Anaesthesia, Theatres and Intensive Care A Patient Information Booklet Your Anaesthetic some questions answered The Walton Centre for NHS Foundation Trust. All rights reserved. No reproduction by or for commercial organisations is allowed without the express written permission of the Walton Centre
What is Anaesthesia? Anaesthesia means without feeling and so our aim is painless surgery. At the Walton Centre that usually means a General Anaesthetic. This means that you will be deeply unconscious and completely unaware of what is happening. However some operations can be done under Local Anaesthesia. If you have a local anaesthetic, the area to be operated upon is numbed by a special injection. Which is better will I get a choice? There are advantages to both types of anaesthetic, but the majority of Neurosurgical operations require general anaesthesia, therefore choice is limited. However some Neuro-surgical operations need your cooperation during the surgery so a Local is necessary. In some but not all cases a general anaesthetic may be given for the first part of the operation, to allow the surgeon to access your brain whilst minimising discomfort to you. You would then be woken up to allow them to assess what you are doing whilst they operate. Once that is done you would be given the option to go back to sleep whilst the operation is finished, or to have more local anaesthetic and stay awake. For other procedures which require your cooperation during the operation a little sedation can be given with the local to ease your nerves. If you prefer one or the other, please tell your doctors, and we will do our best to explain things and follow your wishes if possible. How safe is Anaesthesia? Modern drugs, equipment, techniques and anaesthetic training make it extremely safe and effective. The risk to you as an individual will depend on: whether you have any other illness such as Diabetes or heart disease personal factors, such as whether you smoke or are overweight surgery which is complicated, long or done in an emergency. If you have significant problems with your health then the risk may be increased, and you will need to discuss that with your anaesthetist before your operation. The risk can be minimised but not removed completely, as long as your anaesthetist is aware of your health problems. Complications can occur, but the more common ones are all of a minor nature, such as bruising at the site of injection or damage to your teeth. Major ones such as death and allergic reaction are very rare. Others tend to be related to pre-existing medical complaints such as heart or breathing problems. The scale of risk of a complication occurring is quantified as follows: Very Common 1 in 10 10% (i.e. will occur every 10th patient) Common 1 in 100 1% Uncommon 1 in 1000 0.1% Rare 1 in 10,000 0.01% Very Rare 1 in 100,000 0.001%
List of potential complications against frequency of risk and type of anaesthetic: RA = GA = This may occur with a regional anaesthetic/local anaesthetic. This may occur with a general anaesthetic. Very common and common side effects RA GA Feeling sick and vomiting after surgery GA Sore throat RA GA Dizziness, blurred vision RA GA Headache RA GA Itching RA GA Aches, pains and backache RA GA Pain during injection of drugs RA GA Bruising and soreness GA Confusion or memory loss Uncommon side effects and complications GA Chest infection RA GA Bladder problems GA Muscle pains RA GA Slow breathing (depressed respiration) GA Damage to teeth, lips or tongue RA GA An existing medical condition getting worse GA Awareness (becoming conscious during your operation) Rare or very rare complications GA Damage to the eyes RA GA Serious allergy to drugs RA GA Nerve damage RA GA Death RA GA Equipment failure Deaths caused by anaesthesia are very rare, and are usually caused by a combination of several complications together. There are probably about five to ten deaths for every million anaesthetics in the UK. Who are Anaesthetists? Anaesthetists in the UK are fully qualified doctors. After qualifying as a doctor, they then undergo a minimum of seven years postgraduate training to become eligible for consultant anaesthetist status. Although their main role is to look after you whilst you are asleep, they also usually take the lead in most hospitals for pain management, resuscitation and intensive care. Within the Walton Centre there are doctors training to be anaesthetists, and they give some of the anaesthetics under the supervision of a consultant anaesthetist.
When will I meet my anaesthetist? Usually you will be visited on the ward by your anaesthetist before you go to theatre. He or she will want to know about your health, any drugs you are taking, any allergies which you have and any previous anaesthetics you have received. If necessary he or she will examine you to further determine your physical fitness to undergo your operation. It is possible that the anaesthetist will want to arrange further tests prior to giving you the anaesthetic. In rare circumstances this could lead to the need to either postpone your surgery or even cancel it. The anaesthetist will tell you about the anaesthetic, including additional procedures which may be required (e.g. insertion of special drips and catheters), any potential risks and problems, and options available, including pain management after the operation. He or she will then ask you to verbally consent to the anaesthetic discussed. The anaesthetist may prescribe sedative tablets as a pre-med (premedication) to help you feel more relaxed prior to coming to theatre. They will also discuss with you about taking your normal medication, if any, around the time of the operation. In some cases where there are concerns with your fitness for an anaesthetic in advance of your admission for surgery, you may be invited to attend the Walton Centre to meet a consultant Anaesthetist in the clinic. They will fully assess you and make recommendations about your fitness for an anaesthetic. This may include referral for further tests or a specialist review of for example your heart or lungs, to see if they can be improved prior to surgery. If you have any worries about the anaesthetic, the anaesthetist will be pleased to discuss them with you. What about the medication I am already on? It is very important that you bring in all your medication with you, both for the preoperative assessment and when you are admitted for surgery. This will allow the staff to advise on which medication needs to be stopped or changed to make surgery as safe as possible. For example most heart and blood pressure medication should be continued right through the period of surgery and recovery, but some need to be temporarily stopped to prevent your blood pressure being very low or to stop you bleeding excessively during the operation. These will be reviewed and discussed with you before the operation by the clinic nurse, surgeon and anaesthetist. Should I give up smoking before my operation? Yes. Smoking causes two problems which can effect you during an operation. Firstly it decreases the lungs ability to clear phlegm, which may increase the chance of getting a chest infection after your operation. It takes six weeks for the phlegm clearance to get back to normal. Secondly the blood can t carry as much oxygen if you are smoking, but that will improve within a few days of stopping. Therefore stop smoking for as long as possible before coming into hospital for your operation.
Why am I not allowed to eat and drink before my operation? Being sick while you are asleep can be dangerous. We want to reduce this risk by having your stomach empty. The easiest way to do this is to stop you eating and drinking. We also do this for people having a Local just in case you need to be sent to sleep as well. However if the anaesthetist wants you to take your normal tablets and medicines on the day of surgery, they will normally be happy for you to have Sips of water to help swallow the medication. The present guidance is that food or milky drinks should be stopped at least six hours before the planned time of surgery, but that STILL water may be drunk up to two hours before the planned time of surgery. The anaesthetist may vary this on an individual case basis for reasons of safety. What happens when I get to theatre? When you first arrive in theatre a nurse will ask you questions to confirm your identity and your operation. You will then be taken to the anaesthetic room, where the whole team go through a checklist to ensure that everything is place for your safety. An anaesthetic technician will then help the anaesthetist to attach some monitoring equipment to you; this is routine for all patients coming to theatre and is so that we can keep a close eye on you during the anaesthetic. Usually a fine plastic tube will then be inserted into one of your veins, most commonly in the back of your hand or forearm. Sometimes the anaesthetist will ask you to breathe oxygen for a few moments before starting the anaesthetic, which is normally by an injection of medicines through the plastic tube. Alternatively we sometimes need to send you to sleep by giving you gas to breathe, which will be explained to you beforehand. Even if you are having a Local we still attach monitoring to you. A nurse will be with you all the time to reassure you. Any additional anaesthetic procedures required will usually be done once you are asleep, however occasionally for safety reasons they may have to done whilst you are still awake (all this will be explained to you by your anaesthetist). You will then be taken into the operating theatre, positioned upon the operating table and the operation will proceed. An anaesthetist will be with you throughout, closely monitoring and adjusting drugs and equipment as necessary. The same doctor will oversee your waking up and initial recovery.
Where and when will I wake up? Many neurosurgical patients will routinely be cared for in the critical care unit rather than the ordinary neurosurgical ward after surgery. However you will normally wake up shortly after your operation in a place called the recovery ward. In some circumstances you will be taken directly from theatre to the critical care unit. In both places specially trained nurses will look after you as you recover from your operation and anaesthetic. When you wake up you will have an oxygen mask on your face and you will still have the plastic tube in your hand or arm, which may be attached to a drip. Sometimes other tubes inserted in theatre will still be in place such as one to accurately measure your blood pressure and catheters into your bladder. These will be removed once no longer needed, and should cause you little or no discomfort. Will I be in pain? Some neurosurgical operations are painful, and some are less so. Therefore the anaesthetists will give painkillers during the operation to reduce any pain when you wake up. He or she will also prescribe painkillers, and so if you are in pain after your operation you must tell your nurse. The nurse can then give you medication to help control the pain. In the Walton Centre we mainly use tablets and injections for pain control, although occasionally suppositories may be prescribed. For some types of spinal surgery (not brain operations), we are able to offer a patient controlled analgesia (PCA) service. This is a drug pump which you control by pressing a button when you want more pain control. If this would be appropriate for your operation, then the anaesthetist will discuss it with you and explain how it works. Will I be sick afterwards? Some people are more likely to feel sick and vomit than others. The sickness is caused by the anaesthetic drugs or the operation. Your anaesthetist will usually give a drug to reduce the risk, and will prescribe drugs to be given afterwards to continue to combat it. So if you feel sick, ask the nurse for some treatment for it. If you have suffered from sickness after operations in the past, it is worth telling your anaesthetist. How soon will I be back to normal? For most surgery, this is far more to do with your operation than the anaesthetic, so ask your surgeon! This particularly applies to such things as driving. However the effects of the anaesthetic may last for up to 48 hours, making you unfit to drive, work, take alcohol or make important decisions.
Will I wake up during the operation/anaesthetic? If you are having a general anaesthetic, modern anaesthetic drugs, equipment and techniques make this is very unlikely. However as mentioned earlier for occasional cases it will be planned to wake you up during the operation, and this will be discussed with you beforehand. Will I be given blood? Most operations aren t associated with a need to transfuse blood during them. However some do and the anaesthetist will discuss the possibility with you. Blood is only given if really necessary. However many people will need an intravenous drip for their operation, through which they will get special salty or sugary water. The need for a drip doesn t mean the need for a blood transfusion! Will I talk in my sleep? No.
Please help us to help you We aim to make your anaesthetic and operation as pleasant as possible. If you have any comments, please tell the ward staff, surgeon or anaesthetist. You may prefer to contact our clinical director of anaesthesia at the address below, who will be pleased to hear your views as this will help us to help others. Further information The Directorate of Anaesthesia, Theatres and Intensive Care can be contacted during office hours on 0151 529 5152/5153. If you do ring up, please be patient, as we are a very large department and it can take us some time to find the right person. It will make it easier for us to contact the right person to speak to you, if you know who the consultant surgeon looking after you is. Department of Neuro-anaesthesia and Critical Care The Walton Centre for Neurology and Neurosurgery Lower Lane Liverpool L9 7LJ 0151 525 3611 Information can also be found on line at: www.youranaesthetic.info This site is run by the Royal College of Anaesthetists
For practical advice our Customer Care Team provide a (PALS) service. Contact Customer Care Service Manager, Fran Seagreaves or a member of the Customer Care Team on 0151 529 6100, email Francis.Seagreaves@thewaltoncentre.nhs.uk or www.thewaltoncentre.nhs.uk Alternatively, log on to: www.neurosupport.org.uk or call 0151 298 2999 for advice and information for people with neurological conditions and their carers.