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.

Some risks associated with anaesthetics

1. 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

2. 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).

3. 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

4. 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.

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.

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.