ‘bonding’, or wear dentures or plates.

You may be given questionnaires to complete, or be asked questions by nurses, before seeing your anaesthetist. Your anaesthetist needs to have the best possible picture of you and your present condition so that the most suitable anaesthesia can be planned. Answer all questions honestly – it is really all about minimising risk to you.

There are some things you can do which will make your anaesthesia safer.

  1. Get a little fitter regular walks will work wonders.
  2. Don’t smoke ideally, you need to stop six weeks before surgery. However, stopping for even 24 hours can help. Your GP may be able to assist.
  3. If you are overweight, make a serious attempt to reduce your weight before your procedure.
  4. Minimise alcohol consumption.
  5. Continue to take any medications which have been prescribed but remember to let your anaesthetist and surgeon know what they are.
  6. If you are taking aspirin, non-steroidal anti-inflammatory agents or other blood thinning drugs, consult your surgeon or anaesthetist about whether you should stop taking them prior to surgery.
  7. If you have any kind of health problem or have had problems with previous anaesthesia, tell your anaesthetist and surgeon so that they are fully informed.
  8. If you are concerned about your anaesthesia, make an appointment to see or talk your anaesthetist before admission to hospital and get the answers you need.
  9. For children, many hospitals can arrange a preoperative visit.
  10. Discuss any herbal products you might be taking with your anaesthetist. It may be necessary to cease taking them two to three weeks prior to surgery.
  11. Inform your anaesthetist if you use ‘so called’ recreational drugs as these may interact with the anaesthesia.
  12. Inform your surgeon/anaesthetist if you have any issues with blood transfusions.

You will usually be advised to avoid food for six hours and fluids (including water) for three hours before your operation. Food or fluid in the stomach may be vomited and could enter your lungs while you are unconscious.

If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety. Your surgeon, anaesthetist or the hospital will advise you how long to fast.

There is no safer place in the world to be anaesthetised than in Australia.

Nevertheless, some patients are at an increased risk of complications because of health problems e.g. heart or respiratory disease, diabetes or obesity, age, and/ or because of the type of surgery which they are undergoing.

Infrequent complications include: bruising, pain or injury at the site of injections, temporary breathing difficulties, temporary nerve damage, muscle pain, asthmatic reactions, headaches, the possibility of some sensation or awareness during the operation (especially with caesarean section and some emergency procedures), damage to teeth and dental prostheses, lip and tongue injuries, and temporary difficulty in speaking.

Nausea and vomiting are quite common after certain types of surgery, and rare after other types. The type of anaesthesia used may also be a factor. Even with the use of modern medications, a small percentage of patients may experience nausea and vomiting that is difficult to control. If you have had difficulties in the past, please let your anaesthetist know.

There are also some very rare, but serious complications including: heart attack, stroke, seizure, severe allergic or sensitivity reactions, brain damage, kidney or liver failure, lung damage, paraplegia or quadriplegia, permanent nerve or blood vessel damage, eye injury, damage to the larynx (voice box) and vocal cords, pneumonia and infection from blood transfusion. Remember that these more serious complications, including death, are quite remote but do exist.

We urge you to ask questions. Your anaesthetist will be happy to answer them and to discuss the best way to work with you for the best possible outcome.

Risk of infections

Needles, syringes and intravenous lines are all used only once. They are new in the packet before your surgery commences and they are disposed of immediately afterwards. Cross infection from one patient to another is therefore not possible.

Blood transfusion

With modern surgery the requirements for blood transfusion are less common. All blood collected today from donors is carefully screened and tested but a very small risk of cross infection still remains.

Your anaesthetist is aware of these risks and only uses blood transfusions when absolutely necessary. For major surgery, your anaesthetist may supervise a system of collecting your blood during or after your operation, processing it and returning it to you. This is called blood salvage and sometimes this can avoid the need for a transfusion.

Please contact the staff at Wakefield Anaesthetic Group PRIOR to your operation for an estimate of anaesthetic fees

Our anaesthetists work as individual practitioners and as such fees vary, with each specialist determining their own fee schedule. The fee for the anaesthetic is separate to the fee for your surgeon and the hospital. The fee will be determined by a number of factors including the type of procedure, the length of time the procedure will take, the patient’s age and the patient’s health fund.

Due to the failure of the Commonwealth Government to index the Medical Benefits Schedule (MBS) in line with inflation and the cost of running a modern medical practice, over the last 30 years the “gap” between the MBS and anaesthetic fees has steadily increased.

The ASA has created an information sheet with more detailed information on fees, rebates and indexation. You can contact the ASA Policy team policy@asa.org.au with any additional questions.