You and your anaesthetic

Anaesthesia stops you feeling pain and other feelings. It can be given in different ways. It does not always make you unconscious. Local anaesthesia are given by injections which numb a small part of your body. You stay awake but free from pain.

Regional anaesthesia are given by injections which numb a larger or deeper part of the body. You stay awake but free from pain.

General anaesthesia is essential for some operations. You are unconscious and feel nothing.

Anaesthetists

Anaesthetists are doctors with special training who:

• talk about types of anaesthesia with you and find out what you would like. This includes helping you to make choices
• talk with you about the risks
• agree a plan with you for your anaesthetic and pain control
• give your anaesthetic and look after your well being and safety throughout your surgery
• manage any blood transfusions you may need
• plan your care, if needed, in the Intensive Care Unit
• make your experience as pleasant and pain free as possible

If you smoke, giving up for several weeks before the operation will cut the risk of breathing problems. The longer you can give up before the operation, the better. If you cannot stop smoking, cutting down will help.

If you are very overweight, losing weight will reduce many of the risks of having an anaesthetic.

The anaesthetist may need to put a tube in your throat to help you breathe. If you have loose teeth or crowns, dental treatment may cut the risk of damage to your teeth.

You will be asked some questions to check your health before your operation. This may be:

• at a pre-assessment clinic
• by talking to doctors on the ward, or
• when you meet your anaesthetist

It is important for you to bring a list of:

• all the pills, medicines, herbal remedies or supplements you are taking
• any allergies you may have

You should fast – that is have nothing to eat or drink. The hospital should give you clear instructions about this. It is important to follow these. You should not have any food or liquid in your stomach during your anaesthetic. This could come up to the back of your throat and damage your lungs.

Take your medicines as usual, unless your anaesthetist or surgeon has asked you not to.

If you feel ill when you are due to come into hospital, please telephone the ward for advice.

Your anaesthetist will meet you before your operation and will:

• ask you about your health
• talk with you about what anaesthetics can be used
• talk about the benefits, risks and what you would prefer
• decide with you which anaesthetic would be best for you
• if you would prefer, the anaesthetist will decide for you

Nothing will happen to you until you understand and agree with what has been planned. You have the right to refuse if you do not want the treatment suggested.

The choice of anaesthetic depends on:

• the surgery you are having
• your health and how fit you are
• your choices, and the reasons for them

Premedication (a ‘premed’)

This is the name for drugs sometimes given before an anaesthetic. Some prepare your body for the anaesthetic, others help you to relax.

They may make you more sleepy after the operation. If you want to go home on the same day, this may be delayed.

If you think a premed would help you, ask your anaesthetist.

A needle may be used to start your anaesthetic. If this worries you, you can ask to have a local anaesthetic cream put on your arm to numb the skin. The nurses should be able to do this before you leave the ward.

If you are having a local or regional anaesthetic, you will need to decide whether you would prefer to:

• be fully awake
• be relaxed and sleepy (sedated). You will be given small amounts of anaesthetic or similar drugs to put you in a ‘sleepy like' state
• have a general anaesthetic as well

Going to theatre

A member of staff will go with you to theatre. A relative or friend may be able to go with you to the anaesthetic room. A parent will normally go with a child.

You will walk to theatre if able, if not you will be taken in a wheelchair. You will need your dressing gown and slippers.

You can wear your glasses, hearing aids and false teeth until you are in the anaesthetic room. If you are having a local or regional anaesthetic, you may keep them on.

Jewellery and decorative piercing should be taken off. If you cannot do this, it can be covered with tape. This will stop damage to it or to your skin.

If you are have a regional anaesthetic, you can take a personal tape or CD player with you to listen to music.

As a final check that you are having the right operation, theatre staff will check:

• your identification bracelet
• your name and date of birth, and
• will ask you about other information in your medical records

The anaesthetic

You will be attached to machines to measure your heart rate, blood pressure and oxygen levels.

Local and regional anaesthetics

Your anaesthetist will ask you to keep quite still while the injections are given. You may notice a warm tingling feeling as the anaesthetic starts to work.

Your operation will only go ahead when you and your anaesthetist are sure that the area is numb.

If you are not having sedation you will remain awake and aware of your surroundings. A screen will shield the operating site. You will not see the operation unless you want to.

Your anaesthetist is always near to you. You can speak to him or her whenever you want to.

General anaesthetics

There are two ways of starting a general anaesthetic:

1. Anaesthetic drugs may be injected into a vein through the cannula (a thin plastic tube). This is usually used for adults.

2. You can breathe anaesthetic gas and oxygen through a mask. You may hold this if you would like to.
When the anaesthetic has started, you will go through to the theatre for your operation.

Once you are unconscious, an anaesthetist stays with you all the time. He or she will give you drugs to keep you anaesthetised. As soon as it is finished, the drugs will be stopped or reversed so that you become conscious again.

After the operation

After the operation, you may be taken to the recovery room. Staff will be with you at all times. When they are satisfied that you have recovered safely from your anaesthetic you will be taken back to the ward.

Pain relief

Good pain relief is important. Some people need more than others. It is much easier if it is dealt with before it gets bad. Pain relief can be increased, given more often, or given in different combinations.

Occasionally, pain is a warning sign that all is not well. You should therefore ask for help when you feel pain.

Some ways of giving pain relief are listed below:

• Pills, tablets or liquids to swallow.
• Injections.
• Suppositories. These are waxy pellets that are put in your bottom.
• Patient controlled analgesia. Given by a machine that lets you to control your pain relief yourself.
• Local anaesthetics and regional blocks. These can be very useful for pain relief after surgery.

In modern anaesthesia, serious problems are not common. However, risk cannot be removed completely. The risk to you will depend on:

• whether you have any other illness
• personal things, such as smoking or being overweight
• surgery that is complicated, takes a long time, or is done in an emergency

Questions you may like to ask your anaesthetist

• Who will give my anaesthetic?
• Do I have to have a general anaesthetic?
• What type of anaesthetic do you recommend?
• Have you often used this type of anaesthetic?
• What are the risks?
• Do I have any special risks?
• How will I feel after the operation?

Side effects and complications

• Deaths caused by anaesthesia are very rare.
• They are usually caused by 4 or 5 complications happening together.
• There are probably about five deaths for every million anaesthetics in the UK.
• The information on the next page lists likely side effects from regional and general anaesthetics.

Adapted from a leaflet from
The Royal College of Anaesthetists and The Association of Anaesthetists of Great Britain and Ireland. (Second Edition January 2003)