ANAESTHESIA, WHAT TO EXPECT

DO I HAVE TO HAVE AN ANAESTHETIC AT ALL?

There are not many types of surgery that can be managed with no anaesthetic at all. If a procedure is minor enough not to need any type of anaesthetic your surgeon will usually try to do the procedure in their rooms. Gastroscopies and (rarely) colonoscopies can be done without any sedation but it is not pleasant and you would want to have very good reasons to avoid anaesthesia. Removal of skin lesions can sometimes be done with only local anaesthetic but generally if your surgeon wants to do the procedure in hospital, the lesion is more complicated and time consuming and at least some sedation is recommended.

If your concern is a reluctance to have a general anaesthetic, this is easier to accommodate. Many operations can be done using local anaesthetic (especially as various nerve blocks) plus some or minimal sedation. A good example is Caesarean sections where mums usually stay awake for the whole operation.

What type of anaesthetic will I have?

There are many types of anaesthetic, but they tend to fall into a combination of the following; general anesthesia, sedation or local anaesthetic.
The choice is guided by many factors including the type of surgery, your general health and your own preferences. It is quite acceptable for you to leave the choice up to your anaesthetist if you wish.
See our guides about specific operations below for further details or discuss any concerns with our practice nurse (03 5334888) or your anaesthetist on the day of surgery.

• General Anaesthesia

When you have a general anaesthetic, your mind is placed in to a carefully controlled state of unconsciousness so that you will not experience pain or respond to any stimuli. This is different to sleep and to coma. Drugs are given intravenously or as gases that you breathe. While you remain unaware of what is happening, your anaesthetist monitors how ‘deep’ you are and whether the drugs are affecting your breathing and circulation.

• Sedation

Sedation is often used for minor procedures, such as gastroscopy and colonoscopy and in combination with regional or local anaesthesia. The aim is to have the patient sleepy and relaxed—sometimes called twilight sleep—without being fully unconscious. Usually, patients have no memories of the procedure, even though they may not be fully asleep.
The drugs used are similar to those given intravenously for general anaesthesia but usually in lower doses.
The benefits to sedation are quicker awakening than general anaesthesia and less effect on breathing and circulation.

• Local Anaesthesia
  

Local anaesthetic is injected at the site of surgery. This is most commonly done for removal of small skin lesions. Local anaesthetics are drugs that block the ability of nerves to carry pain impulses back to the brain. Mild sedation is commonly used to make the experience more comfortable. How long the numbness lasts depends on the drug used and can be from 1-12 hours.

• Regional Anaesthesia

Local anaesthetic is injected around more major nerves to block a larger area of the body.

Common examples are;

• Epidurals for labour
• Spinals for Caesareans, prostate surgery or leg surgery
• Eye blocks for cataract surgery
• Arm blocks for arm and shoulder surgery

During the procedure, you may be awake and pain free, sedated or under a full general anaesthetic depending on your wishes and the type of surgery.
How long the numbness lasts depends on the drug, its concentration and the type of block; it can be from 2-24 hours.

WHAT HAPPENS ONCE I ENTER THE OPERATING THEATRE?

• In the Theatre; Operating Room Reception

In the theatre, you will be taken to a reception area or directly to the anaesthetic room. Here you will again be asked your personal details. The site of your operation and your consent form will be checked. There is usually a bit more waiting at this stage.

Theatre staff normally wear coloured ‘pyjamas’ and paper hats. Because of this, they all look similar but you will probably recognise your Anaesthetist as you will have met him/her already.

• The Anaesthetic Room

This room is where some basic preparatory steps are taken for your anaesthetic. There will be an anaesthetic nurse and/or theatre technician assisting your Anaesthetist. S/he will attach Electrocardiograph (ECG) stickers and leads to your chest that will later monitor your heart, and a blood pressure cuff.
Your Anaesthetist may insert an intravenous cannula, usually in the back of your hand, and this may be connected to a ‘drip’. In some patients this can be difficult and may need a few attempts, so it helps if you try to keep your arms warm on the trip to theatre. The ‘drip’ is usually a solution of salt and water (saline) that helps to keep you well hydrated. You may be given a mild sedative at this stage to calm any last minute nerves, which are very common. This drug also affects the memory and many patients don’t remember anything further until they wake up in recovery. If you are cold, please ask for an extra blanket.

If you are having a local or regional anaesthetic, this will usually be done at this stage.

• ​The Theatre

When they are ready for you in theatre, you will be wheeled in to the theatre on a trolley. There will be several people in here, those you have already met plus at least two more nurses. It often seems busy, cold and noisy; there may be music playing. We then use a plastic board to slide you over on to the theatre operating table - this is usually fairly cold and hard. The ECG leads and blood pressure cuff will be attached to a machine (the monitor) as will a peg that clips on to your finger and measures the level of oxygen in your blood. An oxygen mask may be placed over your face. The Anaesthetist will then inject some drugs in to your intravenous line, this may sting a bit, and you will fall asleep.

During the procedure, the Anaesthetist ensures that you continue to receive adequate drugs to keep you asleep and monitors the functioning of your heart and lungs. Often, an ‘airway’ will be placed (after you are asleep) in to your throat to allow you to breathe more easily.

• The Recovery Room

When your procedure is finished, anesthetic medications or gases are ceased and you rapidly wake up. You are then taken to the recovery room and are given time to fully wake up. You will be given oxygen and your vital signs will be recorded. We will also make sure any pain is controlled. When everything is stable you will be taken back to the ward or a second stage (sit up) recovery area until you are ready to go home.

WHAT WILL HAPPEN AFTER MY SURGERY?

When your surgery is complete, the administration of anaesthetic drugs and gases is stopped. You will wake up over the next few minutes and will then be taken on a trolley to the recovery room. You will be given some oxygen and your observations will be checked for 10-30 minutes. You may be given painkillers or drugs for nausea. When everything is stable and you are comfortable and awake you will be transported back to the ward or helped to get dressed and directed to the waiting room.

If you are a day patient you will be able to go home when your pain is well controlled and you can walk, eat and drink. We will make sure you understand any postoperative instructions about appointments, pain relief and things to watch out for.

For the rest of that day, you need to rest. Don’t try to eat or drink too much. Take painkillers as advised. Your mental faculties will be slightly impaired even though you may feel normal, so don’t drive, operate machinery or make important decisions until the next day. Avoid alcohol. Tiredness is very common for many reasons and may last a few days.

HOW WILL I FEEL AND WILL I BE SICK AFTER MY SURGERY?

How you feel after your procedure depends on the type of procedure, your general health and how much you need in the way of painkillers.
Most people feel fine after their operation.

However, you may suffer from side effects of some sort. You may feel sick, dizzy or shivery, or have general aches and pains. Some people may have blurred vision, drowsiness, a sore throat, a headache and breathing difficulties. These usually settle down over the first hour or two.

Nausea and vomiting after surgery is much less common these days as both anaesthetic drugs and anti-vomiting drugs have improved enormously. Unfortunately, some people are still very sensitive, especially in certain types of surgery or if large amounts of painkillers are required. Please let your anaesthetist know if you have suffered previously from postoperative nausea or travel sickness and we will do our best to prevent this problem.
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​WILL I HAVE PAIN AFTER SURGERY?

​This obviously depends on the type of surgery but we go to great lengths to make sure that you do not have too much pain after surgery. Good pain relief is very important after your operation. As well as relieving your suffering, it can also reduce complications like chest infections and vein thrombosis in your legs. You will be able to mobilise earlier and go home sooner.

​You will usually receive a combination of local anaesthetic, simple painkillers (eg paracetamol), anti-inflammatories and stronger painkillers (morphine, fentanyl, Endone). ​The stronger painkillers account for most side effects (nausea, itching, drowsiness, hallucinations, constipation) so we try to reduce the doses needed. For very painful surgeries (abdominal surgery, joint replacement, shoulder surgery) there are several specialised techniques that we can use; these will be discussed with you by your anaesthetist.

• Further information; Ways to provide pain relief

Local Anaesthetic
During your operation, we often inject long lasting local anaesthetics in to your wound or the nerves supplying the area of your operation. This numbness may last from 4–24 hours depending on the site. Your Anaesthetist will warn you when it is likely to wear off and you should take some form of oral painkiller as it starts to wear off. This gives the tablets a chance to start working before you are in more severe pain.

While the local or block is working it is important to be careful not to injure the area as you will not sense any knocks or normally uncomfortable positions.

Oral Medications
There are many painkillers that can be taken as tablets varying from the simple paracetamol up to stronger proprietary medications such as Panadeine Forte, Endone and Tramal. Anti-inflammatory drugs, such as Naprosyn, are also commonly used. Generally, the stronger the medication, the more likely are side effects such as nausea, drowsiness and constipation so we try to start with the weaker drugs.

Suppositories
When the taking of oral medications may be a problem, for example after bigger operations, sometimes with children and if nausea is a problem, we sometimes use suppositories inserted in to the back passage. These can be very effective.

Suppositories are sometimes given to children while they are anaesthetised so that they can be working when your child wakes up. More commonly we try to give paracetamol as a premed before the operation.

Injections
If the pain is more severe, then morphine or pethidine may be given by intramuscular injection. This is used less commonly for bigger operations but is often used if the oral medications are not quite enough and maybe one injection is required to tide you over.

Intravenously—Infusions
For operations where pain can be severe, opiate drugs like morphine and fentanyl can be infused continuously in to a ‘drip’—an intravenous infusion. The amount of drug you get is controlled by the nursing staff who can turn the rate up if you still have pain, or down if you are getting side effects.
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Intravenously—Patient Controlled Analgesia (PCA)
A better technique is to allow you, the patient, to control how much of the opiate you need. With a PCA machine you have a small button that gives you a small dose of morphine or fentanyl when you push it. It then waits 5 minutes to allow that dose to work before letting you have another press. Many people find this great as they are in control and can balance the pain relief they need with side effects such as drowsiness and nausea. Also, you don’t have to wait for a nurse to come and give you more painkiller.

Spinal opiates
If a very small dose of morphine is injected into the spinal fluid, it has a very long duration of action (24hrs) with a reduction in the normal morphine side effects (nausea, sleepiness, itch). It cannot usually be topped up like an epidural so is used with other medications for when it wears off. This technique is commonly used when surgery is very painful initially such as Caesarean delivery and major abdominal surgery.

Epidurals
The most effective pain relieving method we have is the use of epidural infusions. An epidural is a small plastic catheter inserted in to a space around the spinal cord. Painkilling drugs such as local anaesthetics and opiates are then delivered in to this space where they alter the transmission of pain signals back along the nerves to the brain.

This technique is sometimes used for more major surgery such as in the abdomen or for major orthopaedic Surgery. It is also useful if patients are very sensitive to opiate drugs.
 
The disadvantages are that:

• It is an invasive procedure where a needle is inserted near the spine and a foreign material is left in the body. There is a very remote risk of infection and of damage to nerves in the spine
• Patients will be usually confined to bed as the muscles in their legs will be weak thus preventing early mobilisation
• A catheter may be required because of difficulty urinating
• There can be complications such as low blood pressure, nausea or itching

We only offer this technique if there would be definite advantages to you. Your Anaesthetist will discuss the advantages and disadvantages and the final choice will be yours.

WHY DO I HAVE TO GO HOME SO SOON AFTER SURGERY?

​It used to be common to admit patients to hospital the day before surgery and keep them in hospital after surgery for days or weeks. Over the last few decades there have been enormous improvements in both anaesthetic drugs and surgical techniques. Drugs have been designed to wear off very quickly with minimal hangover. Nausea is now uncommon. Pain control is much improved. Surgeries are now designed to be as minor as possible (eg. keyhole surgery).

As a result of this, patients generally stay in hospital for the least time possible both before and after surgery. This reduces stress, time away from families/work and also the risk of complications such as infections, thrombosis, bowel problems and stiffness. It is also cheaper.

WHY DO I HAVE TO STAY IN HOSPITAL AFTER SURGERY?

Generally, modern medicine is all about getting patients out of hospital as quickly as possible. If your surgeon has arranged for you to stay in hospital after surgery, it usually means that the type of surgery is associated with a higher risk of complications such as pain, nausea, infections or bowel or lung problems. Be assured that we are still trying to get you home as safely and as soon as possible.

​CAN I BE THERE WHEN MY CHILD/PARTNER WAKES UP?

​We understand that people may be anxious if someone they care for is having surgery and we understand that you may want to be by their side as soon as possible. As a general rule, we are happy to bring parents or carers into the recovery room as soon as the patient is awake and we are happy with their breathing. Occasionally this may be delayed if the recovery room is particularly busy and we need to respect the rights and privacy of other patients.

​THE HOSPITAL SAYS I MUST HAVE SOMEONE AT HOME WITH ME AFTER SURGERY

​After any anaesthetic your judgement and other mental abilities will be impaired for several hours. Also, you may be at risk from complications of the surgery such as unexpected pain or bleeding. Even though you may feel normal, we strongly recommend that you arrange someone to be closely available for the first night post surgery to assist with any problems. ​

WHEN CAN I DRIVE/FLY/WORK/PARTY/PLAY?

​If you have had a general anaesthetic or sedation, you must not drive, operate machinery or make important decisions for the rest of the day as your thinking and reaction times will be slightly impaired even though you may feel normal.

You may also need to discuss with your surgeon whether the surgery that you have had will interfere with your ability to drive (eg pain, mobility or vision). If you require time off work or a work certificate, discuss this with your surgeon.

If you need to fly soon after an anaesthetic/surgery you may be placing yourself at increased risk of thrombosis. If you are concerned, discuss this with us or your General Practitioner as preventive measures can be taken.
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Generally, we recommend that you do not over-exert yourself on the day of surgery as the body needs some time to recuperate. Your activity levels on the days after surgery depend largely on the type of surgery and whether you need any ongoing drugs such as pain-killers.