Your anaesthetic explained
At Berkshire Grove Hospital, you will be looked after by a highly trained anaesthetic consultant from the start of your operation until you have fully recovered from the anaesthetic.
Most operations here are performed under general anaesthesia, where you are put to sleep for the duration of the operation. Some operations can be carried out using sedation or regional anaesthesia (where part of your body is made numb).
Preparing for your anaesthetic
-
You will be invited to complete a questionnaire before your operation. This includes questions about your medical and anaesthetic history, as well as any medications you are taking. You may also be asked to have some routine tests before your operation, like blood tests or an electrocardiogram (an electrical tracing of your heart).
-
You might be asked to stop some medications before your operation. If you are in any doubt, please check with the hospital beforehand. Examples include blood thinning tablets (e.g. warfarin, rivaroxaban and clopidogrel), blood pressure tablets (e.g. ramipril) and some herbal medications.
-
Sometimes it is necessary to see an anaesthetist in person beforehand, but usually you won’t meet them until you arrive at the hospital on the day of your surgery.
-
We ask patients not to eat anything for six hours before an operation. It is OK to drink clear fluids until two hours beforehand. When you arrive at the hospital, you may be told you can continue drinking small sips of water until you come to the operating theatre. It is very important to follow these instructions carefully. They are designed to keep you safe and minimise the risk of anything in your stomach coming back up while you are asleep.
-
It is OK to drink alcohol the day before an operation but this should be limited to 1-2 units. This will ensure that your body has had a chance to clear the alcohol and that you are clear-headed for your operation.
-
If you wear contact lenses, these can be worn on the day but make sure you bring your glasses with you as your contact lenses must be removed before you come to theatre.
If you have false eyelashes, it might be best to remove these before you come to hospital. Your eyes will be taped closed to protect them. If false eyelashes are left in place, removing the tapes at the end of the operation can pull some (but not all) of the false lashes away, leading to an uneven appearance.
We advise patients with gel or varnished nails to ensure that one finger has its gel or varnish removed. This ensures that the finger probe used to monitor oxygen levels during the operation can function without any interference. Modern probes are very good but thick nails or certain colours can sometimes cause problems with getting a good reading.
What to expect on the day
You will meet your anaesthetist at the hospital. They will review your medical history with you and explain what the anaesthetic involves, as well as answer any questions you may have. It is important to mention any past experiences you have had with anaesthetics, including any side effects you may have experienced. If you have any allergies, let your anaesthetist know.
Your anaesthetist will ask you to open your mouth and move your neck. They will also ask if you have any loose teeth, caps or crowns. This is to check for any possible difficulties with looking after your airway and breathing while you are asleep, as sometimes your anaesthetist will need to prepare special equipment.
With your anaesthetist you will agree a plan to keep you safe, relaxed and comfortable during your operation. Usually this will be a general anaesthetic.
Your general anaesthetic
Almost always a general anaesthetic starts with:
- Monitoring being applied to your body to check your oxygen levels, heart rate and blood pressure
A small cannula being inserted, usually in the hand, to give you your anaesthetic
Breathing oxygen through a plastic mask before going to sleep
The anaesthetic can sometimes make your arm ache or feel heavy once it passes through the cannula. This is completely normal.
Once you are asleep, your anaesthetist will insert a breathing tube into your mouth. This keeps you breathing during the operation. During the operation you will be attached to a ventilator that will be used to give you oxygen and air to breathe. You will be kept asleep by either a pump that gives anaesthetic through your cannula, or by anaesthetic gases that will be added to the oxygen and air. Your eyes will be protected during the operation, usually using special eye tapes. This prevents your eyes drying out during the operation and also protects them from any splashes or grazes.
If the anaesthetic is being given through your cannula, your anaesthetist will usually use special electrodes on your forehead to monitor your brainwaves and make sure you are fast asleep. If you are being kept asleep by anaesthetic gases, these will be measured – again to make sure you are fast asleep.
During the operation you will be given any necessary pain relief so that when you wake up you feel comfortable. You will usually also be given a combination of anti-sickness medication to reduce the chance of any sickness afterwards.
After your anaesthetic
At the end of the operation, the anaesthetic will be stopped and you will wake up. Your breathing tube will be removed. You will be looked after in the recovery area until you are fully awake and have had any extra pain relief you may need. You will then be taken back to the ward.
Is it safe?
Modern anaesthetics are very safe and well-tolerated. Many things which we do without thinking, such as going in a car as a driver or passenger, are more dangerous than a safely administered and carefully monitored general anaesthetic.
It is important to understand that there may be some side effects related to your anaesthetic. Your anaesthetist will do all they can to prevent or minimise these.
-
Very common side effects (experienced by more than 1 in 10 patients) include feeling sick or shivery, thirst, having a sore throat, bruising and temporary memory loss.
Common side effects (experienced by 1 in 10 to 1 in 100 patients) include feeling pain or aching when the anaesthetic is given, and minor grazing to the lips or tongue.
Uncommon side effects (experienced by 1 in 100 to 1 in 1000 patients) include minor nerve injury that gets better completely. Sometimes this can result from being in a certain position for a long time. Your anaesthetist and surgeon will carefully pad your arms and legs to reduce the chance of this as much as possible.
Rare side effects (experienced by 1 in 1000 to 1 in 10 000 patients) include nerve damage that is permanent (1 in 1000), a dry or scratched eye (1 in 3000), damage to teeth (1 in 4500) and anaphylaxis, a severe allergic reaction (1 in 10 000).
Very rare side effects (experienced by 1 in 10 000 to 1 in 100 000 patients) include awareness of part of an operation (1 in 20 000), loss of vision (1 in 100 000) and death as a result of an anaesthetic (1 in 100 000).
These statistics are compiled looking at all patients having operations, including emergency surgery. When we just consider patients having planned operations, it is likely that many of the risks stated above are considerably smaller. If you have any concerns about the risks of anaesthesia, please ask your surgeon or the hospital if you can speak to the anaesthetist beforehand.