To have an operation you need an anaesthetic. Anaesthetics stop you feeling pain and other sensations. There are different types of anaesthetic:
- General anaesthesia gives a state of controlled
It is essential for some operations. You are unconscious and feel nothing.
- Local anaesthesia involves numbing a localised part of your
- Regional anaesthesia involves numbing a larger part of the body such as an arm or leg or the lower half of the body. You stay conscious but free from pain.
Sedation with local or regional anaesthesia
You will usually have the option of remaining awake or getting drugs that will help you to relax or fall asleep.
The choice of anaesthetic depends on:
- Your
- Your physical
- Your answers to the questions you have been
- Your anaesthetist’s recommendations for you and the reasons for them.
- Your
- The equipment, staff and other resources at your
Anaesthetists are doctors with specialist training who:
- Are responsible for giving your anaesthetic and for your wellbeing and safety throughout your
- Make your experience as pleasant and pain free as
- Discuss types of anaesthesia with you and find out what you would like, helping you to make choices.
- Agree a plan with you for your anaesthetic and pain
- Discuss the risks of anaesthesia with Surgery and anaesthesia always have a degree of risk associated with them. Please read the section on Risk at the end of the booklet.
- Plan your care, if needed, in the intensive care or high dependency
You will usually have an opportunity to speak with your anaesthetist in advance of your operation. This will be an opportunity to discuss any issues so that the anaesthetic can be tailored to any specific needs.
Preparation for your surgery
The anaesthetist may discuss the use of a premedication (a ‘premed’). This is the name for medicines which are sometimes given before an anaesthetic.
Some premeds prepare your body for the anaesthetic, others help you to relax. Other premeds help prevent nausea and vomiting, others help prevent pain postoperatively.
You will travel from the ward to the operating theatres area. Usually you will walk, but it may be possible for you to travel in a chair.
When you reach the anaesthetic room you will have your blood pressure checked. We will monitor your heart and pulse with special equipment on the tip of your finger and on your chest.
Usually a small cannula (needle) will be placed into a vein, often on the back of your hand. It may be possible to apply cream to your hand before coming to theatre to reduce the feeling of any injection or jag. (ask the ward nurses or your anaesthetist if you would like this).
Surgery and anaesthesia in women of childbearing age
Routine surgery is avoided in women who are pregnant or believe they may be in the early stages of pregnancy. On admission you will be asked when your last menstrual period started and whether you could be pregnant. If your menstrual period is late or irregular and you are sexually active, you will be offered a pregnancy test. To minimise the risk of unrecognised pregnancy, you are advised to avoid unprotected sexual intercourse from the time of your last period up until your hospital admission.
General anaesthetics
There are two ways of starting a general anaesthetic.
- Anaesthetic drugs may be injected into a vein through the cannula or Sometimes you are asked to breathe oxygen through a mask before the drug is injected. This is called ‘preoxygenation’.
Or
- You can breathe anaesthetic gases and oxygen through a mask, which you may hold if you
Once you are unconscious, an anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised. As soon as the operation is finished, the drugs will be stopped or reversed so that you regain consciousness. After the operation, you may be taken to the recovery room.
Recovery staff will be with you at all times. When they are satisfied that you have recovered safely from your anaesthetic you will be taken back to the ward.
Local and regional anaesthetics
- Your anaesthetist will ask you to keep still while the injection is
- You may notice a warm tingling feeling as the anaesthetic begins to take effect.
- Your operation will only go ahead when you and your anaesthetist are sure the area is numb.
- If you are not having sedation you will remain alert and aware of your surroundings. A screen shields the operating site, so you will not see the operation site.
- However your anaesthetist may be able to make you lightly sedated or asleep depending on your condition and
- Your anaesthetist is always near to you and you can speak to him or her whenever you want to.
There are risks in all walks of life. Many of these risks we take without thought. For example, travelling by car. In modern anaesthetics there are also risks but these risks are small. You should not think about the risks of anaesthetics without thinking about why you are having the anaesthetic – which is to allow you to have an operation safely. You must balance the benefits of the operation with the risks of the anaesthetic and with the risks of the surgery.
To get a complete picture you should ask about benefits, risks, alternatives available or consequences of doing ‘nothing’ with the surgeon.
To understand the risks associated with anaesthetics you need to know:
- How likely something is to
- How serious this might
- How it can be
The risk to you as an individual depends on:
- Whether you have other
- Personal For example smoking and being overweight.
- How complex the surgery
- Whether the surgery is being done as a planned operation or as an
People vary in how they interpret words and numbers. The scale below explains how we have defined these words. For example, we describe an event as uncommon if it happens “1 in 1,000”.
An example of an uncommon problem is damage to teeth. This means that we would expect damage to teeth to happen once every 1000 anaesthetics given. Unfortunately we do not know when the “1” will happen. In Forth Valley we give about 10,000 anaesthetics every year. A rare event might therefore happen once a year in Forth Valley.
| Very Rare
1 in 100,000 |
Rare
1 in 10,000 |
Uncommon
1 in 1000 |
Common
1 in 100 |
Very Common
1 in 10 |
Some risks associated with anaesthetics
- Minor problems are common
- Nausea and
- Pain – up to 1 patient in 10 will suffer severe
- Sore
- Drowsiness and
- Once every 4500 operations a patient needs treatment by a
- Back pain is common, especially after long
- Itch is common and due to pain
- Some rare anaesthetic risks
- Choking on stomach contents happens 1 in every 2000 operations. The chance of dying from this is very small (one in 45,000 operations).
- Waking up and remembering part of the This happens once every 20,000 operations.
- Blurred vision happens 4 in 100 Serious damage to the eyes is rare (once every 10,000 operations).
- There is a small risk of damage to nerves under general
- For some major operations anaesthetists need to place special drips into an artery (usually the wrist) and into a big vein in the neck or under the collarbone. These are used to continuously monitor your condition and to give you
There are major problems with drips in the artery in less than 1 in 100 cases. Drips put into the large veins can damage the lung (2 in 100 cases).
- Major illness after surgery
Major complications are biggest after operations inside the abdomen, inside the chest and after operations on the arteries. These complications include:
- Heart The risk is increased in patients with heart disease.
- Breathing
- Confusion and memory These are common after big operations. For people aged over 60, 1 in 10 may become confused after the operation. Although most recover, 1 in 100 may have ongoing issues.
- There is a small risk of stroke after
- Dying from the anaesthetic
There is a risk of dying after any operation. The chance of a patient dying from the anaesthetic is very rare.
For generally fit patients the risk of death from anaesthetic is very rare, 1 death in every 100,000 operations.
For patients with medical problems not related to the operation, the risk of death from anaesthetic is 1 death in every 10,000 operations.
Some risks associated with regional anaesthetics
For some operations and some patients an injection in the back to ‘freeze’ you from the waist down is the best anaesthetic (spinal anaesthetic). There are several potential problems:
- Headache can This is different from ‘normal’ headaches – getting worse on standing and better on lying down. This happens in 1 in 200 injections and can be treated in most (75%) of cases.
- Bladder problems, which might require a catheter being put into the bladder for a short time, are quite
- Damage to nerves. This is rare. Permanent damage to nerves happens about 1 in every 10,000
- Major complications like paraplegia (being paralysed from the waist down), infection and bleeding (in the back) are very rare 1 in 100,000 injections or less.
- Sometimes injections to freeze individual nerves or limbs (often the upper arm) damage a nerve. Often the damage is short lived but permanent damage can occur once in 5000
- Itching – this can commonly occur if morphine-like drugs have been used in the spinal Medication can be given to help. More information is available from www.rcoa.ac.uk/patientinfo.
Preparation for your surgery
Patients are respectfully requested not to bring in ANY aerosols into hospital as they can create health, safety and environmental problems.
There are some things that you can do to prepare yourself prior to having an anaesthetic.
- If you are very overweight, reducing your weight may reduce the extra risks you face during and after your anaesthetic and It may also make the surgery easier.
- You should inform nursing and medical staff of any medical problems, such as diabetes, asthma, thyroid problems, epilepsy or high blood It is important to ensure these are controlled before your surgery. Your admission time will be either 07.45am or 11.30am.
- Stop smoking (See later section).
You should inform nursing and medical staff if you have any loose teeth or crowns, and if possible seek treatment from your dentist prior to your anaesthetic.
- You should inform nursing and medical staff of any allergies you may have to medicines, foodstuffs, plasters, rubber or
- It is important for you to bring, on admission, your pills, medicines, herbal preparations or supplements you are taking, in their original boxes. The nursing or medical staff will advise you on what medication it is important for you to take prior to your
- Your admission time will be either 45am or 11.30am. This allows staff to complete all the necessary checks prior to your operation. The time of your operation can be between 9.00am-12.30pm or 1.30pm- 5.00pm as circumstances affecting the timing of operations can change.
If there is any food in your stomach during your anaesthetic, it could come up into the back of your throat and then go into your lungs. This would cause choking, or serious damage to your lungs. To make sure your stomach is empty before your planned operation you must follow the rules about fasting.
- Eat meals as normal the night before
- If you are having day surgery or 23 hour surgery, please ensure you have a supply of painkillers at home as advised at the pre op assessment Eat no solid foodstuffs, milk, fizzy drinks or alcohol after midnight before your operation.
- Please drink up to a cup of water on the morning of your operation before 06.30am. Thereafter sips of clear fluid, such as water, are permissible until you go to
- Take your usual medicines as normal at the usual times unless otherwise informed (you are allowed a small amount of water with tablets).
Do not chew gum or suck sweets before your operation
- Eat meals as normal the night before
- Eat a light breakfast ‘snack’ (a bowl of cereal or 2 slices of toast or biscuits or similar and a cup of tea, coffee or glass of milk).
- Breakfast must be completed by 07:30. We encourage you to drink clear fluids, such as water, black tea or coffee throughout the morning until 30am. Thereafter sips of clear fluids are permissible until you go to theatre.
- Take your usual medicines as normal at the usual times unless otherwise informed (you are allowed a small amount of water with tablets).
Do not chew gum or suck sweets before your
Alcohol before surgery can be dangerous. Please try and refrain from drinking alcohol the day before surgery.
If you are a smoker it is very important that you stop smoking as soon as possible.
Smoking greatly increases the risk of complications during and after your surgery.
These complications include:
- Infections (especially chest and wound infections)
- Anaesthesia related problems
- Slower wound healing and bone repair
- Cardiovascular complications such as heart attacks
There has never been a better time to quit smoking. The sooner you stop before your op, the better.
Managing to quit 6-8 weeks prior to an operation dramatically reduces the risk of these problems. But even stopping for 24-48 hours before an operation may help.
Visit our Stop Smoking Service for help quitting.
After the operation
Pain relief (analgesia)
The anaesthetist will make sure that you are comfortable immediately after your operation. Good pain relief is important and some people need more pain relief than others. You should be able to cough and move freely after your operation. It is much easier to relieve pain if it is dealt with before it gets bad. Pain relief can be increased, given more often or in different combinations.
There are different ways of getting pain relief:
These are used for all types of pain. They may take up to half an hour to work. You need to be able to eat, drink and not feel sick for these drugs to work. To be most effective they often need to be taken regularly before pain builds up.
These may be given into your leg or buttock muscle. They may take up to 20 minutes to work.
These waxy pellets are put in your back passage (rectum). The pellet dissolves and the drug passes into the body. They are useful if you cannot swallow or if you might vomit.
This is a method (usually for more major surgery) using a machine that allows you to control you pain relief yourself.
These types of anaesthesia can be very useful for relieving pain after surgery. Epidurals usually numb up a part of your body and can be very effective for pain relief after some types of surgery.
The pain after an operation usually subsides with time, ranging from days to weeks and months depending on the type of surgery.
If you are discharged home it is important to take regular pain killers for a period of time to cover any discomfort that you may have. The ward staff will advise.
If you are having day surgery or 23 hour surgery, please ensure you have a supply of painkillers at home as advised at the pre op assessment clinic.
Certain operations and anaesthetics can cause sickness and vomitting after the operation. We do give treatments to reduce the chances of this happening.
If you have suffered from this before be sure to remind us so that we may take extra precautions.