Before your Operation
Try to get as fit as possible – even a regular walk can make a difference. Stop smoking – Do not smoke on the day of surgery. Continue to take your usual medications including the morning of surgery. If you are diabetic or are taking blood thinning medicines tell your surgeon and they will give you specific instructions. Please bring all your medicines into hospital with you.
You need to fast before coming into hospital.
If you are having a morning procedure you may not have anything to eat or drink after midnight. If you are having an afternoon procedure you may eat food until 7:30 in the morning, between 7:30 and 11:00 you may drink clear fluids (water, apple juice, black tea or black coffee).
After your Operation
Immediately after the operation you will be taken to the recovery room where we will continue to monitor you. You will be given additional oxygen and encouraged to breathe deeply and cough. You will stay in recovery until you are fully awake and comfortable. You may experience some drowsiness, blurred vision, headaches, memory loss or sore throat. Some patients may feel sick or even vomit. Although these symptoms are unpleasant they usually pass quickly.
Almost all operations involve cutting soft tissue or bone and this can cause pain after the operation. I will give you medicine to reduce pain during the operation and organise additional pain relief for recovery and either the hospital ward or for you to take home. If you are prescribed Paracetamol I would like you to use it quite regularly at 4-6 hour intervals. Anti inflammatory agents like Voltaren or Celebrex should also be taken quite regularly for the first few days after your operation. Use strong pain killers like Endone or Panadeine Forte if you have pain that isn’t covered by the paracetamol or anti inflammatories. If you take the Endone or Panadeine Forte you should not drive or use machinery. These medicines may also cause nausea or vomiting.
It may take up to 24 hours to clear all of the anaesthetic out of your body. You must organise a contact person to accompany you home and stay with you for at least the first night after your procedure. We cannot allow you to be at home alone. For the first 24 hours after the operation don’t drive a car, operate any machinery, do important paperwork or drink alcohol.
If you have been booked as a day surgery patient we expect you to be able to be discharged home fairly soon after the procedure. Very rarely the operation may become more complicated than first thought or you may not feel well after the procedure. In this case it may be advisable for you to be admitted for an overnight stay in hospital.
Anaesthesia in Australia is extremely safe. The chance of sustaining a serious injury or dying from an anaesthetic is less than 1 in 20,000. You are more likely to have an accident causing death or serious injury as a road user than having a serious anaesthetic complication. I will review your medical history, examine you and consider your test results and operative procedure before suggesting an anaesthetic technique for you. With any medical procedure there are potential risks. I have outlined some of the common risks associated with different anaesthetic techniques in the following paragraphs.
Infection: Whenever a foreign material is introduced into the body there is a risk of transmitting an infection to the patient. These risks are minimised by having single use items that are new in sterile packets and are disposed of immediately after use. All anaesthetic needles and drugs are single use only. It is quite common to get a bruise at an injection site.
General Anaesthesia and Sedation:
With this technique you are given medications that put you to sleep for some time. When you are asleep you are unable to protect your body from injury. It is possible for nerves to be damaged if an arm or leg is stretched or bent while you are asleep. Similarly there have been cases of damage to eyes and even neck injuries when unconscious patients are moved. When you are anaesthetised the muscles around the top of your stomach relax and any material in the stomach can track back up the throat and into your airway – this is why we ask you to fast before surgery.
The medications we use can cause an allergic reaction in some people – so it is important to tell us if you have any known allergies. The anaesthetic drugs can have an effect on your breathing pattern and your heart and blood pressure. Serious risks include heart attacks, strokes, pneumonia and worsening of asthma or bronchitis. It is the anaesthetist’s job to stay with you all the time and monitor how your body is reacting to the anaesthetic. Other side effects of the medicines include nausea or vomiting, dizziness, short term memory loss, muscle aches and headaches – these symptoms usually resolve quickly. There is some evidence that elderly patients are vulnerable to impaired brain function after prolonged anaesthetics.
In General Anaesthesia you are more deeply asleep so we usually need to place a breathing tube at the back of your mouth to keep your airway open. Anytime we put anything artificial in your mouth there is a chance of damaging your lips, tongue or teeth. Caps and crowns are more vulnerable than natural teeth. Sometimes the tube can irritate the throat which may stay sore for a day or two, very rarely the vocal cords could be damaged. Everybody has different shaped faces and necks and in some people it can be difficult to properly position the breathing tube – please tell me if you have had a ‘difficult intubation’.
With a sedation technique you are not as deeply asleep as for a General Anaesthetic. Usually we aim to sedate you for a short time so that we can inject local anaesthetic around the operative site. At some stage during the procedure you start to slowly wake up. Don’t worry the sedation will still have you feeling really relaxed and comfortable. We always screen off the operative site to prevent infection so you can’t see anything. We don’t need to put in a breathing tube for sedation. If for some reason you feel uncomfortable during a sedation procedure you will be able to tell us and we can easily put in more local anaesthetic or give you more sleepy medicine.
With the following techniques we are looking to only put the part of the body we are operating on to sleep. It is usually combined with some sedation so that you are feeling comfortable and relaxed. We can often add extra sedation if you want to be more sleepy.
A spinal anaesthetic can be used to put your legs to sleep. After numbing the skin an injection is made at the base of your spine and local anaesthetic put around the nerves. The local anaesthetic can make the blood pressure dip down so we keep a close eye on the blood pressure through the case. Sometimes the anaesthetic can numb the bladder for a few hours after the procedure so the ward staff may need to pass a catheter to empty the bladder. The spinal anaesthetic can cause a specific type of headache which can be quite uncomfortable. The most serious concerns involve damage to the nerves which could cause long term leg numbness, weakness or paraplegia. These are extremely rare complications and are usually seen in higher risk patients for example patients with bleeding problems or pre existing infections. The technique is carried out in a fully sterile manner by the anaesthetist to minimise any risk of infection.
An arm block can be used to anaesthetise just the hand or arm. An injection of local anaesthetic is made in either the arm pit or side of the neck. As with any injection you may develop a bruise, bleeding or infection. We are looking to inject the local anaesthetic around the nerve to numb it up. If the injection is made directly in the nerve the nerve fibres could become damaged. This could cause long term arm weakness or numbness. To make the injection safer I use an ultrasound machine to watch the tip of the needle come to the right spot. We will check that the anaesthetic is working before we start the operation. If you feel any discomfort during the procedure we can easily add more local anaesthetic or give you more ‘sleepy’ medicine.
Eye blocks are often used for cataract surgery. We first give you some sedation to help you feel very relaxed and comfortable. This is followed by an injection with a very fine needle into the skin below the eye. The local anaesthetic spreads around and numbs the eye. We will check that the eye is asleep before the operation starts. You may get some bruising or a ‘black eye’. Very rarely there may be some bleeding behind the eye – which usually resolves itself but may delay your operation. During the anaesthetic injection and the actual operation you will need to stay quite still – we provide a special head rest that comfortably supports your head. If you need to cough or feel uncomfortable we would like you to say ‘STOP’ – we will then take the sharp things away from your eye and ask how we can help you. During the operation we will monitor your heart with an ECG, check your blood pressure and keep an eye on your breathing.