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

For your safety, you must follow the fasting advice of your surgeon and/or hospital, or any specific instructions from your anaesthetist. If these have not been provided, please follow these general instructions and ask if you have any concerns or questions:

No food, protein, dairy or solids for 6 hours prior to your surgical time. Clear fluids can be consumed in small volumes (of up to one cup an hour), until 2 hours before surgery and this is recommended to avoid dehydration. This includes black tea or black coffee (no milk), clear cordial, apple juice, or clear electrolyte “sports” drinks.

Fasting and certain weight loss or diabetes medications

If you are taking GLP-1 receptor agonists or dual GLP-1/GIP receptor co-agonists for weight loss or diabetes, you will need to begin preparing for your surgery the day before. These medications include:

• Liraglutide (Victoza or Saxenda)
• Semaglutide (Ozempic or Wegovy)
• Dulaglutide (Trulicity)
• Tirzepatide (Mounjaro)
• Retatrutide (Reta)

To help ensure that your stomach is empty when beginning your procedure, you will need to stop eating food 24 hours prior to surgery and then only drink clear fluids for the remaining 24 hours. On the day of your procedure, you will need to change to only drinking small amounts of clear fluids for the last six hours before your procedure. The hospital will contact you to let you know the time of your procedure. For more detail, please see the ANZCA GLP-1 receptor agonist clinical practice recommendations: https://www.anzca.edu.au/safety-and-advocacy/standards-of-practice/clinical-practice-recommendations-regarding-patients-taking-glp-1

Medications

Please bring all your medications to the hospital. Unless you are told otherwise, you should take your regular medications up to and including the day of surgery. When you are fasting, please take any required medicines with small sips of water. If you take insulin or tablets for diabetes, please follow your surgeon’s advice. Your surgeon may have asked you to stop taking blood-thinning medications — if you are unsure, please ask.

CPAP

If you have obstructive sleep apnoea (OSA) and use a CPAP machine at home, please bring it with you to hospital, as you may need to use it after your surgery.

Improving your health

Improving your fitness and being active before surgery can help with recovery. To improve your general condition before surgery:

• Do some gentle exercise if possible, such as walking or swimming — every bit counts
• Stop smoking as soon as possible (ideally at least 6 weeks before your surgery)
• Cut back on alcohol, and avoid drinking alcohol heavily the evening before your procedure
• Use your CPAP or other breathing devices every night

On the day

Before your procedure, I will make a thorough assessment of your health and work with you to develop a plan to make your experience as safe and comfortable as possible. Please let me know about any allergies and any past problems or reactions you or your family have had with anaesthesia. There will be time for you to ask questions on the day, but if you want to discuss anything before the day, please contact my office.

Types of anaesthesia

General anaesthesia
General anaesthesia refers to a carefully controlled state of unconsciousness. The goal is that you feel nothing and have no awareness during your operation. I will give you medicines through a small plastic tube in your hand or arm. Throughout the procedure, I continuously monitor your breathing, heart rate, and other vital signs, adjusting the anaesthetic and continuing to give you medications as needed to keep you as safe and comfortable as possible.

Deep sedation (such as gastroscopy or colonoscopy)
The goal is that you feel calm, and completely comfortable during your procedure. Most people will have very little or no recollection of the procedure afterwards. I will give you medicines through a small plastic tube in your hand or arm. I will monitor you continuously, and you will recover in a monitored area by trained staff. This sedation wears off quickly and most people feel well enough to head home on the same day.

Light sedation (such as cataract surgery)
I will give you medication to help you feel relaxed and drowsy while remaining conscious. You will be aware of your surroundings but should feel calm and comfortable. If having eye surgery I will also use local anaesthetic eye drops or perform an eye block (numb the nerves to the eye) so you shouldn’t feel pain. This sedation wears off quickly, and most people go home shortly after their procedure.

Spinal or regional anaesthesia
I will numb a specific part of your body so you have little or no sensation during the procedure. Alongside this, you can either remain awake, have light sedation/deep sedation to help you relax, or be given a general anaesthetic — for example, joint replacements are often done with a spinal combined with a general anaesthetic, so you are numb and unconscious at the same time. You will often be numb for a period of time after the procedure finishes, which is helpful in making you more comfortable.

Caesarean section
This is usually performed under a spinal anaesthetic, which numbs you from the chest down while you remain awake. This allows you to be present for your baby’s birth and to have your support person with you. Rarely, a spinal is not suitable, in which case a general anaesthetic may be used instead.

Anaesthesia for children
To ensure your child’s experience is as calm as possible, please be mindful of your words and body language. When talking to your child about what will happen, try to avoid negative words like “pain” and phrases like “it won’t hurt a bit.” Instead talk about how they will be as “safe and comfortable as possible.” On the day, your child will generally respond better when they can see that you are outwardly calm (even if you’re feeling nervous too). If they are particularly anxious, please let staff know, and a sedative medication can be provided before starting the anaesthetic. One person may accompany the child into the operating room to assist with going to sleep. As soon as your child is asleep, we will show you to a waiting area.

There are two ways to begin anaesthesia in children:

1. Anaesthetic gases are inhaled through a mask, then once asleep, an intravenous line (IV) is placed.
2. An IV is placed while the child is awake and medications given through the IV to begin the anaesthetic. Before placing the IV, the anaesthetist will talk to children about “putting a tiny plastic straw” in their hand or arm. Often a white numbing cream, EMLA, is placed on potential IV sites prior to placement.

As children grow, it is more often appropriate to place an IV before they go to sleep. The pre-operative staff will apply topical numbing cream in preparation for a possible IV insertion.

More about anaesthesia

Preoperative Anxiety

It’s common to feel anxious before surgery. Please let me know if this applies to you — there are things we can do to help, including talking through what to expect and, if appropriate, a mild sedative before your procedure.

Monitoring

Throughout your operation, you will be monitored continuously. Routinely, your heart rate and rhythm, blood pressure, respiratory rate, and oxygen levels will be observed. Sometimes, you may require a direct blood pressure monitor, which involves placing a tiny plastic tube into a blood vessel. After the operation, if you require ongoing close monitoring for any reason, you may be placed in the High Dependency Unit.

Comfort

As your procedure is finishing, I will give you medicine to ensure that your recovery is as comfortable as possible. The recovery room team will give you additional medication as needed. Most patients are managed with a combination of paracetamol, anti-inflammatory medication (if suitable), and stronger oral pain killers for breakthrough pain. In some cases, particularly after more significant surgery, I will take additional steps to help with making your recovery as comfortable as possible. I will discuss this with you if it’s likely to apply to your procedure. You will also be given a supply of regular oral painkillers to take home if needed.

Nausea

I routinely give preventative anti-nausea medication during your anaesthetic, and further treatment is available during your recovery if needed. If you have a history of motion sickness, nausea after a previous anaesthetic, or other risk factors, please let me know beforehand – this helps me tailor your anaesthetic to reduce this risk.

Infection

For some types of operations I may need to give you a dose of antibiotics during surgery to help prevent infection. Often patients recall that they have had a previous reaction to a particular type of antibiotic. Please remember to seek out that type of information from your other health providers, so that we can be aware of the specifics of those past reactions and most safely care for you.

If you have a current infection anywhere in your body (including dental infections), or any cuts or abrasions, please let staff know beforehand so we can decide whether it is safe to proceed with surgery as planned.

Risks of Anaesthesia

It is generally very safe to have an anaesthetic, but as with all medical procedures, there is an element of risk. While I am always working to make your anaesthetic as safe as possible, I believe it is important to inform you of the possible risks.

Minor complications may include headache, nausea and vomiting, bruising or inflammation where a needle or drip was placed, temporary nerve damage (such as numbness or tingling that resolves over time), and a sore or irritated throat from breathing tubes or anaesthetic gases.

Major complications (very rare) may include damage to teeth, awareness during surgery, aspiration or other respiratory issues, allergy and anaphylaxis, heart attack, stroke, brain damage, and death.

Overall, these risks are extremely low. Some factors can place you in a higher-risk category: heart or lung disease, blood pressure problems, a previous stroke, diabetes, smoking, and older age. Major surgery and significant blood loss can also increase risk. Knowing your medical history helps me plan the safest anaesthetic for you, which is why it is important to tell me about your health beforehand.

For more detailed information about anaesthesia and its risks, you can visit the ANZCA and ASA patient information pages:

https://www.anzca.edu.au/patient-information/about-anaesthesia
https://asa.org.au/patients

Post-Operative Medications at Discharge

If needed, I will give you painkillers to take home. You may also be given anti-inflammatory medication for 5–10 days to help reduce swelling after your operation. In some cases, you may be prescribed blood-thinning medication to continue after surgery to help reduce the risk of blood clots, and occasionally a course of antibiotics may be required.

Going Home

If you have had a general anaesthetic or sedation, you must not drive, use public transport, operate machinery, sign legal documents, or drink alcohol for 24 hours afterwards. If you are having a day procedure, you will need a responsible adult to take you home and stay with you overnight. Your judgement, reflexes, and memory can be affected for longer than you realise, even if you feel like you are back to normal, especially if are taking strong pain killers.

It’s important that you understand this information. If anything is unclear, or you have questions about any part of your anaesthetic, please ask – I am happy to discuss it with you before your procedure.