Operative Anaesthesia
The prospect of ‘going under’ for an operation can often be frightening if you’ve never had a general anaesthetic. Understanding anaesthesia, why it’s needed and how it all works, can address your concerns, and make your more relaxed when it comes to your surgery.
Purpose of Anaesthesia
Modern anaesthesia serves several roles during an operation. The main, and most important phases of an anaesthetic, address aspects required for a safe, and controlled environment for an operation.
These important parts include:
- analgesia (pain relief)
- amnesia (memory loss)
- unconsciousness
- paralysis
- Physiological control (heart rate, blood pressure, breathing rate , etc.)
Analgesia is obviously very important for a patient. Most medications are aimed at controlling how your body senses and transmits pain. Most surgeons like Dr Scamp should use a combination of local anaesthesia injected, or infused into your surgical site, plus medications used by your anaesthetist aimed at relieving the pain from the surgery. Anaesthesia depends on many factors, such as your physiology, fat content, tolerance to medication, and the strength of the medication.
Types of Anaesthesia
During an operation, there are multiple types of anaesthetic used to ensure safety and comfort. The main categories of anaesthesia are:
- Local
- Regional
- Sedation
- General
Local anaesthesia is a medication that stuns the nerves and prevents them from transmitting information to the brain. They work for variable lengths of time. They are effective, but too much can be toxic. Side effects from too much local anaesthetic include nausea, vomiting, dizziness, heart palpitations, seizures, and even heart attacks (TCI). It is used to numb the immediate area when injected into your tissues (skin, fat, muscle, etc.).
Regional anaesthesia targets specific nerves that are known to supply a certain area of the body. By injecting the same type of local anaesthesia around a nerve, a large area of your body can be anaesthetised. An example of a regional nerve block is an epidural or spinal, like those used during childbirth.
Sedation, or twilight anaesthesia, is usually administered intravenously (IV) and is used to make you drowsy and relaxed. There are various types of medication used depending on the operation being performed. Small amounts of this type of anaesthesia will not require your anaesthetist to support your airway, but in bigger doses, your breathing and airway will need to be managed. This means a breathing tube and a machine to assist with your breathing.
General anaesthesia affects your whole body and is used for large, long, complex, or otherwise painful procedures. This can be administered with an inhaled gas, through an IV, or both. Some people have side effects from a general anaesthetic, including nausea, and vomiting. Both of these side effects can be treated after your operation is finished. While you are asleep, your airway will need to be supported, and you may require a machine to temporarily help with your breathing. Because of this, you would normally have a tube inserted into your throat, and trachea. As a result, you may have an irritated throat after your operation.
Fasting
Before an operation, one of the most important aspects is when to refrain for eating or ‘fasting’ time. Any undigested food in your stomach has the potential of affecting your airway if you vomit at any point during your anaesthetic. This is one of the most serious risks with an anaesthetic and is avoidable by making sure you’re fasted for AT LEAST 6 hours before your surgery. If you need to take medication, discuss this with your surgeon or anaesthetist.
Anaesthetist
In Australia, your anaesthesia should be performed by a specialist Anaesthetist, or in rural areas, a specially trained GP Anaesthetist. Either one of these types of doctors should have a current registration, which can be checked on AHPRA.
Recovery
Your recovery from an anaesthetic can be highly variable, and a personal experience. Some of the side effects of an anaesthetic can be the sensation of hot, cold, numbness, nausea, and confusion. You may wake up suddenly, or gradually, feeling a bit ‘cloudy’, and unable to see properly. These are all normal responses to an anaesthesia, and are temporary side effects. Its not uncommon to have a ‘cocktail’ of medications while you are asleep to try to prevent the post-op nausea. Sometimes, you will require some extra medication to assist with the prevention of post-op nausea.
You should be monitored by a nurse in the recovery are, who is specially trained to monitor and treat patients who have just had surgery.
As you become more awake and alert, the nurses will disconnect you from these machines, and help you get dressed to move on to the ‘second stage recovery’. The second stage recovery is the final area to keep an eye on patients before they go home. It is here that the doctor may stop by to discuss your surgery, and have a second look at you to make sure your pain and nausea free before you leave. If you have any last minute questions or extra instructions that need to be given, this is the place where this can be discussed.
Risks of an Anaesthetic
No anaesthetic is risk-free, but the vast majority of anaesthetics are given without any problems. Risks are usually related to your health, allergies, and the type and length of procedure being performed. If you or any one in your family has had any issues with anaesthesia, this needs to be communicated to your anaesthetist. Its also important to let your anaesthetist know about any of the medications, or health issues you may have. Some patients need to have different anaesthetics or have specific medications withheld, depending on your health issues.
Smokers will always have more complications after any procedure. This can be due compromised blood supply, affecting your ability to heal, or from lung and airway complications. Stopping smoking before your operation will result in a much smoother recovery and less risk of problems along the way.
