General Anaesthetic
Information Leaflet
The following information sheet explains our role in ensuring the safe conduct of your anaesthetic and operation.
Specialist anaesthesiologist qualifications
Specialist anaesthesiologists are medical doctors who have undergone a minimum of: six years medical training, two years general internship, one year community service, plus four years of specialist training. This amounts to a total of (at least) thirteen years of training to enable them to anaesthetise you for any procedure. They typically have the following qualifications: MBChB (Medical degree), DA(SA) (Diploma in Anaesthetics), FCA(SA) (Fellowship of the College of Anaesthetists, South Africa), MMed (Masters degree).
Before your procedure
Medical history
Please complete the accompanying medical questionnaire to highlight potential problems. Bring any information on medical conditions you suffer from along when you are admitted to hospital.
Medication
Please bring the following along to the hospital on the day you are admitted for your procedure:
A list of all medical conditions and allergies that you may have.
A list of all medication you have been on for the last three months (including homeopathic and natural products).
Your current medication if there is any chance that you may need to take it while in the hospital.
Your CPAP mask if you use one.
What you may eat and drink
Unfortunately all patients (including children) need to fast before any anaesthetic or sedation is given. Patients should stop consuming any food or milk products at least 6 hours before reporting to the hospital (admission time). Patients may have clear fluids (water, black tea or clear apple juice) up to 2 hours before their procedure.
Morning surgery – No food or milk products after midnight. Clear fluids up to 5am.
Afternoon surgery – No food or milk products after an early light breakfast (before 6am). Clear fluids up to 10am.
When will your operation be done
Although an operating list is scheduled to start at a particular time, only one patient can be anaesthetised and operated on at a time. This means that your surgery may be hours after the scheduled start time of the list. If the surgeon offers you an admission time after the start time of a list, you may only see the anaesthesiologist in the theatre waiting area. If you have a medical condition or anything else to discuss with the anaesthesiologist please either make contact before the day of surgery or ensure you are admitted to the ward at least one hour before the start time of the list.
You are strongly advised not to drive (arrange a lift home), operate dangerous machinery or make important decisions in the 24 hours following your anaesthetic. DO NOT CONSUME ALCOHOL post anaesthesia or while still taking medication prescribed post operatively (i.e. pain killers, anti-inflammatories, antibiotics etc.) If in doubt, please consult your treating surgeon or anaesthesiologist. Female patients: Please note that some agents used in anaesthesia may render oral contraceptives ineffective. If you have received such an agent or are unsure, please use additional contraceptive measures for the remainder of your cycle.
Types of anaesthesia
Different types of anaesthesia techniques can be used individually or in combination. Each patient therefore receives an individualised treatment. The aim is to achieve the safest anaesthetic for each patient.
1. General anaesthetic (also called a GA)
You will be put into a state of controlled unconsciousness and therefore not be aware during the procedure. This is done by injecting drugs into a vein, inhalation of gases or a combination of the two.
2. Regional (Spinal, epidural and blocks)
Local anaesthetic drugs are injected near specific nerves. Whole body parts can be made numb. You will remain conscious, but pain free.
SPINAL AND EPIDURAL BLOCKS: Injections into the lower back are used to temporarily paralyse the nerves of the spinal cord. This produces numbness of the lower half of the body. BLOCKS: Local anaesthetic is injected around a nerve making a selected area numb.
3. Sedation (also called conscious sedation)
Injected drugs or gases are used to keep you calm and slightly drowsy but arousable. Gastroscopies and colonoscopies are often done under sedation.
Risks associated with anaesthesia
Modern anaesthesia is safe but does have potential side effects and complications. The risk of experiencing a complication is affected by the patient’s general state of health, specific medical conditions and the complexity of the procedure. The information below aims to place these risks into context. Please discuss any queries/concerns with the anaesthesiologist before your procedure.
How safe is anaesthesia (Ann Intern Med. 2005;142:756-764)
Anaesthesia in a fit healthy patient (ASA 1) is comparable in risk to a commercial air-flight and safer than driving in a car. Anaesthesia in a sick patient undergoing high risk surgery (ASA 3-5) has a similar risk to flying in a helicopter.
Complications of anaesthesia
Unfortunately adverse events can occur during any anaesthetic procedure and may incur further medical expenses. The effects can range from trivial to brain damage or death. These events may occur due to: reactions to anaesthetic drugs, underlying medical diseases, complications with performed procedures or due to surgery. Anaesthetists have been trained to manage these complications. If a complication persists for more than 48 hours please inform your anaesthesiologist or surgeon.
The following list covers some of the complications that may occur under anaesthesia or after an operation:
Common complications (1 to 10% of cases)
Minimal treatment usually
Nausea and vomiting
Sore throat Shivering or feeling cold
Headache
Dizziness
Itching
Pain during injection of drugs
Swelling or bruising at the infusion site
Confusion or memory loss (common if elderly)
Rare complications (Less than 0.1% of cases)
May require further treatment
Injuries to teeth, crowns, lips, tongue and mouth
Hoarse voice, voice changes
Vocal cord injuries
Painful muscles
Difficulty in urinating
Difficulty breathing
Lung infection
Visual disturbances
Heart attacks (more common in patients with heart disease)
Worsening of underlying medical conditions like diabetes, asthma or heart disease
Very rare complications (0.0005% to 0.01% of cases)
Often serious with long-term damage
Eye injuries
Nerve injuries causing paralysis
Awareness of the operation
Bleeding
Stroke
Allergic reactions
Unexpected reactions to anaesthetic drugs
Inherited reactions to drugs (Malignant hyperthermia, Scoline apnoea, Porphyria)
* Side effects or interactions from post-operative medication can cause many complications that vary in severity
Complications arising due to procedures that may be performed during your anaesthetic
Intravenous line (“drip”)
Pain, swelling, bleeding, inflammation, infection, repeated insertions.
Central line for specialised monitoring or therapy
Pain, swelling, bleeding, inflammation, infection, repeated insertions, puncture of lung, artery or nerve.
Arterial line for specialised monitoring
Pain, swelling, bleeding, inflammation, infection, repeated insertions, loss of blood flow to the hand leading to death of fingers.
Airway management
Damage to lips, teeth, tongue, palate, throat, vocal cords, hoarseness, inhalation of stomach contents (aspiration), pneumonia, obstruction of breathing, failure to manage the airway which may require an emergency operative procedure.
Nerve blocks, spinal or epidural injection
Nerve damage, paralysis, backache, headache, nausea, vomiting, dizziness, shortness of breath, pain, bleeding, inadequate pain control, repeated attempts.
For more information please to visit the following websites:
*The information above has been modified from documents by Dr. E Welch.