This booklet is designed to be read in clinics, wards, waiting rooms and surgeries. It explains anaesthesia how important it is to provide information and choice for AAnnaaeesstthheessiiaa patients. It was written by a partnership of patient representatives, patients and anaesthetists, and eexxppllaaiinneedd is one of a series that includes information about anaesthesia in specific situations. You can find more information about having an anaesthetic on the inside front cover of this booklet. Information for patients, relatives and friends The Royal College of Anaesthetists The Association of Third edition May 2008 Anaesthetists of Great Britain and This leaflet will be reviewed within five years of the date of publication Ireland This booklet is for adults who are expecting to have an Contents anaesthetic. It offers some information about anaesthesia and suggests how and where you can find out more. It has been written by patients, patient representatives and anaesthetists, working in partnership. You can find more information in other leaflets in the series on the website www.youranaesthetic.info. They may also be 1 An introduction to anaesthesia 4 available from the anaesthetic department in your hospital. Some types of anaesthesia 5 The series includes the following: The anaesthetist 7 ● You and your anaesthetic (a shorter summary) 2 Before you come into hospital 9 ● Your child’s general anaesthetic ● Your spinal anaesthetic 3 On the day of your operation 12 ● Epidurals for pain relief after surgery Meeting your anaesthetist 13 ● Headache after an epidural or spinal anaesthetic Local and regional anaesthetics 20 ● Your child’s general anaesthetic for dental treatment General anaesthetics 23 ● Local anaesthesia for your eye operation 4 After your operation 26 ● Your tonsillectomy as day surgery ● Your anaesthetic for aortic surgery 5 Pain relief 28 ● Anaesthetic choices for hip or knee replacement Ways of giving pain relief 29 Drugs you may receive 30 Risks Assoicated with your anaesthetic 6 How did it all go? 32 A collection of 14 articles about specific risks associated with having an anaesthetic has been developed to be used with the patient information 7 Benefits and risks of anaesthesia 33 leaflets. The risk articles are available on the website www.youranaesthetic.info. 8 Index of side effects and complications 36 9 Useful organisations 41 Throughout this booklet we use these symbols: To highlight To highlight where To point your options you may want to you to more or choices take action information Anaesthesia explained Anaesthesia explained An introduction to 1 1 Some types of anaesthesia anaesthesia Local anaesthesia A local anaesthetic numbs a small part of your body. This booklet aims to offer you and your relatives and friends It is used when the nerves can easily be reached by drops, an introduction to anaesthesia. There are wide differences sprays, ointments or injections. You stay conscious but free in how much information people want. Only you can know from pain. how much you want to know. We offer some information here and suggest how and where you can find out more. Regional anaesthesia Your anaesthetist will discuss the anaesthetic methods Regional anaesthesia can be used for operations on larger or that are appropriate for you and will find out what you deeper parts of the body. Local anaesthetic drugs are injected would like. Sometimes you can make choices if you want near to the bundles of nerves which carry signals from that to – anaesthetists try to offer individual care. You and your area of the body to the brain. anaesthetist can work together to make your experience as calm and free from pain as possible. The most common regional anaesthetics (also known as regional ‘blocks’) are spinal and epidural anaesthetics. What is ‘anaesthesia’? These can be used for operations on the lower body such as Caesarean sections, bladder operations or replacing a hip The word ‘anaesthesia’ means ‘loss of sensation’. If you have joint. You stay conscious but free from pain. ever had a dental injection in your mouth or pain-killing drops put in your eyes, you already know important things General anaesthesia about anaesthesia. General anaesthesia is a state of controlled unconsciousness ● It stops you feeling pain and other sensations. during which you feel nothing and may be described as ● It can be given in various ways. ‘anaesthetised’. This is essential for some operations and may ● Not all anaesthesia makes you unconscious. be used as an alternative to regional anaesthesia for others. ● It can be directed to different parts of the body. Anaesthetic drugs injected into a vein, or anaesthetic gases breathed into the lungs, are carried to the brain by the blood. Drugs that cause anaesthesia work by blocking the signals They stop the brain recognising messages coming from the that pass along your nerves to your brain. When the drugs nerves in the body. wear off, you start to feel normal sensations again, including pain. 4 www.youranaesthetic.info www.youranaesthetic.info 5 Anaesthesia explained Anaesthesia explained Anaesthetic unconsciousness is different from 1 unconsciousness due to disease or injury and is different from 1 The anaesthetist sleep. As the anaesthetic drugs wear off, your consciousness starts to return. Anaesthetists are doctors who have had specialist training in anaesthesia, in the treatment of pain, in the care of Combining types of anaesthesia very ill patients (intensive care), and in emergency care Anaesthetic drugs and techniques are often combined. (resuscitation). They will make major decisions with you, although if you are unconscious or very ill, they will make For example: decisions on your behalf. ● A regional anaesthetic may be given as well as a general Your anaesthetist is responsible for: anaesthetic to provide pain relief after the operation. ● your wellbeing and safety throughout your surgery ● Sedation may be used with a regional anaesthetic. The regional or local anaesthetic prevents you from feeling ● agreeing a plan with you for your anaesthetic pain, and the sedation makes you feel drowsy ● giving your anaesthetic and mentally relaxed during the operation. ● planning your pain control with you ● managing any transfusions you may need Sedation ● your care in the Intensive Care Unit (if this is necessary). You will be treated by a consultant anaesthetist, or by Sedation is the use of small amounts of anaesthetic or another qualified anaesthetist or an anaesthetist in training. similar drugs to produce a ‘sleepy-like’ state. It makes you You can ask to talk to a consultant anaesthetist if you want physically and mentally relaxed during an investigation or to – there is always one available to help if needed. procedure which may be unpleasant or painful (such as an endoscopy). You may remember a little about what happened or you may remember nothing. Sedation may be used by other healthcare professionals as well as anaesthetists. If you are having a regional or local anaesthetic, you may want to ask for some sedation as well. 6 www.youranaesthetic.info www.youranaesthetic.info 7 Anaesthesia explained Anaesthesia explained Before you come into The anaesthetist and the team 1 Anaesthetists work closely with surgeons and other theatre staff. hospital ● Operating department staff with training in anaesthesia, who prepare and maintain equipment, help the anaesthetist and take part in your care. 2 Here are some things that you can do to prepare yourself for ● Trained staff in the recovery room will care for you your operation and reduce the likelihood of difficulties with after your surgery until you are ready to go back to the the anaesthetic. ward. ● If you smoke, you should consider giving up for several ● Medical students and other healthcare staff weeks before the operation. The longer you can give up in training can only take part in your care with your beforehand, the better. Smoking reduces the amount of permission. If they do, they are closely supervised. oxygen in your blood and increases the risk of breathing ● Physicians’ assistant (anaesthesia) or PA(A)s problems during and after an operation. If you cannot are a new grade of healthcare professional trained stop smoking completely, cutting down will help. to maintain anaesthesia under the supervision of a ● If you are very overweight, many of the risks of having consultant anaesthetist. This means they look after the an anaesthetic are increased. Reducing your weight will anaesthetic once it is underway. An anaesthetist will help. Your GP or practice nurse will be able to give you always be present at the beginning and end of each advice about this. anaesthetic. PA(A)s are not medically qualified, but they have completed training and assessments for the skills ● If you have loose or broken teeth, or crowns they need. They will always have access to an anaesthetist that are not secure, you may want to visit your dentist when they need it. At the moment they are only for treatment. The anaesthetist may need to put a tube in employed in a small number of hospitals. your throat to help you breathe, and if your teeth are not secure, they may be damaged. ● If you have a long-term medical problem such as diabetes, asthma or bronchitis, thyroid problems, heart problems or high blood pressure (hypertension), you should ask your GP if you need a check-up. 8 www.youranaesthetic.info www.youranaesthetic.info 9 Anaesthesia explained Anaesthesia explained Health check before your anaesthetic The pre-assessment clinic Before your anaesthetic we need to know about your general Nurses usually run this clinic. There may be a surgical team health. You may be asked to go to a pre-assessment clinic or doctor and sometimes an anaesthetist available for advice. If you may be asked to fill in a questionnaire. Sometimes the you need blood tests, an ECG (electro-cardiogram or heart health check happens on the ward after you are admitted to tracing), an Xray or other tests, these will be arranged. Some 2 2 hospital. tests can be done in the clinic, for others you may need to come back another day. This is a good time to ask questions You may be asked about: and talk about any worries you may have. If you want to talk ● your general health and fitness to an anaesthetist, you should ask for this to be arranged. ● any serious illnesses you have had ● any problems with previous anaesthetics ● whether you know of any family members who have had Pills, medicines, herbal remedies and allergies problems with anaesthetics ● any pains in your chest ● If you are taking any pills, medicines, herbal remedies or ● any shortness of breath supplements, it is important to bring these with you. ● any heartburn A written list of everything you are taking, whether they have been prescribed or whether you have bought them ● any pains you have which would make lying in one over the counter, would be helpful for your anaesthetist. position uncomfortable ● If you have any allergies, a note of these will also be helpful. ● any medicines you are taking, including herbal remedies and supplements you may have been prescribed or may have bought ● any allergies you have ● any loose teeth, caps, crowns or bridges ● whether you smoke ● whether you drink alcohol ● whether you use recreational drugs (drugs that are not prescribed to you or bought over the counter). 10 www.youranaesthetic.info www.youranaesthetic.info 11 Anaesthesia explained Anaesthesia explained On the day of your Meeting your anaesthetist operation You will meet your anaesthetist before your operation. Your anaesthetist will make every effort to meet you on the ward before your surgery, but this is not always possible. Your anaesthetist will look at the results of your health check Nothing to eat or drink – fasting (‘Nil by mouth’) and may ask you more questions about your health. He or she may also need to listen to your chest with a stethoscope, The hospital should give you clear instructions about fasting. examine your neck and jaw movements, and look in your It is important to follow these. If there is any food or liquid in 3 mouth. 3 your stomach during your anaesthetic, it could come up into the back of your throat and then go into your lungs. Your anaesthetist will discuss with you which anaesthetic This would cause choking, or serious damage to your lungs. methods can be used. In an emergency (such as needing surgery for badly broken bones), where people have not had time to fast, there are The choice of anaesthetic depends on: other techniques and drugs that allow anaesthesia to be given safely which your anaesthetist will explain to you. ● your operation Your normal medicines ● your answers to the questions you have been asked You should continue to take your normal medicines up to ● your physical condition and including the day of surgery, unless your anaesthetist ● your preferences and the reasons for them or surgeon has asked you not to. However, there are ● your anaesthetist’s recommendations for you exceptions. For example, if you take drugs to thin your blood and the reasons for them (such as wafarin, aspirin or clopidogrel), drugs for diabetes or herbal remedies, you will need specific instructions. If you are ● the equipment, staff and other resources at your hospital. not sure, your anaesthetist or surgeon will advise you. Having talked about the benefits, risks and your preferences, If you feel unwell you can then decide together what would be best for you. If you feel unwell when you are due to come into hospital for Nothing will happen to you until you understand and agree your operation, the hospital will need to know. Depending with what has been planned for you. You have the right to on the illness and how urgent the surgery is, your operation refuse if you do not want the treatment suggested or if you may need to be postponed until you are better. Your hospital want more information or more time to decide. should give you details of who to contact. 12 www.youranaesthetic.info www.youranaesthetic.info 13 Anaesthesia explained Anaesthesia explained Premedication Occasionally, you might need blood unexpectedly. You have the right to refuse a blood transfusion, but you must make Premedication (a ‘pre-med’) is the name for drugs which are this clear to your anaesthetist and your surgeon before the given before some anaesthetics. These days they are not used operation. very often, but if you feel a pre-med would help you, you can ask your anaesthetist about having one. What blood will I be given? Most are tablets or liquid that you swallow, but you may Your anaesthetist will know your blood type from your records. need an injection, a suppository (see page 29) or an inhaler. They can: Most commonly, you will receive blood from a volunteer (a blood donor). It is supplied by the National Blood Service. 3 ● reduce or relieve anxiety 3 In some hospitals the following services are available, so ask ● help to prevent sickness after the operation your surgeon or GP about them in good time if you want to ● treat any health problems you may have know more. ● help with pain relief after your operation. ● It may be possible to collect your blood during the operation and return it to you (‘blood salvage’ They may make you more drowsy after the operation. If you or ‘cell saving’). want to go home on the same day, this may be delayed. ● It may be possible to take blood from you before your Needles and local anaesthetic cream operation and store it so that it may be returned to you during your surgery (autologous transfusion). A needle may be used to start your anaesthetic. If this worries you, you can ask to have a local anaesthetic cream put on your arm to numb the skin before you leave the ward. The Why does the anaesthetist postpone some ward nurses should be able to do this. operations? Blood transfusion Occasionally, your anaesthetist might find something During most operations, you will lose some blood. If about your general health that could increase the risks of necessary, your anaesthetist will usually make up for this your anaesthetic or operation. It might then be better to blood loss by giving you other types of fluid into a vein delay your operation until the problem has been reviewed through a drip. If you lose a lot of blood, your anaesthetist or treated. The reasons for any delay would always be will consider a blood tranfusion. discussed with you at the time. If your anaesthetist expects you to need a blood transfusion, Your anaesthetist’s main concern is your safety. he or she will discuss this with you beforehand. 14 www.youranaesthetic.info www.youranaesthetic.info 15 Anaesthesia explained Anaesthesia explained Getting ready for ‘theatre’ ● If you are having a local or regional anaesthetic block, you can take a personal tape, CD or MP3 player with you Here are some of the things that you may be asked to do to listen to music through your headphones. to get yourself ready for your operation. Washing and changing When you are called for your operation ● A bath or shower before your operation will clean your When it is time for your operation, a member of staff will go skin and reduce the risk of infection. You must avoid using with you to the theatre. make-up, body lotions or creams as they prevent heart ● A relative or friend may be able to go with you to the monitor pads and dressings from sticking to your skin anaesthetic room. A parent will normally go with a child. 3 properly. 3 ● Most people go to theatre on a bed or trolley. ● You will be given a hospital gown to put on. You may like You may be able to choose to walk but this will depend to wear your own dressing gown over this. on your general health, whether you have had a premed ● You can keep your pants on as long as they will not get in and how far the theatre is from your ward. If you are the way of the operation. Sometimes, you may be given walking, you will need your dressing gown and slippers. paper pants. The operating department (‘theatres’) ● Please remove nail varnish and ask for advice about false nails. These can interfere with oxygen monitoring. The operating department includes a reception or waiting Personal items and jewellery area, anaesthetic rooms, operating theatres and a recovery room. It looks and feels quite different from other hospital ● You can wear your glasses, hearing aids and dentures to departments – more cold and clinical. Operating theatres are go to the operating theatre. If you are having a general brightly lit and may have no natural light. anaesthetic, you will probably need to remove them in the anaesthetic room to make sure they are not damaged The theatres may also be quite cool. As it is important for you or dislodged while you are anaesthetised. They will be to keep warm, a blanket will help if you feel cold. returned to you as soon as you want them. If you are not The staff having a general anaesthetic, you can keep them in place. ● Jewellery and decorative piercing should ideally be Theatre staff normally wear coloured ‘pyjamas’ and paper removed. Bare metal against your skin could get snagged hats. Because of this, they all look much the same, but you as you are moved. If you cannot remove your jewellery, will probably recognise your anaesthetist as you should have it will need to be covered with tape to prevent damage met him or her already. to it or to your skin. 16 www.youranaesthetic.info www.youranaesthetic.info 17 Anaesthesia explained Anaesthesia explained Reception To monitor you during your operation, your anaesthetist will attach you to machines to watch: If you have walked to theatre, you will now need to get onto a theatre trolley for your anaesthetic. This is narrower and ● your heart: sticky patches will be placed on your chest higher than a hospital bed and may feel quite cold and hard. (electrocardiogram or ECG) A member of staff will help you climb onto it. ● your blood pressure: a blood-pressure cuff will be Theatre staff will check your identification bracelet, placed on your arm your name and date of birth, and will ask you about other ● the oxygen level in your blood: a clip will be placed on details in your medical records as a final check that you are your finger (pulse oximeter). 3 having the right operation. 3 More monitoring may be needed for major operations. The anaesthetic room Setting up your cannula You will then be taken into the anaesthetic room or, Your anaesthetist may need to give you sometimes, into the operating theatre. Several people will drugs into a vein. A needle will be used be there, including your anaesthetist and the anaesthetic to put a thin plastic tube (a ‘cannula’) assistant. There may also be an anaesthetist in training, a into a vein in the back of your hand nurse and a student doctor or nurse. or arm. This is taped down to stop it All the checks you have just been through will be repeated slipping out. Sometimes, it can take more once again. If you are having a general anaesthetic, you will than one attempt to insert the cannula. probably now need to remove your glasses, hearing aids and You may be able to choose where your dentures to keep them safe. cannula is placed. If you would prefer to leave your dentures in place, If you have not been able to drink for ask your anaesthetist if this would be alright. many hours before your operation, or you have lost fluids from being sick, you may have become dehydrated. Bags of sterile water with added salt or sugar can be given through a drip into your cannula to keep the right level of fluids in your body. Any blood you need will also be given through the drip. 18 www.youranaesthetic.info www.youranaesthetic.info 19