YOUR ANESTHESIA EXPLAINED

This booklet provides some information about anesthesia & may answer a few queries regarding anesthesia. If you have any further questions, we would be happy to answer them.

What is anesthesia?

Anesthesia is given so that you do not feel pain or other sensations during an operation.

Types of Anesthesia

Anesthesia can be given in various ways and does not always make you unconscious.

Local anesthesia is given in the form of an injection that numbs a small part of your body. You remain conscious but free from pain.

Regional anesthesia:  A local anesthetic is used to numb a larger or deeper part of your body, for example an arm or a leg. The common regional anesthetics are spinal and epidural anesthesia. They involve injections in the back to remove feeling from the waist downwards. You stay conscious but free from pain. Epidurals may be used during and/or after surgery for pain relief.

General anesthesia: You are unconscious and will feel nothing for the duration of your operation.

Sedation is the use of small amounts of medication to produce a ‘sleep-like’ state.

Sedation relaxes you during an investigation or procedure which may be unpleasant or painful (such as an endoscopy) but where your co-operation is needed. You may remember very little or nothing at all of the procedure. If you are having a regional or local anesthetic, you may be given some sedation as well.

Combining types of anesthesia

Anesthetic drugs and techniques are often combined so as to make you comfortable during an operation .e.g;

Anesthetists are doctors who have had specialized training in

• providing anesthesia
• treatment of pain
• care of very ill patients (intensive care), and
• emergency care

 

Your anesthetist is responsible for:

• your wellbeing and safety throughout your surgery
• giving your anesthesia
• planning your pain relief 
• managing any blood transfusions you may need during an operation

Before admission to the hospital for an operation

You need to know the following things before your operation.

If you smoke, stop smoking several weeks before the operation. The longer you can give up the better. Smoking reduces the amount of oxygen in your blood and increases the risk of breathing problems during and after an operation.

If you have loose or broken teeth, or crowns/caps that are not secure, they may be further damaged during the anesthesia

If you have a long-standing medical problem such as diabetes, asthma, hypertension, thyroid problems or epilepsy, you may need to undergo some checkups to ensure that they are under control.

The anesthetist and the team

Anesthetists work closely with surgeons and other theatre staff. Operation theatre staff helps the anesthetist and take part in your care. Trained staff in the recovery room will take care of you after your operation until you are ready to go back to your ward.



The pre-assessment clinic (PAC)/ Health check-up before your anesthesia

Is managed by the Department of Anesthesia, Critical Care & Pain & attended by an Anesthesia Consultant & a junior doctor

You will be asked a number of questions to check your health before your operation.

The questions will be about:

• your general health and fitness
• any serious illnesses you have had in the past
• any problems with previous anesthesia
• whether you know of any family members who have had problems with anesthesia
• any pains in your chest
• any shortness of breath
• any heartburn/acidity/reflux
• any pains you have which would make lying in one position uncomfortable
• any medicines you are taking, including herbal remedies and supplements you may have been prescribed
• any allergies you have
• any loose teeth, caps, crowns
• whether you smoke/ drink alcohol or chew tobacco

If you are taking any pills, medicines, herbal remedies or supplements, please bring these with you to the PAC. It will be helpful to your anesthetist.

If you have any allergies, kindly inform the doctor

You may require more tests/ investigations after your checkup and may have to return to the pre-assessment clinic once again with the results of the tests asked for.

The pre-assessment clinic is the right place to ask questions about the anesthesia and discuss your worries regarding the same (if you have any).

On the day of your operation

• Nothing to eat or drink – fasting (‘Nil by mouth’/ NBM)

You must follow the instructions about fasting. If there is any food or liquid in your stomach during your anesthesia, it could come up into your throat and go into your lungs. This could cause choking, or serious damage to your lungs.

• Your normal medicines

You should continue to take your normal medicines up to and including the day of surgery, unless your anesthetist or surgeon has asked you not to. There are exceptions. For example, if you take drugs to stop blood clotting (anticoagulants), aspirin, and drugs for diabetes or herbal remedies, you will need specific instructions. If you are not sure, kindly ask your anesthetist or surgeon & they will advise you accordingly.

The choice of anesthesia depends on:

• your operation
• your physical condition

Premedication

Medication which is sometimes given before an anesthetic, May be a tablet or an injection. It helps to;

• reduce or relieve anxiety

A premedication may make you  drowsy after the operation.

Blood transfusion

During an operation, you may lose some blood. Your anesthetist can usually make up for this blood loss by giving you other types of fluid (saline) into a vein through a drip.

You will be given a blood transfusion only if your anesthetist thinks it necessary.  You will be informed by your doctor about the possibility of a blood transfusion & you must ensure the presence of donors (relatives) prior to the operation.

Why does the anesthetist postpone some operations?

Occasionally, your anesthetist might find something about your general health that could increase the risks of your anesthesia or operation. It might then be better to delay your operation until the problem has been reviewed. This would be less likely if you have been to a pre-assessment clinic. The reasons for any delay would always be discussed with you at the time.

Your anesthetist’s main concern is your safety.

Getting ready for ‘Operation theatre’

Here are some of the things that you may be asked to do to get yourself ready for your operation

• Bath or shower: before your operation will clean your skin and reduce the risk of infection.
• Do not use any makeup, body lotion or cream as they prevent dressings from sticking to your skin properly.
• Remove any nail polish and jewellery (bangles, ear-rings, toe/finger rings) that you may have on you. If you cannot remove your jewellery, it will need to be covered with tape to prevent damage to it or to your skin.
• You will be asked to remove all your undergarments and wear the hospital gown given to you.

You can wear your glasses, hearing aids and dentures to go to the operating theatre. If you are having a general anesthesia, you will need to remove them in the anesthetic room to make sure they are not damaged or dislodged while you are anaesthetized. They will be handed over to your relatives outside the operation theatre. If you are not having a general anesthesia, you can keep them in place.

When you are called for your operation

You will be taken to the operation theatre on a patient trolley by a ward boy. One of your relatives may accompany you to the main door of the operation theatre complex.

The operating theatre complex

The operating department includes waiting area, operating theatres and a recovery room. Operating theatres are brightly lit and may have no natural light. The theatres may also be quite cold.

The waiting area

You will now be asked to get onto a theatre trolley. Theatre staff will check your identity, your name and date of birth, and will ask you about other details in your medical records

The operation room

This is often a busy place, with staff bustling to get ready for your surgery and noises echoing around. Music may be playing. You will be moved from your trolley onto the operation table.

It is here that your anesthetist will prepare you for your anesthetic. All the checks you have just been through will be repeated once again.

If you are having a general anesthesia, you will now need to remove your glasses, hearing aids and dentures to keep them safe

To monitor you during your operation, your anesthetist will attach you to machines to watch:

• your heart: sticky patches will be placed on your chest (electrocardiogram or ECG)
• your blood pressure: a blood-pressure cuff will be placed on your arm
• the oxygen level in your blood: a clip will be placed on your finger (pulse oximeter).
More monitoring may be needed for major operations

IV cannula

Your anesthetist will need to give you medications & saline into a vein. A needle will be used to put a thin plastic tube (a ‘cannula’) into a vein in the back of your hand or arm. Sometimes, it can take more than one attempt to insert the cannula. Saline will be given through a drip into your cannula during your operation. If you need blood during the operation it will be given to you through the cannula.

Regional anesthesia (Spinal/Epidural/Nerve blocks)

Spinals or epidurals, the most common regional blocks, are used for operations on the lower half of your body.

Spinals are single injections which take only a few minutes to work and last about two hours.

Epidurals can take up to half an hour to work but can be used to relieve pain for hours and sometimes days after your operation.

Your anesthetist will explain the procedure of a regional anesthetic to you prior to your anesthesia.

Local anesthesia will be given to help reduce the discomfort of the injection for the block. It can take more than one attempt to get the needle in the right place so that the area is properly numbed. Your anesthetist will ask you to keep quite still so he or she can give you your local or regional anesthetic block. If you move during the block, you may make it difficult for your anesthetist. You are requested to kindly co-operate with your anesthetist. You may notice a warm tingling feeling as the anesthetic begins to take effect. It is common to feel as though the part of your body which is anaesthetized does not belong to you. Your operation will go ahead once the the area is numbed.

Local and regional anesthetics are usually given to you while you are conscious. You can

• help your anesthetist get you into the correct position
• tell your anesthetist if the needle causes pain
• tell your anesthetist when the anesthetic is taking effect.

The type and place of a local or regional anesthetic injection will depend on the operation you are having and the pain relief you will need afterwards.

General anesthesia

There are two ways of starting a general anesthesia;

• anesthetic drugs may be given through the cannula (this is generally used for adults); or
• you can breathe anesthetic gases and oxygen through a mask, which you may hold if you prefer.

You may have a light-headed feeling and will lose consciousness within a minute or so. It might hurt when anesthetic drugs are given through your cannula.

After your operation

You will be moved from the operation room to the recovery area by your anesthetist. Recovery staff will continue to monitor your blood pressure, oxygen levels and pulse rate. Here;

You may have a tube in your nose (if you have undergone some operation on your head or neck) to help you breathe. This tube stays in place till the next morning, when it is removed.

• Oxygen will be given through a lightweight clear-plastic mask, which covers your mouth and nose.
• If you feel any pain, let the staff in the recovery know so that they can give you some pain killers.
• If you feel sick, you may be given drugs which will help this.
• Depending on the operation you have had, you may have a urine catheter. This is a thin soft tube put temporarily into the bladder to drain it.

If you have had a local or regional anesthesia

It will take some hours for feeling to return to the area of your body that was numb. You may feel a tingling sensation as the feeling returns. Until the block wears off you will feel fine, but once it wears off you will start to feel the pain.

Let the recovery staff know if you are feeling any pain, so they can provide the necessary pain killers

High Dependency Unit (HDU) or the Intensive Care Unit (ICU)

After a major operation, you may be taken to the HDU or ICU. If this is planned, it will be discussed with you beforehand. You may remember little about your stay in ICU. This is because you will be receiving sedation and other medicines to help you recover.

Back to the ward

Once the recovery staff is satisfied that you have safely recovered from your anesthetic, and all your observations (such as blood pressure and pulse) are stable, you will be sent to your ward.

It is important that you ask for help:

• when you first get out of bed (although you may feel fine lying in the bed, you may feel faint or sick when you first get up)
• if you have had a spinal or epidural, as your legs may still be weak or numb for some hours. They may not regain their full strength for about 12 hours. Kindly do not get out of your bed without assistance.

Pain relief

Good pain relief is important.

• It avoids the suffering
• helps you recover more quickly.
• helps prevent complications (chest infection & blood clots in veins)

If you can breathe deeply and cough easily after your operation, you are less likely to develop a chest infection.

If you can move around freely, you are less likely to get blood clots (deep-vein thrombosis or DVT) in your legs.
It is much easier to relieve pain if it is dealt with before it gets bad. So, ask for help as soon as you feel pain, and continue the treatment regularly.

Pain relief can be given in the following way;

• Tablets or liquids to swallow

These are used for all types of pain. They take at least half an hour to work and should be taken regularly. You need to be able to eat, drink and not feel sick for these to work.

• Injections

These are often needed, and are given either into a vein for immediate effect, or into your leg or buttock muscle which may take up to 20 minutes to work.

• Patient-controlled analgesia (PCA)

This is a method using a machine that allows you to control your pain relief yourself. It has a pump which contains a pain killer (medicine). The pump is linked to a handset which has a button. When you press the button, you receive a small dose of the medicine painlessly into your cannula. Ask your anesthetist for more information.

• Local anesthetics and regional blocks

These types of anesthesia can be very useful for relieving pain after surgery.

Pain killers (Medications)

• Opiates: These are the medications often used for severe pain. They include morphine, codeine and pethidine. They may be given by tablets, injections or patient-controlled analgesia. They may also be added to a spinal or epidural to give longer and better pain relief. Some people have side effects the most common include nausea (sickening feel), vomiting, constipation, and drowsiness. Larger doses can produce breathing problems and low blood pressure (hypotension).The nursing staff will watch you closely for these.
• Other pain killers (analgesics): such as diclofenac, ibuprofen or paracetamol may be given during anesthesia or afterwards as injections or tablets. They must be used carefully by people with asthma, kidney disease, and heartburn or stomach ulcers. If you are allergic to these or have had any problems with these medications you must inform your anesthetist about it.

Acute Pain Service team (set up exclusively for the perioperative period)

The team comprises of an anesthetist and a nurse (who specialize in pain relief after surgery) to provide you pain relief or regulate your pain relief once you are in the ward.
They will meet you on the ward after your surgery and provide you pain relief or regulate your pain relief to suit you and keep you as comfortable as is possible. They will meet you regularly for the first 2-3 days after your operation depending on your need. Feel free to discuss with them any aspect of pain relief that you would want to know. Your queries are welcome

If you feel that you are in pain you must let the nurse or doctor know so that appropriate measures can be taken to control your pain satisfactorily

Risks & benefits of Anesthesia

Anesthesia has made much of today’s surgery possible, and has brought great benefit. 
Anesthesia removes pain and any sensation during an operation. This benefit needs to be weighed against the risks of the anesthetic procedure and the medications used. This will vary from person to person. With modern anesthesia, serious problems are uncommon. Risk cannot however be removed completely, though modern equipment, training and drugs have made it a much safer procedure.
The risk to you as an individual will depend on:

• Whether you have any other illness
• Personal factors, such as smoking or being overweight
• Surgery which is complicated, long or carried out as an emergency.

Side effects of anesthesia

The incidence of these side effects varies from person to person. It may be possible that you have none of these problems after you have had your anesthesia.
The following table below will give you an idea of the possibility of side effects after anesthesia.

The incidence is as follows;   

Common (Incidence: 1 in 100)	General Anesthesia	Regional Anesthesia
Vomiting after surgery	ü	ü
Sore throat	ü	Î
Dizziness, blurred vision	ü	ü
Headache	ü	ü
Itching	ü	ü
Bodyache, pain & backache	ü	ü
Bruising & soreness	ü	ü
Confusion & memory loss	ü	Î

 

Uncommon (Incidence: 1 in 1000)	General Anesthesia	Regional Anesthesia
Chest infection	ü	Î
Bladder problems	ü	ü
Muscle pains	ü	Î
Breathing problems	ü	ü
Damage to lips, teeth & tongue	ü	Î
Awareness	ü	Î

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