If you are having major surgery then you will receive a phone call a few days before you are due to come in where we discuss your general health and any concerns you have about the anaesthetic.
For smaller and day case procedures I will see you on the day of surgery either in the day stay unit or on the ward. After a discussion about your general health, fitness and regular medications you will be asked to sign a consent form to agree to have an anaesthetic for your operation.
When you arrive in theatre, you will be introduced to the theatre staff and we will do our final checks before starting.
Monitoring to look at your heart rate, blood pressure, breathing and brain wave activity is attached. I insert a small line into a vein through which I can give fluid rehydration and any medication you need during surgery. When everyone is ready, I give you the anaesthetic medication through the line and you fall asleep. While asleep, you will have a small breathing tube inserted through your mouth to keep your airway safe during the operation and when I’m happy that you are warm, safe and secure, the surgeon will start the operation.
At the end of surgery, I turn off the anaesthetic agents that are keeping you asleep and as they wear off, you will wake up. The breathing tube will still be in your mouth and you will hear me calling your name, asking you to take some slow deep breaths and open your mouth so I can pull the tube out. Very few people remember this stage. Once you are breathing well without the tube, we transfer you to your hospital bed and move you through to recovery, where you are monitored closely until you are awake enough to move through to the ward or to second stage recovery prior to going home.
We have lots of different options for pain relief following surgery. All patients are prescribed a range of pain relieving medications which can be taken by mouth or given directly into the drip. Every patient will have a pain management plan formulated which may be as simple as taking regular paracetamol for a few days, or as complicated as specialised pain management pumps where you press a button to give yourself a dose of pain medicine - and you can press as often as you need to. Some patients who have had operations involving a larger cut into the tummy may have some very small tubes inserted at the end of the operation into the muscle layer, through which we give local anaesthetic. This is called a PainBuster system and stays in place for up to 5 days after surgery.
What if clients are anxious about their intended procedure?
We understand that having an operation can be a very stressful time. If you have any concerns which you would like to discuss with me before your admission, you can contact me via Jane, or ask for me to call you. If needed, I can arrange to see you at Manuka Street Hospital prior to your admission to talk through your concerns, sign any paperwork necessary and prescribe a calming pre-med for you to be given on arrival.
All medical intervention carries some risk and part of the job of the anaesthetist is to work out the safest form of anaesthetic for you. This might be a general anaesthetic, a regional anaesthetic (spinal or epidural), sedation, or a combination of techniques.
This involves medication being given to you through an IV line that makes you fall asleep. Once you are asleep, your anaesthetist will insert a breathing tube into your throat through your mouth. You may be kept asleep with a special gas that you breathe through the tube, or with the anaesthetic medicine being given through the IV line throughout the operation. The anaesthetist will turn off either the medicine or the gas at the end of the case and as you wake up, take the breathing tube out. Common risks of this type of anaesthetic include a sore throat or nausea and vomiting when you wake up. Rarer risks include damage to your teeth if the tube is difficult to put into the correct place and allergic reactions to the anaesthetic medications.
This involves an injection of local anaesthetic medication into the spinal fluid in your back. You will usually be sitting up for the spinal injection and the anaesthetist will place the anaesthetic into your spinal fluid using a specially designed needle. The spinal will make you numb to pain and temperature from the waist down, so that you can have your operation without being able to feel any pain. This type of anaesthetic is often used for hip and knee replacement surgery or gynaecological procedures. Sometimes this is also given with sedation so that you are not completely awake during the procedure. Common risks of this type of anaesthetic include failure (it not making you numb enough to have the operation) which would mean you needed a general anaesthetic, a headache afterwards and low blood pressure (which may make you feel sick). Very rare risks of spinal anaesthesia include the level of numbness going too high and damage to the nerves in your back.
This involves medication being given to you through an IV line that makes you drowsy and relaxed. You may fall asleep but some people do not fall completely asleep. Oxygen is given to you through a clear plastic mask that fits loosely over your nose and mouth. You will be fully monitored while the sedation is being given to you. Parts of the procedure may be uncomfortable and wake you – the anaesthetist will be able to give further doses or increase the sedative infusion to allow you to doze off again. Most people have no memory of the procedure at all once they are fully awake in the recovery ward.
Your anaesthetist will discuss the options for anaesthetic choices with you when they see you and will choose the most appropriate anaesthetic based on your medical fitness, type of surgery and your own preferences. Once the decision is made, you will be asked to sign a consent form highlighting the risks relating to that type of anaesthetic as a record that this conversation has taken place.