ANAESTHESIA FOR SPECIFIC SURGERIES
Nearly all cataract surgery is done under local anaesthetic at a day surgery hospital. The main benefit of local anaesthesia during eye surgery is that it avoids possible side effects of a general anaesthetic such as nausea and vomiting and confusion (not uncommon in elderly patients) after the operation. Eating and drinking can be resumed sooner when a general anaesthetic is avoided and recovery is generally more rapid. Pain is minimized when local anaesthesia is used because the eye is numbed and usually the patient can go home within hours.
When is a local anaesthetic not suitable for cataract surgery?
These days it is uncommon for eye surgery to be performed under general anaesthesia, however sometimes it is still necessary. General anaesthetics are used when a patient is unable to lie still or has a significant head tremor, extreme anxiety or claustrophobia or an allergy to local anaesthesia. Children are more likely to require a general anaesthetic.
How is the local anaesthetic performed?
The local anaesthetic is administered in the anaesthetic room of the operating department. You may be given some sedative medication through an intravenous cannula to help you relax and often you remember nothing about any other injections. Local anaesthetic is then injected around the eye socket using a very fine needle that passes alongside the eyeball.
What happens during the operation?
Once the local anaesthetic is working, you will be taken into the operating theatre and positioned on the operating table so that you are lying flat with your head under the microscope. It is important that you feel relatively comfortable, as you will need to lie in this position for approximately 10-20 minutes.
Your face will be covered by a sterile drape and your other eye taped for protection, leaving only the eye to be operated on exposed. You will be asked to keep still and not talk once the surgery starts. You will be awake but should feel no pain although you may see some lights. If anything is worrying you, you can talk to us.
How fast will I recover from the local anaesthetic?
Most patients having this procedure go home after getting changed and having something to eat and drink.
You may experience slight pain, which should be relieved with simple pain reliving drugs such as paracetamol. If you experience severe pain you should contact your surgeon.
What are the possible complications of local anaesthesia for eye surgery?
Local anaesthesia is safe and effective but does have some risks you need to be aware of. These include:
Shoulder surgery is often associated with significant amounts of post-operative pain. For this reason, the anaesthetic usually consists of a general anaesthetic plus an arm block.
The “block” (technically an interscalene block) is a type of anaesthetic which provides dense numbness to the shoulder and arm. The numbness can last for 8-24 hours.
The block is performed just before the operation but usually after you have been given some sedation. The injection is placed in your neck next to the nerves to your arm and an ultrasound machine or a small electrical pulse is used to locate the correct nerves.
When you wake up at the end of surgery your arm should feel numb and heavy. We will provide a sling for you but you need to be careful not to injure the arm whilst it is numb.
This is a very good way to treat much of the pain but you will probably still need strong tablet or patch painkillers when the numbness wears off.
There are also some possible side effects which should resolve as the block wears off:
Serious complications are fortunately very rare and include:
If you think something is wrong please contact our Practice Nurse on
(03) 5331 4888 or after hours please contact St John of God Hospital
(03) 5320 2111 and ask for the Anaesthetist on call to be contacted.
There are three main types of endoscopy commonly performed in Ballarat.
Endoscopy is used to help diagnose a great number of problems, such as bleeding, infection, inflammation, ulcers, polyps and cancers.
In nearly all cases, the anaesthetic used is simple intravenous sedation. Occasionally, gastroscopes are done with just local anaesthetic spray and NO sedation. This is uncomfortable but has the benefit that you can get up and go back to work or drive straight away.
Sedation is used to reduce anxiety, pain and discomfort. Patients become very sleepy and recall very little (usually nothing) of the whole procedure.
In Ballarat, the sedation for the endoscopies is administered by a trained Anaesthetist who can administer a carefully titrated dose of the sedative drugs and monitor your vital signs for the adverse effects of those drugs, such as reduced breathing or blood pressure.
LOCAL ONLY; Your surgeon/physician will spray a local anaesthetic on to the back of your throat. This spray has an unpleasant taste but numbs your throat and deadens the 'gag reflex'. You will be asked to lie on your side and you will be asked to swallow the gastroscope. This is then pushed down in to the stomach and a picture is seen on a television monitor. This part may take 3-10 minutes. Once it is finished, the gastroscope is removed and you can get up and go home - usually an Anaesthetist will not be required.
SEDATION (normal technique); Your Anaesthetist will meet you before the procedure, make an assessment of your general health and discuss the risks and benefits of the appropriate forms of anaesthetic. You will be taken in to the endoscopy room where the nursing staff will check your details and consent form. Various monitors (blood pressure, cardiograph and pulse monitor) will be attached to your body and an oxygen mask or nose tubes will be placed on your face. Your Anaesthetist may spray some local anaesthetic on to the back of your throat. This spray has an unpleasant taste but numbs your throat and deadens the 'gag reflex'. An intravenous cannula will be inserted - usually in to the back of your hand. You will be asked to lie on your side and then your Anaesthetist will administer the sedative drugs. Usually you don't remember anything more until you are out in the recovery room.
If your surgeon/physician is only looking at the first part of the colon (sigmoidoscopy) this will sometimes be done without sedation. However, a normal full colonoscopy will always require some sedation. The colonoscope is passed through the anus and rectum along the length of the large bowel to the caecum—this may be a total distance of 1–1.3 metres.
The anaesthetic part of the procedure is very similar to that for a gastroscope and some people may be having both under the same anaesthetic—one after the other.
You will be taken in to the endoscopy room where the nursing staff will check your details and consent form. Various monitors (blood pressure, cardiograph and pulse monitor) will be attached to your body and an oxygen mask will be placed on your face. An intravenous cannula will be inserted (usually in to the back of your hand) and you will be asked to lie on your side. Your anaesthetist will then administer the sedative drugs and usually you don't remember anything more until you are out in the recovery room. The duration of the procedure can vary from 10–45 minutes but your Anaesthetist will continue to give sedative medications for as long as necessary. During the procedure you may be moved on to your back. You will awaken near the end of the procedure (this part is not as uncomfortable) or very soon after.
Bronchoscopy is usually done using intravenous sedation, although rarely a full general anaesthetic is required.
Often you will be given a 'nebuliser mask' as used for asthmatics but with nebulised local anaesthetic instead of Ventolin. You will then be taken in to the endoscopy room where the nursing staff will check your details and consent form. Various monitors (blood pressure, cardiograph and pulse monitor) will be attached to your body and a fine oxygen tube will be placed inside your nose. An intravenous cannula will be inserted - usually in to the back of your hand. Further local anaesthetic spray and jelly may then be applied to your nose and the back of your throat.
Sedative drugs will then be administered through the IV while the physician/surgeon passes the fine bronchoscope through your nose and down in to the lungs. This part of the procedure usually takes 5–10 minutes.
When the procedure is finished, you will be transferred to the recovery area where you are still monitored and given oxygen until fully awake. At this stage you may have a cough and sometimes cough up blood if a biopsy was taken. This usually settles over the following 30 minutes.
After Your Endoscopy
You will spend 10–20 minutes in the recovery room and then be transferred back to the day ward or second stage recovery. At this point you can get dressed and have something light to eat and drink if you wish. Usually you will feel well enough to go home 1–2 hours after your procedure.
Anaesthetic Complications after endoscopy
In our practice, anaesthesia may be required for:
Many of these cases are done in the Dentists' surgery using local anaesthetic, which avoids the risks and inconvenience of a general anaesthetic. However, the dentist or oral surgeon may request a general anaesthetic if the work is extensive or difficult or the patient is particularly anxious. Children often benefit from having dental procedures done under general anaesthetic and this can help prevent future anxiety for dental consultations.
Nearly all of our dental and oral surgery cases are done as day cases; that is, the patient comes in to hospital just before their procedure and goes home a few hours later. The procedure itself may take anywhere between a few minutes and several hours depending on the nature of the surgery.
Before your procedure
Refer to “Preparation for Surgery and Anaesthesia” for instructions to help you prepare for your procedure and advice about fasting and medications. If your child is having the procedure, please refer to “My Child Needs an Anaesthetic”. We recommend that you discuss openly with your child what will happen.
The procedure itself
Nearly all cases that we are involved with require a general anaesthetic. The details of the preparations and administration of this are very similar to those explained in “Anaesthesia, what to expect”.
For nearly all general anaesthetics, we need to insert a tube for you to breathe through - this is done after you are asleep. In some dental cases, this tube is inserted through the nose (normally it goes through the mouth) if this is the case you may experience some minor bleeding from the nose after the procedure. Often, we will give you some nasal spray before or after you go to sleep to try and prevent this.
While you are asleep during the procedure, the surgeon or dentist will often give you an injection of local anaesthetic as well to make you more comfortable after the procedure. When you wake up your mouth will be numb and this will last from 6–8 hours.
After the procedure
You will wake up in the recovery room when the procedure is complete. Some discomfort is common but usually pain is not severe as local anaesthetic is used for more major surgery. There will often be some blood in your mouth and sometimes some gauze to soak up the blood until this settles down - usually the bleeding settles over the following half-hour.
You will be able to go home (with an accompanying adult) when you have recovered from the anaesthetic, there is minimal bleeding and your pain is well controlled. For more major procedures your oral surgeon will provide you with an information sheet about what to expect and how to care for your mouth after the operation.
Possible risks and complications
All medical procedures including anaesthesia include some degree of risk. Although we practice with the highest standard of care, unexpected complications can occur and rarely they may be serious and permanent. We do not wish to alarm you, but it is important that you have some knowledge of the risks involved so that you can make an informed decision about any medical procedure. Please discuss these issues with your Anaesthetist if you are concerned.
The following are some side effects and complications that are related more to dental procedures. Please refer to “Risks and Complications” for a more detailed list of complications that can follow any anaesthetic. Following are just a few:
Very rare complications; Serious problems with your breathing during the operation. This can occur due to problems with the "breathing tube" that allows you to breathe while the dentist or surgeon is working in your mouth. Death or brain damage is possible but extremely unlikely.
Your anaesthetist is trained to manage any of these reactions and the chance of a disastrous outcome is extremely remote, especially for dental procedures where nearly all patients are very fit and healthy—serious complications are more likely when patients are very sick.
These are only some of the possible side effects and complications that can occur during and after an anaesthetic. Please refer to “Risks and Complications” for further details on this subject. If you are concerned about a procedure that you need to have or you think you may have suffered a complication, please contact our practice on (03) 5331 4888.
KNEE ARTHROSCOPY; STAYING AWAKE
When you have your knee surgery, it is possible to remain awake and view the procedure on the television screen. This has the advantage that the surgeon can explain the findings and show them to you at the time of surgery. To achieve this, you need a ‘Spinal Anaesthetic’.
What is a ‘Spinal’?
Instead of a more traditional general anaesthetic, your Anaesthetist can inject local anaesthetic into the fluid surrounding your spinal cord. This is done in the lower back and results in numbness and immobility in your legs for a few hours. Local anaesthetic drugs block the nerve impulses, preventing messages of pain from reaching the brain and also preventing the brain’s movement messages from reaching the muscles in the effected body parts.
How is the spinal put in?
First your Anaesthetist will place an intravenous drip in your hand to give you some fluid. Usually you are positioned sitting up and antiseptic is ‘painted’ on your back. Some local anaesthetic is injected in your skin and then the fine spinal needle is inserted in to the fluid surrounding the spinal cord. After injecting the local anaesthesia the needle is removed from your back.
Does insertion of the spinal hurt?
The initial injection of local anaesthetic into the skin may give a burning or stinging sensation for a few seconds, but most people do not experience significant discomfort during the insertion of the spinal needle itself. Rarely you may feel some pain down the legs if the needle touches one of the nerves.
How long does it take to work?
Once injected, the legs and lower part of the body start to warm up in seconds, and within 5 minutes the legs feel very numb and heavy. Usually the legs are numb enough for surgery to begin in 5-10 minutes.
How long does the spinal block last?
Using different drugs the block will last about 1-2 hours for day cases and sometimes up to 3-4 hours for more major surgery. During this time you will slowly start to regain feeling and movement in your legs. If you start to feel pain at this point, let your nurse know and pain relief medication can be given.
What are the advantages of spinal anaesthesia?
In certain cases a spinal anaesthetic may be recommended by your Anaesthetist as being safer than a general anaesthetic, especially if you have heart or lung disease. Spinal anaesthetics also tend to have less pain, nausea and hangover effects compared to a general anaesthetic. The major benefit is the ability to actually see what is happening inside your knee.
What are the disadvantages of spinal anaesthesia?
As with all types of anaesthesia, spinal anaesthesia carries risks. Serious risks are rare and your Anaesthetist takes all possible precautions to avoid them. The major problem is that it may add an extra 1-2 hours to your hospital stay waiting for your legs to ‘wake-up’.
Minor and Uncommon Risks
Nausea or dizziness during or just after the operation. This is due to your blood pressure going down and is usually prevented by the fluids given through the drip. It is usually easy to treat if you tell your Anaesthetist.
Some discomfort during surgery. This is sometimes seen with day cases where we aim to give the lowest dose possible to enable you to go home early. Very rarely you may need some sedation or even a general anaesthetic for the operation to continue.
Some back pain for one or two days after your procedure. This is rare and is probably due to bruising from the injection.
More Serious but Rare Risks
Spinal headache - caused by a small leakage of the spinal fluid through the needle hole. Spinal headaches were more of a problem in the past but modern spinal needles are specifically designed to help prevent this problem, and only a very small percentage of patients develop it.
Leg pains - very rarely the local anaesthetic can irritate the spinal nerves causing pains in the legs. This resolves over a few days.
High Spinal - Occasionally the spinal anaesthetic block extends to a higher level than expected and may affect breathing muscles, making breathing difficult. If this is severe, a general anaesthetic is given until the spinal starts to wear off.
Serious but Very Rare Risks
Infection and Nerve Damage - there have been rare cases of nerve damage following all types of anaesthetics, including spinal. Fortunately, many of these resolve spontaneously. Spinals are inserted under strict aseptic technique to avoid infections.
It’s your choice
The final decision as to the type of anaesthetic is yours. We may make a recommendation but your procedure can be easily done with you awake or asleep. If you have any questions either before or after your anaesthetic please contact the Anaesthetic Group Ballarat on (03) 5331 4888. If you think you have suffered a complication of your anaesthetic please contact us on this number or after hours through St John of God Hospital.