What can you expect prior to surgery?

To minimise the risk to you and plan the most suitable anaesthetic, I need to know how fit you are. I am interested to know, for instance, if you get short of breath doing normal activities such as showering, walking on the flat or going upstairs. I also need to know if you have any history of medical problems. Examples include:

• Breathing problems like asthma or bronchitis
• Heart problems like hypertension, angina, palpitations, blackouts
• Nerve problems like strokes, mini-strokes
• Neck problems or back problems such as sciatica
• Gland problems like diabetes or thyroid disease
• Severe reflux, indigestion or ulcer problems
• Recent illnesses such as a bad cold.

Other important information includes:

• Past problems with anaesthesia or surgery
• Dentures, caps, crowns, bridges, plates or loose teeth
• Heavy smoking, alcohol, recreational drug use
• Any prescribed medication
• Any allergies
• Bad reactions to pain killers.

There are some things you can do which will make your anaesthetic safer:

• Get a little fitter– even a regular walk can do wonders
• Don’t smoke– ideally stop 6 weeks before surgery
• Drink less alcohol
• Observe fasting guidelines

If you are being admitted on the day of surgery, I would like to meet you before the commencement of the list so that I can review your medical history and discuss any questions with you. For morning surgery which starts at 0745, this means that you need to arrive well before 7am to get through the hospital paperwork. For afternoon surgery which starts at 1310, this means that you need to arrive before midday. (In contrast, patients undergoing short procedures where they will go home on the same day as their operation (day surgery) should arrive at the time advised by your surgeon’s secretary.)

Fasting

It is crucial for your safety that you follow the fasting advice of your surgeon and/or hospital. If you haven’t already received advice about fasting, please follow these instructions:

• If your operation is in the morning. You must not have anything to eat after 12 midnight. You may drink water up to 2 hours prior to the time you have been asked to attend the hospital.
• If your operation is in the afternoon. Please have a light breakfast prior to 7.00am. Do not eat or drink anything after this time except for water which you may continue to drink up to 2 hours prior to the time you have been asked to attend the hospital.

ANZCA fasting guidelines are available at the Australian and New Zealand College of Anaesthetists (ANZCA) website, which you can access via this link.

• If the link to the above document on the ANZCA website is no long current, please notify our rooms at ifc@vag.com.au.
• You can also manually search for the ANZCA fasting guidelines by visiting ‘www.anzca.edu.au’ and searching for ‘fasting guidelines’; the document itself should be entitled ‘Appendix 1 – Fasting guideline’, or something similar.

Medication Information

On the day of surgery continue to take all prescribed drugs with a sip of water. One exception is tablets for diabetes which should not be taken. Patients who take insulin should contact their specialist or me at my office for specific advice. If you are taking aspirin or other blood thinners, you should contact your surgeon as these may need to be stopped up to 10 days before the date of surgery.

Anaesthetic techniques

Depending on the type of procedure, you may have a general anaesthetic, a regional anaesthetic or intravenous sedation associated with local anaesthesia. I will discuss the various anaesthetic and post-operative pain control options available to you at the pre-operative assessment. General anaesthesia involves placing you in a state of controlled unconsciousness for the period of the operation. This is achieved by administering drugs by a small needle into a vein or by inhalation of anaesthetic gases. All bodily functions are carefully and continuously monitored. As well as adjusting the anaesthetic as required, I will also administer pain killers, fluids, drugs to change the contraction of the heart and medications to prevent nausea. Regional anaesthesia refers to numbing an area by injecting local anaesthetic near major nerves. Examples of this include spinal, epidural and shoulder/arm blocks. Usually you will receive light general anaesthesia as well, so that you are totally unaware of what is going on. The blocks are also often very helpful in controlling post-operative pain. Spinal and epidural injections have great advantages for patients undergoing lower limb joint replacement and prostate and bladder procedures. Intravenous sedation for shorter procedures in association with local anaesthesia may not make you completely unconscious but you will not have any discomfort.

Post operative care

To ensure that your recovery is as smooth and trouble-free as possible, I will continue to monitor your condition in the recovery area. More pain medication will be administered if you are not comfortable, and continued in the ward. Occasionally medication to treat nausea and adjust blood pressure or heart rate may be required.

Risks and complications

Relatively common side effects are feeling drowsy, dizziness, sore throat, blurred vision and mild nausea. These are temporary and usually pass quickly. Please contact me if you have worrying after effects. If you are having day surgery, make sure there is someone to accompany you home. It is not wise to drive, make important decisions, use any dangerous equipment, sign legal documents or drink alcohol on the day of surgery. A prescription for strong pain killers will be given to you if you undergo a painful procedure. As stated previously, the risks of anaesthesia in Australia are very low. Some patients are, however, at increased risk of complications due to their health status and type of surgery they are undergoing. Infrequent complications include: bruising at the injection site, temporary breathing difficulties such as asthma, muscle pains, headaches, lip and tongue injury, temporary voice changes and temporary nerve injury. Even with the greatest of care, damage to teeth, dentures, caps, crowns, bridges and plates is possible during placement of the airway tube at the beginning of the operation or by involuntary forceful biting by the patient on the airway tube at the end of the operation. Waking up in the middle of an operation (more likely during emergency surgery or Caesarean section) is very unusual. There can also be some very rare and serious complications including: seizures, heart attack, stroke, severe allergic reactions, liver or kidney failure, lung damage such as pneumonia, paraplegia or quadriplegia, damage to voice box, infection from blood transfusion and permanent nerve injury. The possibility of death is remote but does exist. For healthy patients the risk of death is approximately 1/200,000. Nerve damage including paralysis has been reported after epidural and spinal injections but is extremely rare.