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What does the Anaesthetist Do During the Operation?

Throughout the operation your anaesthetist will be carefully monitoring your breathing, heart activity and blood pressure, using monitors. He/she will keep the level of anaesthesia as deep as is necessary for your operation to ensure that you are not aware, not feeling pain and that you are sufficiently relaxed for the surgeon to perform his /her task. He/she will also be maintaining your internal body fluids, which may change during surgery and ensuring that you receive the correct amount of intravenous fluids. He/she will only administer blood if it is absolutely necessary. Your anaesthetist will remain with you throughout and will not leave the theatre.

Will I need a Blood Transfusion?

If you bleed a lot during, or after an operation, the loss of blood is initially replaced with non-blood containing solutions. These help to maintain a normal amount of fluid in your blood vessels and a normal blood pressure. However, these solutions dilute your blood. If bleeding continues, the number of red blood cells will become insufficient to transport oxygen around your body. At this stage you will have to be transfused with red blood cells or your recovery maybe severely compromised. Another reason for transfusion occurs when bleeding continues and the blood becomes so dilute that there are not enough special clotting factors and platelet cells. As a result, the blood will not clot, and if these special blood products are not replaced, bleeding will continue indefinitely.

What is Awareness?

'Awareness under anaesthesia' is the term used to describe a situation where a patient undergoing general anaesthesia is not completely unconscious and becomes 'aware', during some, or all, of the operation. Usually the patient does not feel any pain, but remembers being aware at some time. The patient may recall some conversation. Much less frequently the patient may feel pain, but be unable to move. Usually if a patient remembers something, it is from before consciousness is lost, when the anaesthetist is injecting the anaesthetic drugs. This should not be confused with awareness during the operation. Your level of consciousness is monitored very closely by your anaesthetist. Any form of awareness during anaesthesia is extremely rare and is more often associated with life saving emergency surgery than routine planned surgery.

What is Conscious Sedation?

This is a very light form of anaesthesia where the patient does not actually lose consciousness. It is used for procedures such as eye surgery or local anaesthetic procedures. Sedative drugs are used in very low doses so that the patient is rendered free of any anxiety and discomfort, but can communicate verbally throughout the procedure.

What is an Epidural?

An epidural is a fine catheter that is inserted near your spine. There maybe a little discomfort when the anaesthetist first inserts this. To minimise the discomfort the anaesthetist will first inject some local anaesthesia into the skin to make the area numb. Once the epidural is in place, local anaesthetic is injected and the epidural is connected to a pump. This will give you a continuous injection of the pain medicine into your spinal column where it will quickly work to relieve your pain.

Why should I have an Epidural?

The advantages of having your pain relief this way are:

  • Good pain control without being too sleepy
  • It rarely makes you sick
  • You will be able to do your deep breathing and coughing exercises
  • You will be able to move in bed more freely

How do You Wake Up?

After the operation, the anaesthetist stops giving the medicines that were keeping the patient unconscious and he or she is taken to a recovery room where there are specially trained staff. In general the longer the operation, the longer it takes to wake up. When the patient has woken up completely and is stable and pain free, they are taken back to the ward. Occasionally, people recover consciousness in the operating theatre once their operation is over. This is quite safe.

How Will you Feel When You Wake Up?

Patients sometimes feel slightly confused and disorientated. If they have pain or feel a bit sick, these symptoms can be treated by the recovery room nurse directed by the anaesthetist.

What is it like after the operation?

How people feel after the operation depends on the kind of surgery they have had. They will be encouraged to get out of bed as soon as possible and will usually be allowed to eat and drink in the first few hours after a minor operation.

What are the Side Effects?

One of the aims of a modern anaesthetic is a pleasant, pain-free awakening. However some side effects can be unpleasant: Nausea and vomiting occur in approximately 10% of patients (1 in 10 patients), a sore throat is common, a headache may occur, some patients may get muscle aches and elderly patients may get confused. Most side effects can be easily treated with medication.

What are the Risks of Anaesthesia?

Your anaesthetist will plan the safest anaesthetic for you and is specially trained to deal with any problems that arise, but always remember an anaesthetic is a major medical procedure. As in any other medical procedure, there may be major complications, including the risk of dying. Risks are greater in the elderly and very young, but nobody is immune. Each type of anaesthesia has different risks and benefits, and every patient reacts to and tolerates anaesthesia differently. The risk you will face will depend on your health and the operation you are having, as well as personal factors, such as whether you smoke or are overweight. The possibility of dying unexpectedly during anaesthesia if your age is less than 60 years and you are fit and well is 1 chance per 200,000 anaesthetics given. If you are over 60 years the risk is higher, approximately 1 chance per 60,000 anaesthetics. The risk will be higher if you have serious heart or lung conditions. If you have any questions about your anaesthetic or risk please contact us as it is our anaesthetist’s aim to ensure a safe and pleasant experience.

Why is not Eating and Drinking Important?

One of the risks of an anaesthetic is that stomach contents can be regurgitated or that there may be vomiting, and your lungs will be contaminated with stomach contents. This can have very serious consequences. It is recommended that you do not take any fluids for at least two hours or solid food for six hours before your operation. If your operation has been carried out as an emergency and there is no time to allow your stomach to empty, your anaesthetist has to use special techniques to minimise the risk of lung contamination.

Do I have to Stop Smoking?

Smoking increases the risks of anaesthesia. It is important to stop smoking, the longer you can give up for, the lower the risk. If you cannot stop completely, then cutting down will help. This will reduce the carbon monoxide in your blood and improve your lung's ability to remove particles thus lowering the risk of chest infection and painful coughing.

What about Crowns and Loose Teeth?

During the operation, it is often necessary to pass a tube into the throat to permit normal breathing. The instrument used to pass this tube into the larynx can easily damage loose teeth and crowns, so the anaesthetist will ask if you have any so that extra care can be taken to avoid them. Dentures are left in place until you are asleep and then only removed if necessary.

Do I have to remove my false finger nails?

No, most acrylic finger nails and nail polishes are fine. Your anaesthetist will use a monitor on your finger that reads the “colour of your blood”, to make sure it has enough oxygen in it, so avoid dark fingernail polish (e.g. black or blue)

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