Your Anaesthetic
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Most people will be anxious or concerned before coming to hospital for a procedure or an operation. This page explains the process of having an anaesthetic and tries to answer commonly asked questions. This page is about the specifics of anaesthesia. It, therefore, does not contain information on preparation for coming to hospital, criteria for discharge or care following discharge. The document also does not contain information about your surgery.
Specifics of Anaesthesia
01.
As with many medical procedures, consent for the administration of anaesthesia is required and signed by the patient or legal guardian in cases of minor children.
This legal document explains the process of anaesthesia and the risk and side effects involved. Additionally, it is an agreement for the anaesthetic fees.
02.
If you are having an operation you will need some form of anaesthetic. Some patients will be unconscious(general anaesthetic), while others stay awake but are kept pain-free with a special injection(regional and local anaesthetic). Some painful medical procedures also require the presence of an anaesthesiologist in order to be performed successfully and safely(conscious sedation).
03.
What happens to you individually will depend on exactly what operation you are having. Specific questions are best answered by the attending anaesthesiologist. The general procedure is as follows:
Your anaesthetic will be administered by an anaesthesiologist, who will see you before your surgery. Most patients are admitted on the day of surgery, so the visit may not be in the ward but in the theatre waiting area shortly before your operation. The anaesthesiologist will ask you questions and explain what happens to you during your time in theatre. You may also be examined. This is the best opportunity for you to ask any questions you may have.
Occasionally, your operation may be deferred if your medical condition means it would not be safe to proceed. You may be given drugs before surgery ( a ‘premed’) which will help reduce anxiety. You will not be allowed to eat or drink for several hours before your operation.
This is purely for safety reasons. It is very important that your stomach is empty before you are anaesthetized. As a general rule you should not eat for at least six hours before anaesthesia. Clear fluids ( tea or coffee without milk, water, apple juice) may be drunk until TWO hours before the procedure. Please follow instructions you are given prior to admission.
*Please let your anaesthetist know about any dental problems ( i.e. loose teeth and presence of caps, crowns or dentures. This is for reasons of safety.*
When ready you will be taken to theatre on a trolley. You will be asked to confirm who you are and what operation you are having. These careful checks ensure the right person arrives for the right operation.
Arriving in the receiving area you will be asked some questions again, to make sure the right person has arrived and that everyone understands precisely what surgery is planned. Although repetitive, this checklist system is done for your own good as it improves safety.
You will be moved onto the operating table and your anaesthesiologist will then start your anaesthetic. Monitors are used to ensure your safety while you are anaesthetised. The anaesthesiologist stays with you throughout your operation and keeps you safe.
The anaesthesiologist stays with you throughout your operation and keeps you safe. The anaesthesiologist pays attention to you at all times and fine-tunes the anaesthetic carefully in response to the surgery and your responses to it. At the end of surgery the anaesthetist ensures you wake up safely and are as pain free as possible.
When you wake up, once your condition is stable, you will be transferred to a different room, called the recovery room or post-anaesthesia care unit. However, you may not remember waking up until you reach the recovery room or the ward. You will be looked after by a specialized nurse. This nurse will keep you safe. If you have any pain or feel sick this will be treated. You will also routinely be given oxygen through a face- mask.
The anaesthesiologist, or a member of their team, will usually see you in the recovery room to make sure your pain is well controlled, that you are not feeling sick and that there are no problems following your anaesthetic. Where you are admitted to the intensive care unit following your surgery, your anaesthesiologist will continue to look after you until your discharge back to the ward.
The anaesthesiologists at KeiMed Anaesthesiologists work as a team so if your post operative visits continue after the day of surgery, you may well be seen by a different anaesthesiologist. When you go back to the general ward you probably will not be seen by the anaesthesiologist again.
All operations may cause pain. Pain killers will effectively control this and you should usually have nothing more than mild pain. If you do have pain after your operation, ask for treatment as soon as you can.
04.
Here we will discuss the benefits and risks:
Epidural anaesthesia is a regional anaesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anaesthesia, which leads to total lack of feeling. Labour epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.
Epidural medications fall into a class of drugs called local anaesthetics, such as bupivacaine, ropivacaine, or lignocaine. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anaesthetic.
Intravenous (IV) fluids will be started before the procedure of placing the epidural. You can expect to receive 1-2 litres of IV fluids throughout labour and delivery. An anaesthesiologist (specialist in administering anaesthesia) will administer your epidural.
You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing complications and ensuring successful placement of the epidural.
An antiseptic solution will be used to wipe the waistline area of your mid-back to minimize the chance of infection. A small area on your back will be injected with a local anaesthetic to numb it. A needle is then inserted through the numbed area into the epidural space.
After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion. The catheter is taped to the back to prevent it from slipping out.
After the catheter is in place, a local anaesthetic is administered either by a pump or by periodic injections into the epidural space.
It allows you to rest if your labour is prolonged.
By reducing the discomfort of childbirth, some women have a more positive birth experience.
Normally, an epidural will allow you to remain alert and be an active participant in your birth.
If you deliver by caesarean, an epidural anaesthesia will allow you to stay awake and also provide effective pain relief during recovery.
When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
The use of epidural anaesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered.
Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen. You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space, can be performed to relieve the headache.
After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in foetal heart rate. Lying in one position can sometimes cause labour to slow down or stop.
You might experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
You might find that your epidural makes pushing more difficult and additional medications or interventions may be needed such forceps or caesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases.
For a while after the birth the lower half of your body may feel numb. Numbness will require you to walk with assistance.
In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
Does the placement of epidural anaesthesia hurt?
The answer depends on who you ask. Some women describe an epidural placement as creating a bit of discomfort in the area where the back was numbed, and a feeling of pressure as the small tube or catheter was placed.
Typically epidurals are placed when the cervix is dilated to 4-5 centimetres and you are in true active labour.
Your epidural can cause your labour to slow down and make your contractions weaker. If this occurs, you may be given the medicine Pitocin to help speed up labour.
Research on the effects of epidurals on new-borns is somewhat ambiguous, and many factors can affect the health of a new-born.
How much of an effect these medications will have is difficult to predetermine and can vary based on dosage, the length of labour, and the characteristics of each individual baby.
Since dosages and medications can vary, concrete information from research is currently unavailable. One possible side effect of an epidural with some babies is a struggle with “latching on” in breastfeeding. Another is that while in-utero, a baby might also become lethargic and have trouble getting into position for delivery.
These medications have also been known to cause respiratory depression and decreased foetal heart rate in new-borns. Though the medication might not harm these babies, they may have subtle effects on the new-born.
The nerves of the uterus should begin to numb within a few minutes after the initial dose. You will probably feel the entire numbing effect after 10-20 minutes.
Depending on the type of epidural and dosage administered, you can be confined to your bed and not allowed to get up and move around.
If labour continues for more than a few hours you will probably need urinary catheterization, because your abdomen will be numb, making urinating difficult. After your baby is born, the catheter is removed and the effects of the anaesthesia will usually disappear within one or two hours.
Some women report experiencing an uncomfortable burning sensation around the birth canal as the medication wears off.
You might not be able to tell that you are having a contraction because of your epidural anaesthesia. If you cannot feel your contractions, then pushing may be difficult to control. For this reason your baby might need additional help coming down the birth canal. This is usually done by the use of forceps.
For the most part, epidurals are effective in relieving pain during labour. Some women complain of being able to feel pain, or they feel that the drug worked better on one side of the body.
An epidural may not be an option to relieve pain during labour if any of the following apply:
- You use blood thinners
- Have low blood platelet counts
- Are haemorrhaging or in shock
- Have an infection in the back
- Have a blood infection
- If you are not at least 4 cm dilated
- Epidural space cannot be located by the physician
- If labour is moving too fast and there is not enough time to administer the drug
- What combination and dosage of drugs will be used?
- How could the medications affect my baby?
- Will I be able to get up and walk around?
- What liquids and solids will I be able to consume
05.
Yes, they are very safe. The risk of serious complications from an anaesthetic in a healthy patient are very small indeed.
06.
The prospect of a child undergoing surgery is understandably frightening for both the child and parent. It does not, however, have to be a distressing experience and anaesthesiologists are trained to manage children. An honest discussion about what is going to happen is important; this may involve explaining to children that they may be some discomfort after the operation but they will be given sufficient doses of pain medicine to keep them comfortable.
Just as in adult patients, your child will be see by the anaesthesiologist before the operation. We actively encourage parents to be in theatre during the process of putting the child to sleep; this involves the child breathing anaesthetic gases and no needles are used until the child is truly asleep. This is a painless process which takes about a minute or so.
07.
You will be allowed to leave hospital when you feel safe and well. As anaesthetic drugs disappear from your body rapidly, these are likely to have little effect on your recovery. However you are advised to take things easy for the first 24 hours after an anaesthetic and should be accompanied by a responsible adult during this time. You should not return to work, operate machinery (including driving a car) or drink alcohol for 24 hours after an anaesthetic.
