1. Are anaesthetists “proper doctors”?
  Yes, we have all trained as doctors in medical school, then 2 years as a junior doctor or “house surgeon”, followed by several more years in just anaesthesia and intensive care.
2. How do you know which anaesthetic is best for me?
  Depending on the operation or procedure, and your physical fitness, we will suggest the best options for you, but only after full discussion and your understanding and consent. You do not HAVE to have a local, or regional anaesthetic, if you do not want it – though there are rare occasions when this may still be the most sensible option.
3. Why do I have to NOT eat or drink beforehand?
  During anaesthesia your normal protective reflexes are temporarily inactivated, so any material that might regurgitate from your stomach could go straight down your windpipe, into the lungs. This is still one of the major causes of anaesthetic related death.
4. I was sick after my previous anaesthetics – will this happen again ?
  We cannot guarantee that it won’t, but newer, better anesthetics are associated with less post-operative nausea and vomiting. We also use extensive prophylaxis with 2 or even 3 different “anti-emetic” drugs, which counter-act and treat nausea. Using these, we can do much better than in the past, but if you still get sick still we can try a couple of other ones that usually succeed. Unfortunately, the strongest pain killers like morphine or pethidine (narcotics) are associated with that side-effect, so you may prefer to tolerate some pain as a trade-off for no nausea. A regional anaesthetic continued afterwards may be a good idea, to reduce the need for narcotics, and hence nausea or vomiting.
5. My great uncle died under anaesthetic. Should I worry about that ?
  Possibly, yes – depending on the cause of death. There are some inherited /genetic disorders which run in families, the worst of which is called malignant hyperthermia. This is extremely rare, and involves disordered muscle metabolism precipitated by certain anaesthetic drugs This causes you to heat up to a dangerous level, but we do have very good drug to treat this. If we suspect the possibility, we will avoid using the triggering drugs and closely monitor your metabolic response, including your temperature. We may decide to test you for it , but it is an invasive test that involves cutting out a small piece of muscle (biopsy). There are other familial/genetic conditions that increase risk , eg. scoline apnoea, muscular dystrophy and porphyria.
6. I had a heart attack 4 months ago, should I have my hip replacement next month?
  There is a definite risk of having a further heart attack with any procedure, and possibly a further increase within the first few months. This would depend on how severe the heart attack was, and your condition now – do you have any heart failure for instance? Your surgeon should discuss this sort of thing with your anaesthetist first, and then with you of course - if they think it is reasonable to go ahead with it.
7. I have terrible veins and I hate needles, do I have to have an injection?
  Not necessarily, though it is the quickest and easiest way to get you off to sleep. Your anaesthetist may be happy to use a “gas induction”, where you go off to sleep breathing the anaesthetic gases (with oxygen!)
Newer anaesthetics are faster and less smelly, and most people find it reasonably pleasant. We usually offer this option to children and their parents. Sometime it may be safer to have an IV and not use this method, e.g. emergency procedures or critical illness, difficult airway, reflux, or obesity. Another alternative is a local anaesthetic patch or cream applied over a vein, making the skin go numb so you don’t feel the needle much.
It takes at least an hour to work though, so get there early for this!
8. How painful will it be afterwards?
  Most procedures have some pain afterwards. Pain should be minimal with purely diagnostic procedures like colonoscopy, and most severe after chest or upper abdominal major surgery. We try to pre-empt this before you wake up, with analgesic (pain killing) and anti-inflammatory drugs, and local or regional anesthetic in the operative area. Minimal or no pain may be difficult to guarantee, but most of the time you will not suffer too much. A “pain pump” or patient controlled analgesia (PCA) device works well, and you can decide how much you need to remain comfortable. The nurses will explain how to use it, is is not difficult and quite safe, and you will not become addicted to anything in just a few days! Another technique uses a continuous infusion of local anesthetic, most commonly via an epidural catheter placed in your back. The pros and cons will be discussed, if this is an option for you.
9. I am worried about catching AIDS from a blood transfusion.
  For some major procedures e.g. heart surgery, you may “need” one – although we always try to avoid it unless the benefits significantly outweigh the risks. We let your blood count get much lower than we did prior to HIV/AIDS, although blood is fully screened for this and other viruses like hepatitis. Some people totally refuse any blood products, and we will certainly accommodate their wishes, though it is possible someone can literally bleed to death in this situation. The main reasons for needing massive transfusion are major trauma, bleeding from a leaking blood vessel, and severe blood clotting disorders like haemophilia.
10. Will I say anything embarrassing when going off to sleep?
  This is very unusal, the normal defence mechanisms seem well preserved as we induce anesthesia , or under sedation. I cannot remember remarkable anything in 20 years!
11. I am worried about waking up in the middle (I read it in the Women’s weekly !)
  This can happen, and we are very aware of the possibility – known as “awareness”. It is also less likely these days because we monitor the anesthetic and your vital signs continuously. A blood pressure and heart rate increase should alert us to this. It is only possible if you are “paralysed” (temporarily) with muscle relaxant drugs, which we use to allow easy insertion of a breathing tube, or for some operations to reduce the muscle tone for the surgeon. Your anesthetist will be very careful all the time, but certainly discuss this if it is a concern, or especially if you experienced it before!
12. I had a really sore throat last time, why is that?
  Usually because you were “intubated”, or had a plastic breathing tube inserted through your larynx , into your trachea or windpipe. Alternatively you may have had another type of breathing tube called a laryngeal mask airway, which sits above the larynx. Unfortunately, there is an incidence of sore throat after these but it does not usually last more than a day. You may be in the 1 – 2 % of people who are a “difficult intubation” in which case your anaesthetist would usually tell you for future reference.
13. I am worried about not waking up at the end, or brain damage and becoming a “vegetable”.
  Both are extremely unusual, especially with the advanced monitoring we use for every case. These problems are almost all due to a lack of oxygen at some point – a gas supply mix-up for example, or an accidental disconnect from the ventilator (breathing machine). This was one of the most common causes of anesthetic mortality, but these days we would notice a low oxygen level or cessation of breathing almost immediately.
14. My friend had a major allergy to an anaesthetic and nearly died. How common is this?
  Not common, 1 in 10,000 perhaps. The most severe form is called anaphylaxis, sometimes due to an anaesthetic drug or an antibiotic. 99% of the time we can treat anaphylaxis successfully because we have all the best treatments right there – adrenaline and oxygen etc. .You MUST tell us all your allergies when we ask, no matter how trivial theymay seem. Simple allergies like pollens, dust or cats causing hay fever are not usually any problem, neither is an antibiotic causing diarrhoea, unless it was severe!
Some “allergies” are really side effects, e.g. nausea with narcotics.
15. Should I take my tablets or pills the morning of surgery?
  Generally yes, unless they are diabetic medications, especially insulin. This needs to be coordinated with your surgeon and anaesthetist, especially if you have nstable or “brittle” diabetes. Anti-coagulant drugs including warfarin, may need to be stopped several days earlier. Depending on your surgery, aspirin should be stopped a week or more earlier – for example a brain or spinal operation, but discuss this with your surgeon too.
16. My daughter is scheduled to have her tonsils out next week, but has come down with a bad cold. Should we postpone it?
  Possibly, though it may depend on how sick she is, and how often she gets a cold. Some kids have a cold almost continuously until they get their tonsils removed. For other procedures you have to weigh the pros and cons, it may be best to put it off for a week or two. If you feel unwell with it, have a fever, or a bad cough producing a lot more phlegm than usual then it may be best to postpone it. Tell your surgeon/anaesthetist early rather than waiting until you arrive the morning of surgery, only to be “cancelled” leaving a big hole in the list that someone else could have used. Other factors like “ I have taken 3 weeks off work and it is difficult to arrange”, should not have a bearing on it, but in practice they may affect our decision.
17. I hear or read a lot about medical errors in the paper, on TV, in Men’s Health magazine! Is it that common, and how can you prevent it?
  It happens for sure, but we try our best to improve our vigilance and safety , learning with each case (not just ours). Numerous checks for identity , what operation, the correct side and so on should prevent obvious mistakes like “the wrong hip” operated on, but even this can still happen. The wrong drug may be given, or an overdose but this is also rare and thankfully does not usually have serious consequences. Computerised hospital records should eventually make these errors less likely (really!)
18. Could I end up in intensive care after my operation?
  This might be planned anyway, say after heart surgery or some other major operation, or because of your poor state of health before-hand. In these situations it would be discussed pre-operatively, unless you were already unconscious e.g. following major trauma, or a stroke. Sometimes something unexpected may occur during the anaesthetic or procedure – e.g. an anaphylactic reaction, significant aspiration, major unexpected bleeding or an unplanned, but life-saving bigger operation. In this case, your doctors may think it safer to keep a closer eye on you in the ICU, perhaps even kept on the ventilator overnight, or even longer. You would normally be sedated to a comfortable level if this were the case, and the situation explained to you as soon as you were awake enough. Your family would be fully informed at all times too.
19. I have bad emphysema (a lung disease) and need oxygen all the time at home. Should I have my prostate surgery?
  Another case of the benefits vs. the risks, which would be discussed fully with you beforehand. Depending on the severity of you lung disease,(and the prostate!) it may well be quite acceptable to go ahead, especially if using a “spinal” anaesthetic where only the lower half is anaesthetized or numbed. Even general anesthesia is usually OK, although the risk is higher for upper abdominal or chest procedures (although sometimes a lung operation can help with lung diseases too, but only if one area is much worse than the others.Your chest physician will tell you if this is a possibility). Best advice here is DON’T SMOKE!! (ever - or give up now :)
20. Someone told me I should stop smoking a month before my surgery.
  Try to cut down a bit if you can, but don’t give up unless it is 6 weeks or more till your operation. The frequency of smoking related complications actually increased in people who gave up less than 4-6 weeks preoperatively, they had more breathing difficulties under anaesthesia, and postoperative chest infections than those who continued to smoke! Ideally, give up now before you need any surgery, and avoid the need to ever ask question 19 !!
There are plenty of options for giving up – programs, patches, gum, etc so give it a go, and think of all the money you will save too.
21. I always need extra local anesthetic at the dentists, am I resistant somehow?
  This is not uncommon, and a good surgeon and anesthetist will give you plenty of local in the right areas. We cannot always guarantee freedom from pain afterwards, but other alternatives are available should the local be inadequate, or when it wears off.
22. I had a terrible reaction at the dentists, felt panicky, very light headed and my heart was racing. Was it the local?
  Probably not the actual local, but something like adrenaline (epinephrine in USA) which is usually added to the local anaesthetic. This is to constrict the blood vessels, which reduces bleeding and prolongs the duration of the anesthesia. If even a small amount of adrenaline enters the bloodstream it can give you all these symptoms. It should not happen this time.
23. Are there any complications from a regional anaesthetic?
  Yes there are, but thankfully they are rare and almost always transient. Nerves may malfunction afterwards causing numbness, tingling or weakness, especially if they have been directly damaged by a needle tip. We can use special blunted needles to reduce this. This is almost always gone within days or weeks, should it occur. More serious coplications can result from prolonged pressure on a nerve for example, due to significant bleeding or haematoma formation. An overdose of local anesthetic is possible, but rare too. You can get an infection in the area, or a collapsed lung can happen with some regional blocks. Your anaesthetist should discuss major complications with you and get your informed consent for regional procedures.
24. What about local with sedation?
  This is suitable for some smaller procedures, e.g. a breast lumpectomy or a carpal tunnel release. We usually make you very sleepy and relaxed especially before the local goes in, you may become a lot more “awake” after that but it should not hurt. Just tell us if it starts to bother you at all, or if you want to be more “sleepy” or sedated. A regional technique is often supplemented with some degree of sedation too, although it is not necessary if it is working properly! A “light” general anaesthetic may be combined with a regional sometimes, especially if you want to know nothing at all about it, or if it is not working completely which sometimes happens too.
25. Can I drive home after my operation?
  You must not drive the car for 24 hours after your procedure if you had a general anaesthetic or any sedation. Also do not make any important decisions, drink alcohol, or operate machinery where you might harm yourself or others – this might include cooking and doing the dishes :)
The full 24 hours may be a bit excessive with the short acting newest anaesthetics, but ask your anaesthetist if you want to drive within the 24 hours – say to work the next morning? Depending on your surgery it may be sensible to have at least one day off work anyway, your surgeon will give you instructions about that.
26. I don’t want to know about anything, just wake me up when it’s over!
  Perfectly reasonable, as we are all professionals who have your best interests in mind at all times. We are as careful as possible, and know how to treat compications as well as prevent them. Unfortunately they will still occur, often unpredictably, but early recognition usually thwarts more serious consequences. We have done it thousands of times – just relax … easy to say, but that was exactly how I felt when I had my last procedure, and I am a difficult intubation! You don’t quiz the airplane pilot when you get on a plane, you just trust that she knows what she is doing, and the airline/travel agent doesn’t go through the “complications” list either – hijack, bomb, wind shear, crash, severe turbulence, depressurization, bad airline food, delays, misdirected luggage etc! Full explanation does not negate our liability in cases of negligence either, nor does it reduce the actual risk of a complication happening. For us to provide fully informed consent could take hours, for it would involve a deeper understanding of all the nuances of not only types of anaesthesia, but any medical condition, and the proposed surgery vs. not having the surgery, any alternative treatments and so on. Even doctors may disagree on the best course of action, in light of their experience and the latest research findings (which often conflict with previous findings beliefs, just like half the studies or trials you read about in the newpaper). It took us 12 years to just qualify as a specialist, and it may be hard to impart a huge amount of this to you in a short time, so please be patient – but always feel you can keep asking questions until you feel happy about everything – well as happy as you can be under the circumstances.