Anaesthetics: what to expect
Posted on 29 March 2018
It’s normal to be afraid to go under anaesthetics during a surgery, even though the risk of something unusual happening is relatively low. Dr Anthony Allwood specialist anaesthesiologist (Blaine & Associates) at Mediclinic Vergelegen answers some frequently asked questions about anaesthetics.
We are fortunate to live in 2018, where the discipline of anaesthesia has evolved into a sophisticated, safe, and well-understood science performed by highly trained specialist doctors. (Imagine living 150 years ago when it was a completely different story).
When you need a surgical procedure done, it can be performed while you are asleep or sometimes while you are awake. “Asleep anaesthesia” is better known as general anaesthesia (or procedural anaesthesia). “Local or regional” anaesthesia involves numbing nerves with local anaesthetic over a small or larger area of the body. (Like spinal or epidural anaesthesia for labour pain or Caesarian section).
What is an anaesthesiologist?
An anaesthesiologist is a specialist doctor formally trained in delivering the safest and best option of anaesthesia for a particular procedure. Like all medical specialists they have spent a minimum of 13 years studying medicine and then anaesthesia to achieve this.
Can I rely on other doctors for anaesthesia?
It is also possible to receive an anaesthetic from a doctor who is not a specialist. Shorter training programs are available for GP’s in remote areas where they can acquire limited skills in anaesthesia or sedation techniques. It is possible for any doctor to acquire the ability to perform local or regional anaesthetic nerve blocks. For instance, a gynaecologist may offer to do an epidural or a surgeon will offer to do a nerve block.
How do I prepare?
For the average general (asleep) anaesthetic the process starts when a patient is booked for theatre. Before the time of surgery it is important for the patient to be aware of the options, risks, and costs of undergoing an anaesthetic. The anaesthetist must consult with you to discuss any specific medical conditions, medications, side effects and pain control options for your procedure. It is very important to know the names and doses of all chronic medications. It is also very important to follow the fasting guidelines for you or your child prior to surgery. Contact the anaesthetist or surgeon to find out more.
What happens before I sleep?
An individual plan for the anaesthetic is tailor-made for each patient. No two anaesthetics are exactly the same. During a pre-operative consultation in the rooms, ward or theatre, it is important to disclose any pre-existing medical conditions, all chronic medications, and any specific bad reactions or complications experienced with previous anaesthetics. If you are a smoker or taking recreational drugs, it is also important to know what to do well before the day of surgery. If so, contact your anaesthetist a few days before.
Is it safe?
Modern drugs used for anaesthesia are specifically designed for patient safety and reduced side effects. The drugs produce a state of unconsciousness, and are either inhaled or injected. Sophisticated technology and machines are used to assist in this. The advances in real time monitoring of a sleeping patient have also revolutionised safety and the early detection of bad or allergic reactions. It is important for patients to understand that the anaesthetist is highly trained in being in complete control of your body while you are asleep. Your safety and comfort are their primary concern and they never leave your side.
I feel very apprehensive…
The anxiety around receiving an anaesthetic has many causes. The fear of waking up during surgery, not waking up afterwards, or waking up in pain are top of the list. There are also fears of loss of control, soiling oneself and the knowledge of so called “horror stories”. Patients should discuss these fears with the anaesthetist beforehand. They can always help with explanations and information. There is also the possibility of getting a sedative to help you beforehand.
What are the risks?
No anaesthetic is ever guaranteed risk free. But, in a normal healthy person the risk of dying is as low as the risk of a freak accident. Any specific conditions a patient may have will be well discussed and planned around if it affects risk. The doctor will always decide and act in his patients’ best interests. Nothing in life is done without risk: no therapy or procedure in medicine exists without risk. Crossing the road is not without risk. Fortunately, having a complication directly as a result of an anaesthetic is very rare.
Are there any complications?
Although techniques are refined, and drugs sophisticated, some common side effects should be anticipated. Sore throats, nausea and shivering top this list. Feeling tired and washed out for a few days is common. Sleep changes, temporary memory loss and confusion are sometimes seen in the elderly, or very sick high-risk patients. The cause is often the potent painkillers and sedatives given in theatre or prescribed afterwards. Eye damage, teeth damage, and nerve damage are rare. Unexpected allergic reactions are also rare.
How long is recovery?
How long you may take to recover from an operation and anaesthetic is hugely variable. Although you wake up almost immediately in recovery after your procedure, the duration and complexity of the anaesthetic varies. A simple day-case procedure may mean it is possible to return to work the next day, whereas a long complex procedure can mean days in hospital. The agents used to keep you asleep are short acting and work out of your body within hours. A groggy feeling is very often caused by painkillers and sedatives and can persist for days.