Download A guide to your anaesthetic for day surgery

Patient
Information
A guide to your anaesthetic
for day surgery
This information is designed to answer your questions and to help
ease your mind about the anaesthetic you are to have. It is
important that you read this information - you will be asked to
confirm that you have read it and understood it.
What is anaesthesia?
Anaesthesia is a carefully controlled and supervised state, which
allows surgery to be performed without you feeling anything. It is
more than “being put to sleep”.
Who is your anaesthetist?
Your anaesthetist is a fully trained, medically qualified doctor who
has chosen to specialise in anaesthesia. This involves caring for
patients before, during and after operations. All consultant
anaesthetists are Fellows of the Royal College of Anaesthetists (or
have an equivalent qualification).
Your anaesthetic doctor will be assisted by theatre staff who are
also specially trained. You may be seen by a nurse in the preoperative assessment clinic before your operation who can assess
your health and help organise tests beforehand so the anaesthetist
has all the information to make your anaesthetic as safe as
possible.
What types of anaesthesia are available?
There are 2 main types of anaesthesia: General where you are
unconscious and Regional which uses a local anaesthetic to make
a part of the body pain free.
In some cases a combination of both may be used.
About general anaesthesia:
This is where you are put into a state of unconsciousness for the
duration of your operation. This is achieved and maintained by
giving drugs into a vein and/or by a mixture of gases, which you
breathe.
About regional anaesthesia:
This involves an injection of local anaesthetic, which numbs the
nerves to a particular region of the body therefore preventing pain
sensation. You can remain awake but you will be free from pain.
You may receive a spinal or epidural anaesthetic into your back.
Other regional anaesthetic injections are into your arm, neck or leg
and local anaesthesia for the eye. The anaesthetist can explain the
risks and benefits if you are having this type of anaesthesia.
What should I do before the anaesthetic?
If you have any broken or loose teeth you may want to visit your
dentist for treatment. If your teeth are not secure they may get
damaged when you have your anaesthetic.
If you are a smoker you should stop smoking for as long as
possible beforehand, as this may help to reduce chest problems
after the operation.
You should not drink alcohol the night before your surgery but you
should have a light meal.
You must continue to take any prescribed medicines up to and
including the day of surgery, unless you have been specifically
told to stop.
EATING before the anaesthetic
You should not eat for 6 hours before the anaesthetic. Chocolate,
cappuccino and latte coffee count as food.
DRINKING before the anaesthetic
You should not have anything to drink for 2 hours before the
anaesthetic. Having water or clear squash, tea and coffee with a
small amount of skimmed or semi skimmed milk until 2 hours
before is fine.
You can chew gum, but only until 2 hours before the
anaesthetic.
If you don’t follow these rules, your operation may have to be
postponed for safety reasons.
Staying warm before your operation will lower your risk of problems
afterwards, therefore we will check your temperature regularly.
Temperatures around the hospital vary and some areas may be
cooler than your own home. Please bring additional clothing
including a dressing gown to help keep you comfortably warm.
What happens before I get to the operating theatre?
Before going to the operating theatre, you will normally be seen by
an anaesthetist who will ask questions and may examine you.
What will the anaesthetist need to know?
We need the best possible picture of your health so that the most
suitable anaesthetic can be planned for you. The aim is to minimise
risks.
Please tell the anaesthetist about:

any medical problems you have, especially heart disease,
chest disease or diabetes.

any medications you take (whether prescribed or bought at a
chemist).

any allergies you have (and not only to drugs) eg. latex
rubber.

if you have had any previous problems with anaesthesia,
including being very sick after anaesthetics.

if anyone in your family has had any problems with
anaesthesia.

if you have loose teeth, dentures, capped or crowned teeth.

the last time you had something to eat and drink.
After this, your anaesthetist will discuss types of anaesthetic
available for you and the benefits and risks of each. Your
anaesthetist will then explain what he/she considers the best type
of anaesthetic technique for you.
You may ask any questions you wish and you should be able
to understand and agree the plan the anaesthetist has
discussed with you.
You have the right to refuse a technique or anaesthetic plan, but
the anaesthetic doctor may not think it safe to administer exactly
the anaesthetic you may wish and he/she may then decline to
proceed. Occasionally, it may prove necessary to change this
anaesthetic plan (for example if unexpected events occur).
What will happen when I get to theatre?
When the operating theatre is ready for you, you will be asked to
walk to the theatre area. Somebody, usually a nurse, will go with
you.
Please wear enough clothes to keep warm. The temperature may
be cooler than you are used to at home.
You can wear glasses, hearing aids and dentures until you are in
the anaesthetic room.
Jewellery and decorative piercing should be removed. If this is not
possible then it will be covered with paper tape to protect it and
your skin from damage. Tongue studs will need to be removed.
Theatre staff will check your identification and ask other medical
details as a final check that you are having the operation you are
scheduled for.
You will then be taken into an anaesthetic room where monitors will
be attached to your chest/arm/finger to check your heart, blood
pressure and blood oxygen levels.
A warm air blanket may be used to keep you warm.
Special boots may be put on your lower legs to help reduce blood
clots after your operation.
When you are to have a general anaesthetic
A plastic needle is usually inserted into a vein. If this worries you,
you can request a local anaesthetic cream to numb the skin. This
should be put on about 30 minutes beforehand on the ward.
You will usually be given oxygen to breathe from a mask as a
routine safety measure. Drugs are then injected into the plastic
needle, to start the anaesthetic. In some cases, you may be given
the choice to breathe an anaesthetic gas through the mask.
Whichever method is used you will soon lose consciousness.
Once you are unconscious a tube may be inserted into your
windpipe to help your breathing and make it safe (this tube will
usually be removed before you wake up). You are then transferred
(unconscious) into the operating theatre and the operation begins.
The anaesthetist closely monitors your condition throughout the
entire operation and adjusts the level of anaesthetic as needed to
make sure that you remain unconscious at all times.
You will wake up in the recovery room, where you will be looked
after by qualified nursing staff trained in post-operative care. Many
patients do not remember this.
When you are to have a regional anaesthetic
The procedure is similar EXCEPT that you will not be put to sleep.
A local anaesthetic will be given to numb the area being operated
on. You may also be given some sedative if you wish. Your
condition will still be closely monitored throughout the operation.
You may need to sit up and you should keep very still when the
injection is being given.
It is quite normal to feel a warm tingling when the local anaesthetic
is injected.
You may be aware of sensations of pulling or movement but if you
feel pain you should tell your anaesthetist and you may need to be
given a general anaesthetic.
How will my pain relief be given?
This will depend on a number of factors including the severity and
site of your surgery and your medical condition.
Methods of pain relief range from simple pain killers (such as
Paracetamol and Aspirin-like drugs) through stronger tablets (such
as Codeine) to powerful Morphine-like drugs. These are given in
various ways, including by mouth, suppository, or injection (usually
a plastic tube is put in your upper arm so that you do not need
repeated needle injections) or directly into a vein.
Some of these painkillers may be given to you as tablets before
your operation.
In some cases the anaesthetist may use injections of local
anaesthetic to numb nerves.
A combination of the above may be given to you.
The anaesthetist will explain and discuss the methods planned for
your pain relief. Please feel free to ask any questions about your
planned care.
What are the risks and complications of anaesthesia?
Every anaesthetic has small risks and these depend on many
factors such as the type of surgery and any medical conditions you
may have.
Also personal factors such as smoking or being overweight can
affect your risks.
Modern anaesthesia is very safe but risk cannot be removed
completely.
Understanding risk
To understand risk you must know how likely it is to happen. The
scale below can help you do this:
Very common
1 in 10
Common
1 in 100
Uncommon
1 in 1000
Rare
1 in 10,000
Very rare
1 in 100,000
Death from anaesthesia is very rare and usually caused by a
combination of complications happening together. There are about
5 deaths per million anaesthetics per year.
Common temporary side-effects
These include bruising or pain in the area where you were injected;
dizziness, blurred vision, sickness, sore throat and itching.
These can generally be treated and will usually pass quickly.
Uncommon/rare complications
These include:

temporary breathing difficulties,

infections at injection sites,

inflammation of veins where medicines were injected,

muscle pains,

shivering after the operation,

headaches*,

damage to lips, teeth or tongue,

temporary voice hoarseness,

becoming conscious at the end of your operation.
These may be uncomfortable but are rarely dangerous and the
anaesthetist will ensure they are treated promptly.
* Headaches that are worse on sitting, standing or coughing after a
spinal/epidural anaesthetic. If you get this headache tell the nurse
before you go home.
Very rare and serious complications:

severe allergic reactions and death,

brain damage,

kidney and liver failure,

lung damage,

paralysis,

permanent nerve or blood vessel damage,

eye injury,

damage to the voice box.
On the ward after your operation
You will be looked after by the ward nurses who can give you
painkillers and anti-sickness medicines if you need them, until you
are ready to go home.
They will monitor you until you can eat and drink without feeling too
sick, are able to stand and walk steadily and pass urine in the toilet.
You should be awake enough and comfortable enough to go home
after a few hours. Sometimes you may need to stay longer to make
sure you have no bleeding after the operation eg. tonsillectomy.
If you have a question about pain or your wound you can contact
the day surgery unit where you had the operation for advice.
At home after your operation
You may be given strong painkillers at the hospital to use at home
if you need them. Otherwise you can take simple painkillers like
Paracetamol and Ibuprofen at home.
It is best if you take these regularly for the first day. If you have had
local anaesthetic injected take the painkillers before this has worn
off completely or you may get sore.
If you have had a spinal anaesthetic and get a bad headache or
backache at home you should contact the day surgery unit or
telephone the anaesthetic department in the hospital to get advice
from an anaesthetist.
Further information
Further information is available from the anaesthetic department
01332 785549.
Also from the Royal College of Anaesthetists website
www.youranaesthetic.info
Your questions
Please use this space to write down any questions you want to ask
your anaesthetic doctor.
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