Anaesthetist and Director of Anaesthesia and Pain Medicine at St John of God Murdoch Hospital, Dr David Borshoff, says he and his colleagues work hard to ensure the wellbeing of patients before, during and after surgery.
“We want to provide the best pain relief possible, both during surgery and afterwards, and to make patients as comfortable as we possibly can,” Dr Borshoff says.
He says the field of anaesthetics has taken great strides forward over the past thirty years.
“It’s been a wonderful and exciting time to practice anaesthetics.”
“With technological advances, we now have more precise anaesthesia, as well as new techniques and better drugs.”
“There’s also been a fantastic change in equipment – sophisticated video laryngoscopes with high resolution screens, ultrasound machines for nerve blocks and cardiac imaging intra-operatively, and BIS machines which monitor brainwaves to measure anaesthetic depth.”
“All of these factors have led to the reduction of side effects, improved safety and quicker recovery time for patients.”
Types of anaesthetics
The type of anaesthetic you need depends on the procedure and for how long you need to be sedated.
Before, during and after your procedure, your anaesthetist will continually monitor your condition and adjust the anaesthetic accordingly.
Dr Borshoff explains there are four main types of anaesthetics:
You will be in a state of controlled unconsciousness for the period of the operation with either injected or inhaled drugs. You will be attached to monitors to measure cardiovascular, respiratory, neuromuscular and central nervous systems activity.
Used for the majority of significant operations, including orthopaedic, ENT, heart and bowel surgery.
Drugs will be injected at the site of the operation and can be used in conjunction with sedation or general anaesthesia. If used alone, you will be awake for the procedure. However, once sedation is introduced (like a ‘very light’ or ‘twilight’ anaesthetic) you may not remember anything and may even ‘snooze’ during the procedure.
This type of anaesthesia is used for procedures such as cataract surgery or when the operating site is quite small, such as a skin cancer removal.
This can be more major regional anaesthesia, like that produced by epidural or spinal techniques (causing numbness from the waist area and below, or around the abdomen) or a peripheral nerve block where injections of local anaesthetic solution are made near a cluster of nerves to numb the appropriate area of your body extremity that requires surgery.
There is a broad range of uses for this technique including obstetric, gastrointestinal, gynaecological, and orthopaedics procedures.
Sedation is used when anaesthetists do not want a complete loss of consciousness, sometimes to preserve the patient’s reflexes. Drugs used produce a state of detachment, relaxation and tranquillity and the patient will have little or no recollection of the surgery. Most report a dreamlike state that is not unpleasant. Often, patients fall asleep.
Used for procedures such as colonoscopies and gastroscopies.
- Prior to surgery, you will have a pre-operative assessment in which your anaesthetist will look at your health history, previous anaesthetics experiences and discuss your options with you.
- Fasting is necessary to ensure that your stomach is empty. Food or fluid in the stomach may be regurgitated during anaesthesia. If inhaled, this could result in serious lung damage. In most cases, you may eat normally for up to six to eight hours before surgery. Make your last meal before surgery a light one. After this you may have small amounts of clear fluids until two hours before surgery, or until two hours before admission to hospital.
- Continue to take all regular medication up to and including the day of surgery. There are some exceptions like blood thinners but please discuss with your anaesthetist.
- Bring all your current medications with you to hospital.
- Do not smoke or drink alcohol.
- Tell your surgeon or anaesthetist about any health problems or allergies.
Risks and complications
- Side effects such as nausea, vomiting, drowsiness, headache, sore throat, muscle aches, bruising and pain at the site of injections or surgical site are minor and temporary but common.
- Serious complications, such as severe allergic reactions, heart attack, stroke, major nerve or blood vessel injury and organ damage are fortunately very rare.
- Sensation or awareness during surgery is possible but very The risk is highest in emergency procedures but extremely unlikely in elective surgical procedures. It is a very common fear and you will feel reassured after discussing this with your anaesthetist.
- Infection from anaesthesia is extremely rare.
When you are in the recovery room, your anaesthetist will continue to monitor your condition and arrange pain relief, intravenous fluids and analgesic drugs (pain killers) as required. Oral medication will be prescribed to take home for pain relief.
After your anaesthetic or sedation, you must have an adult accompany you home and remain with you until the next day. Your judgement may be impaired so do not drive, operate machinery or other potentially dangerous appliances or sign any legal documents. Rest quietly.
You may eat and drink what you like, unless your surgeon instructs otherwise. It’s best to commence with clear fluids and progress to light foods. Do not drink alcohol for 24 – 48 hours after your anaesthetic.
If you are at all concerned, don’t hesitate to contact your hospital, surgeon, anaesthetist or GP.