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PERI OPERATIVE ANESTHESIA CARE
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What is anesthesia ?
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Anesthesia is given so that you do not feel pain or other sensations during an
operation.
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Type of Anesthesia
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Anesthesia can be given in various ways and does not always make you
unconscious.
Local anesthesia is given
in the form of an injection that numbs a small part of your body. You remain
conscious but free from pain.
Regional anesthesia:
A local anaesthesia is used to numb a large or deeper part of your body,
for example an arm or a leg. The common regional anesthetics are spinal and
epidural anaesthesia. They involve injections in the back to remove feeling from
the waist downwards. You stay conscious but free from pain. Epidurals may be
used during and / or after surgery for pain relief.
General
anaesthesia: You be
unconscious and feel nothing for the duration of your operation. Sedation is the
use of small amounts of medication to produce a 'sleep-like' state.
Sedation
relaxes you during an investigation or procedure which may be unpleasant or
painful (such as an endoscopy) but where your co-operation is needed. You may
remember very little or nothing at all of the procedure. If you are having a
regional or local anesthetic, you may be given some sedation as well. |
Combining types of
anaesthesia
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Anesthetic drugs and techniques are often combined so as to make you comfortable
during an operation e.g
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Regional anaesthesia may be given along with general anaesthesia to provide pain relief during and after the operation.
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Sedation may be given along with regional anesthesia. The regional anesthesia prevents you from feeling pain, and the sedation takes you feel drowsy and relaxed during the operation.
Anesthetists are doctors who have had specialized training in
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providing anesthesia.
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treatment plan.
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care of very ill pains (intensive care) and
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emergency care.
Your anesthetist is responsible for:
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your well being and safety throughout your surgery.
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giving your anesthesia.
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provide your pain relief.
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managing any blood transfusions you may need during an operation.
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Before admission to the
hospital for an operation
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You need
to known the following things before your operation;
If you smoke, stop smoking severe weeks before the operation.
The longer you can given up the better. Smiling reduces the amount of oxygen in
you blood and increases the risk of breathing problems during and after an
operation.
If you have loose or broken teeth, or crowns / caps that are
not secure, they may be further damaged during the anesthesia. Kindly inform you
anesthetist. Loose dentures will need removal.
If you have a long-standing medical problem
such as diabetes, asthma, hypertension, thyroid problems or epilepsy, you may
need to undergo some checkups to ensure that they are under control. |
The anesthetist and the
team
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Anesthetists work closely with surgeons and other
theatre staff. Operation theatre staff helps the anesthetist and
take part in your care. Training staff in the
recovery room will
take care of you after your operation until you are ready to go bank to you ward |
The pre-assessment clinic
(PAC) / Health check-up before your anesthesia
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Is
managed by the Department of Anesthesia, Critical Care and Pain and attended by
an Anesthesia Consultant and a junior doctor.
You will be asked a number of questions to check your health before your
operation.
The questions will be about :
- Your
general health and fitness.
- Any
serious illnesses you have had in the past.
- Any
problems with previous anesthesia.
- Whether
you know of any family members who have had problems with anesthesia.
- Any
pains in your chest.
- Any
shortness of breath or cough.
- Any
heartburn / acidity / reflux.
- Any
pains you have which would make lying in one position uncomfortable.
- Any
medicines you are taking, including herbal remedies and supplements you many
have been prescribed.
- Any
allergies you have.
- Any
loose teeth, caps, crowns.
- Whether
you smoker / drink alcohol or chew tobacco.
If
you are taking any pills medicines, herbal remedies or supplements, please bring
these with you to the PAC. It will be helpful to your anesthetist. |
If you have any
allergies, kindly inform the doctor
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You many
require more tests / investigations after your check up and many have to return
to the pre assessment clinic once again with the results of the tests asked for.
The pre-assessment clinic is the right place to ask questions about the
anesthesia and discuss your worries regarding the same (if you have any). |
On the day of you
operation
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- Nothing
to eat tor drink – fasting ('Nil by mouth' / NBM), usually for 6 hours before an
operation.
You must follow the instructions about fasting. If there is any
food or or liquids in you stomach during your anesthesia, it could come up into
your throat and got into your lungs. This could cause chocking, or serious
damage to your lungs.
- Your
normal medicines
You should continue to take your normal medicines upto tand on the morning of
your surgery with a sip of water, unless your anesthetist or surgeion has asked
you not to. There are exceptions, e.g. If you take drugs to stop blood clotting
(anticoagulants), aspiration, and drugs for diabtes or herbal remedies, you will
need specific instructions. If you are not sure, kindly ask your anesthetist or
surgeon and they will advise you accordingly.
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The choice of anesthesia
depends on:
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Type of operation.
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Your general health.
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Premedicaton
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Medication which is sometiems gien before an anesthetic, May be a tablet or an
injection. It helps to ;
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reduce or relieve anxiety.
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Blood transfusion
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During an operation, you many lose some blood. Your anesthetist can usually make
up for this blood loss by giving you other types of fluid (saline) into a vein
through a drip. Blood transfuions are given when absolutely necessary. You will
be informed by your doctor about the possibility of a blood transfusion and you
must ensure the presence of donors (relatives) prior tto the operation. |
Why does the anesthetist
postpone some operations?
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Occasionally, your anesthetist might find something about your general health
that could increase the the risks of your anesthesia or operation. It might then
be better to delay your operation until your health status is optimized to the
best possible. This would be less likely if you have been to a pre-assessment
clinic. The reasons for any delay would always be discussed with you at the
time. |
Getting ready for '
Operation theatre'
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Here are
some of the things that you may be asked to do get yourself ready for your
operation.
- Bath or
shower: before your operation will clean your skin and reduce the risk of
infection.
- Do not
use any makeup, body lotion or cream as they prevent dressings from sticking to
your skin properly.
- Remove
any nail polish and jewellery (bangles, ear-rings, toe / finger rings) that you
may have on you. If you cannot remove your jewellery, it will need to be covered
with tape to prevent damage to it or to your skin.
- You will
be asked to remove all your undergarments and wear the hospital gown given to
you. You can wear your glasses, hearing aids and dentures to got to the
operating theatre. IF you are having a general anaesthesia, you will need to
remove them in the anesthetic room to make sure they are not damaged or
dislodged while you are anesthetized. They will be handed over to your relatives
outside the operation theatre. If you are not having a general anaesthesia, you
can keep them in place.
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When you are called for
your operation
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You
will be taken to the operation theathre on a patient trolley by a ward boy. One
of your relative many accompany you to the main door of theo operation theatre
complex. |
The operative theatre
complex
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The
operating department includes waiting area, operating theatres and a recovery
room. Operating theatres are brightly lit and many have no natural light. The
theatres may also be quite cold as the place is airconditioned.
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The waiting area
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You will
now be asked to get onto a theatre trolley. Theatre staff will check your
identity, your name and date of birth, and will ask you about other details in
your medical records. |
The operation room
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This is
often a busy place, with staff bustling to get ready for your surgery and noises
echoing around. Music may be playing. You will be moved from your trolley onto
the operation table. It is here that your anesthetist will prepare you for
anesthetic. All the checks you have just been through will be repeated once
again.
If you are having a general anesthesia, you willl now need to remove your
glasses, hearing aids and dentures to keep them safe.
To monitor you during your operating, your anesthetist will attach you to
machines to watch:
- your
heart: sticky patches will be placed on your chest (electrocardiogram or ECG).
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your blood pressure : a blood pressure cuff will be placed on your arm.
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oxygen level in your blood: a clip will be placed on your finger (pulse
oximeter).
More
monitoring may be needed for major operations |
IV cannula
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Your anesthetist will need to give you medications and saline into a vein. A
needle will be used to put a thin plastic tube (a 'cannula') into a vein in the
back of your hand or arm. Sometimes, it can take more than once attempt to
insert the cannula. Your anesthetist may ask your to tightly close your fist so
as to make your veins prominent. Saline will be given through a drip into your
cannula during your operation. If your need blood during the operation ti will
be given to your thought the cannula. |
Regional anaesthesia (Spinal /
Epidural / Nerve blocks)
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Spinal or
epidurals, the most common regional blocks, are used for operations on the lower
half of your body.
Spinals are single injections which taken only a few minutes to work and last
about two hours. Epidurals can take upto the half an hour to work but can be
used to relieve pain for hours and sometimes days after your operation. A very
fine catheter is passed into your back bone through which pain killers would be
given during and after the operation.
Your anesthetist will explain the procedures of a regional anesthetic to you
prior to your anesthesia.
Local anesthesia will be given to help reduce the discomfort of the injection
for the block. It can take more than one attempt to get the needle i the right
place so that the areas is properly numbed. Your anesthetist will ask you to
keep quite still so he or she can given you your local or regional anesthetic
block. If your move during the block, you may make it difficult for your
anesthetist. You are requested to kindly co-operate with your anesthetist. You
may notice a warm tingling feeling as the anesthetic begins to take effect. It
is common to feel as though the part of your body which is anesthetized does not
belong to you. Your operation will go ahead once the are is numbed.
Local and
regional anesthetics are usually given to you while you are conscious. You can;
- Help your
anesthetist get you into the correct position.
- Tell your
anesthetist if the needle causes pain.
- Tell your
anesthetist when the anesthetic is taking effect.
The
type and place of a local or regional anesthetic injection will depend on the
operation you are having and the pain relief you will need afterwards. |
General anesthesia
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There are
two ways of starting a general anesthesia;
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Anesthetic drugs may be given through the cannula (this is generally used for
adults); or
- you can
breathe anesthetic gases and oxygen through a mask, which you may hold if you
prefer.
You
may have a light-headed feeling and will lose consciousness within a minute or
so. It might hurt when anesthetic drugs are given through your cannula. |
After your operation
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You will
be moved from the operation room to the recovery area by your anesthetist.
Recovery staff will continue to monitor your blood pressure, oxygen level and
pulse rate. Here;
- You may
have a tube in your nose (if you have undergone some operation on your head or
neck) to help you breathe. This tube stays in place till the next morning, when
it is removed.
- Oxygen
will be given through a lightweight clear-plastic mask, which covers your mouth
and nose.
- If you
feel any pain, left the staff in the recovery know so that they can give you
some pain killers.
- If you
feel sick (nauseated), you may be given drugs which will help minimize this.
- Depending
on the operation you have had, you may have a urine catheter. This is a thin
soft be put temporarily into the bladder to drain t. You may get the feeling of
wanting to pass urine due to tis very presence.
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If you have had a local
or regional anesthesia
It will
take some hours for feeling to return to the area of your body that was numb.
You may feel a tingling sensation as the feeling returns. Until the block wears
off you will feel fine, but once it wears off you will start to feel the pain.
Let the recovery staff know if you are feeling any pain, so they can provide the
necessary pain killers. |
High Dependency Unit
(HDU) or the Intensive Care Unit (ICU)
After a
major operation, you may be taken to the HDU or ICU. If this is planned, it will
be discussed with you beforehand. You may remember little about your stay in
ICU. This is because you will be receiving sedation and other medicines to help
you recover. |
Back to the ward
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Once the
recovery staff is satisfied that you have safely recovered from your anesthetic,
and all your observations (such as blood pressure and pulse) are stable, you
will be sent to your ward.
It is important that you ask for help :
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when you first get out of bed (although you may feel fine lying in the bed, you
may feel faint or sick when you first get up).
- if you
have had a spinal or epidural, as you legs may still be weak or numb for some
hours.They may not regain their full strength for about 12 hours. Kindly do not
get out of yur bed without assistance.
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Early mobilization is the key to faster recovery from your surgery unless your
surgeon has specially prohibited you to mobilize early.
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Pain relief
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Good pain
relief is important.
- It avoids
the suffering.
- Helps you
recover more quickly.
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Helps prevent complications (chest infection and blood clots in veins).
If you
can breathe deeply and cough easily after your operation, you are less likely to
develop a chest infection.
If you can move around freely, you are less likely to get blood clots (deep vein
thrombosis or DVT) in your legs.
It is much easier to relieve pain if it is dealt with before it gets bad. So,
ask the nurse for help as soon as you feel pain, and continue the treatment
regularly. |
Pain relief can be given
in the following way;
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Tablets or liquids to swallow
These are used for all types of pain. They take at least half an hour to work
and should be taken regularly. You need to be able to ear, drink and not fell
sick for these to work.
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Injections
These are often needed, and are given either into a vein for immediate effect,
or into your leg or buttock muscle which may take upto 20 minutes to work.
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Patient – controlled analgesia (PCA)
This is a method using a machine that allows you to control you pain relief
yourself. It has a pump which contains a pain killer (medicine). The pump is
linked to a handset which has a button. When you press the button, you receive a
small dose of the medicine painlessly into your cannula. Ask you anesthetist for
more information.
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Local anesthetics and regional block
These types of anesthesia can be very useful for relieving pain after surgery.
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Painkillers (Medications)
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Opiates: These are the medications often used for severe pain. They
include morphine, codeine and pethidine. They may be given by tables, injections
or patient-controlled analgesia. They may also be added t a spinal or epidural
to give longer and better pain relief. Some people have side effects the most
common include nausea (sickening feel), vomiting, constipation, and drowsiness.
Larger doses can produce breathing problem and low blood pressure (hypotension).
The nursing staff will watch you closely for these effects.
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Other
painkillers (analgesics): such as
diclofenac, ibuprofen or paracetamol may be given during anesthesia or
afterwards as injections or tablets. They must be used carefully by people with
asthma, kidney disease, and heartburn or stomach ulcers. If you are allergic to
these or have had any problems with these medications you must inform your
anesthetist about it.
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Acute Pain Service team
(set up
exclusively for the perioperative period)
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The
team comprises of an anesthetist and a nurse (who specialize in pain relief
after surgery) to provide you pain relief or regulate your pain relief once your
are in the ward. They will meet you on the ward after your surgery and provide
you pain relief or regulate your pain relief to suit you and keep you as
comfortable as is possible. They will meet you regularly for the first 2-3 days
after your operation depending on your need. They will assess your pain severity
using a scale (0-10) & you can help them by translating your pain intensity into
a number on the scale, which helps them to titrate your pain medication. Feel
free to discuss with them any aspect of pain relief that you would want to knew.
Your queries are welcome.
If you feel that you are in pain you must left the nurse or doctor known so that
appropriate measures can be take to control your pain satisfactorily. |
Risks & benefits of
Anesthesia
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Anesthesia has made much of today's surgery possible, and has brought great
benefit. Anesthesia removes pain and any sensation during an operation.. This
benefit needs to be weighed against the risks of the anesthetic procedure and
the medications used. This will vary from person to person. With modern
anesthesia, serious problems are uncommon. Risk cannot however be removed
completely, though modern equipment, training and drugs have made it a much
safer procedure.
The risk to you as an individual will depend on;
- Whether
you have any other illness (heart or lung disease, high blood pressure, diabetes
etc).
- Personal
factors, such as smoking or being overweight.
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Surgery which is complicated, long or carried out as a emergency.k
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Side effects of
anesthesia
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The incidence of these side effects varies from person to person. It may be
possible that you have none of these problem after you have had an anesthesia. |