PO Box 3
Norfolk and Norwich University Hospital
Colney Lane
Norwich NR4 7ZZ
T: 01603 287089 F: 01603 287669
E: group@norwichanaesthetists.co.uk

Information for Patients

Needing an operation and an anaesthetic can be an anxious time. We are always happy to discuss with you any concerns that you have about your forthcoming anaesthetic, but below are a number of the most frequently asked questions.

What does an anaesthetist do?

Your Consultant Anaesthetist is a doctor who has specialised in the care of patients having surgery. As a result, he or she has many roles in addition to giving an anaesthetic.

What will the anaesthetist do before my operation?

They will ensure that you are fit enough to undergo the specific type of anaesthesia that your surgery requires.

This will involve an interview with you to discuss any potential problems in your medical history, a medical examination and scrutiny of any blood tests, heart traces or x-rays that may be needed.

This will usually happen shortly after you arrive in hospital for your operation. However, if your surgeon has any specific concerns, they may ask us to see you at some time before your operation date. This allows us time to focus on any potential medical problems in advance so as not to add delay (or expense) to your treatment once you are admitted.

On occasions, the anaesthetist may tell you that your operation may only be performed at The Norfolk and Norwich Hospital. This is usually because the additional equipment needed for your particular type of anaesthetic and subsequent care is not readily available elsewhere.

If your anaesthetist has any concerns about your health, he or she may decide to postpone your operation date until you are in better health. This is rare, but is obviously only done in your interests.

Your anaesthetist will discuss with you what to expect after you have had your operation and answer any concerns you may have. They will suggest the best methods of preventing pain after your type of surgery. Fortunately, there are now many ways of doing this and these will all be available to you if needed.

What will the anaesthetist ask me?

The anaesthetist will ask questions about your general health, particularly about any long-standing problems and also about temporary complaints such as colds.

You may need extra treatment to make you as fit as possible for your operation and sometimes this causes a delay. Some of the less obvious questions you may be asked are:

  • Have you been in hospital before?
  • Have you had an anaesthetic before?
  • Did you have any unpleasant experiences with your previous anaesthetic?
  • Were you told of any problems with your previous anaesthetic?
  • Has any of your close family had any problems with anaesthetics? (Some problems can run in families)
  • Do you take any drugs or medicines? (including over the counter medications)
  • Have you had any allergic reactions?
  • Do you smoke or drink? (You should obviously try to stop smoking and reduce your alcohol intake before an operation)
  • Do you have any dentures, caps, crowns or loose teeth? (These teeth are more liable to damage during anaesthesia)
  • Is your neck stiff, or do you have difficulty opening your mouth?
  • Are you happy to have a blood transfusion?

It is important that you answer these questions accurately as it may affect the way in which your anaesthetic is conducted.

What does 'nil by mouth' mean?

Vomiting during an anaesthetic can be very dangerous. It is unlikely to happen if your stomach is empty. The nurses will let you know when to stop eating or drinking. You will be able to take clear 'still' fluid up to 2 hours before the start of your operation. You should not take food in the 6 hours before surgery. However, you will be able to continue to take prescribed medicines.

If you eat or drink too near the time of your operation it will be delayed or even cancelled.

What is a premed?

Occasionally, the Anaesthetist may request that you receive a 'premed' before coming to theatre. This is usually a sedative tablet or injection that calms the nerves. It may also contain something to dry your mouth. Usually, a premed will only be prescribed if the anaesthetist thinks it is needed for the type of anaesthetic you are having; however, your wishes will also be taken into consideration. If you are a 'day-case' patient, it is unlikely that your anaesthetic will require this to be given as it could delay your discharge home.

What sort of anaesthetic will I have?

The anaesthetist will discuss with you the types of anaesthetic which are suitable for your operation. Most surgery is carried out under a general anaesthetic, which means that the patient is deeply unconscious throughout the operation.

If you are having a general anaesthetic, it will usually be given as an injection in the back of your hand. Modern anaesthetic drugs are designed to make you fall asleep quickly and calmly. Most patients report that it is a pleasant sensation.

On occasions, the anaesthetist may have reasons for sending a patient to sleep while asking them to breathe oxygen through a clear mask. This has no unpleasant smell as no other gases are present.

An increasing number of operations are now performed under "local anaesthetic" (for example, spinal or epidural anaesthesia) This means that the site of the operation is numbed. You may remain awake but if you wish you can be made sleepy so that you are less aware of what is going on.

Whatever type of anaesthetic you have, it will be performed in a quiet room next to the operating theatre itself.

There are many factors which determine which type of anaesthetic you will have. These will be discussed fully with you so that your wishes can also be taken into account

What will the anaesthetist do once I am asleep?

Your anaesthetist will stay with you all the way through your operation. In addition to keeping you asleep, they also make sure that the vital functions of the body continue to work normally. They will also give you fluids, blood and other treatment that may be necessary.

The anaesthetist uses a lot of equipment and monitors to help with this process. As a routine, some of this (a finger pulse monitor, blood pressure cuff and some sticky pads to look at your heart trace) will be connected to you just before the start of your anaesthetic. Many patients will be used to other doctors using these gadgets and none of them cause any discomfort.

Unexpected problems are very rare but risk can never be completely removed. However, in many ways you are safer under an anaesthetic than at any other time because the anaesthetist is constantly checking your condition and fine-tuning any potential problems.

What happens after the operation?

At the end of the operation you will be returned to your bed and go to the recovery room where specially trained nurses will look after you and make sure you are in a comfortable and stable condition before you return to the ward.

Some patients worry about feeling sick after an anaesthetic. This was very common in the past, but has been greatly reduced by using modern anaesthetic techniques and anti-sickness drugs.

How can pain be prevented after my operation?

Different types of surgery require different types of pain-control. As mentioned previously, your anaesthetist will discuss the options with you before your operation. All patients are different and vary in the amount of painkillers they need. As a general rule most modern methods of pain control can be constantly fine-tuned by the nursing staff to cater for an individual's needs. It is therefore important that you let them know if you ever start to become uncomfortable.

It is particularly important that you should feel comfortable enough to:

  • Move comfortably from bed to chair or change your position in bed, moving from side to side.
  • Take big breaths, filling your lungs as much as you can.
  • Cough.
  • Move your legs up and down in the bed, stretching out each leg, wriggling your toes. This is good for the circulation.

Although many of the medicines that are used to help pain are addictive, if you are prescribed them for the relief of pain you will not become addicted. It is important that you take as much medicine as you need to prevent pain. Some of the methods of pain control that you may have heard of are briefly described below. If they are appropriate for your particular operation then your anaesthetist will obviously discuss them in more detail.

P.C.A.

This means Patient Controlled Analgesia. Pain relieving medicine is painlessly delivered from a pump into the drip in your arm when you feel you need some. The pump is computer programmed by the anaesthetist to give a safe but effective amount of the medicine when you operate a hand set by pressing a button. The machine is programmed so that you cannot give yourself too much medicine.

Epidural

A small tube is safely inserted into the space surrounding your spine, either under local anaesthetic or during the course of your general anaesthetic. The tube lies near the nerves that sense pain from the operation site. A pain killing drug can therefore be injected painlessly through the tube from a computer-controlled pump to numb these nerves. This is a very safe and effective way to control pain.

Rectal Suppositories

Whilst you are under your anaesthetic, a medicine may be given by the rectal route as a suppository. It is a long acting anti-inflammatory and is very effective in taking away the soreness associated with most wounds. This type of suppository will not affect the bowels. Occasionally, they may be used after your operation if you are not able to swallow tablets.

The anaesthetist will not administer this without your express permission.

Nerve Blocks

In a similar way to having a filling at the dentist, many types of surgery can be rendered pain-free by injecting local anaesthetic to numb the nerves that carry sensation from the site of the wound. This is commonly done in addition to a general anaesthetic so that you are pain-free when you wake up.

What happens when I go home?

If it is anticipated that you will still need pain-killers when you go home, the anaesthetist will ensure that the ward staff will supply you with something appropriate.

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