FAQs | Atlantic Anaesthetics

What should I do as soon as my surgical procedure is confirmed?

Surgery under general or regional anaesthesia is a significant event in any person’s life.
In order for us to provide our patients with the best possible clinical care and administrative service, we recommend that you contact Atlantic Anaesthetics as soon as you know you are coming for surgery.
The anaesthetic or surgeons office will direct you to the specific anaesthetist – who will provide detailed quotations, estimates and information regarding the anaesthesia service for your surgical procedure.

Eating and drinking before anaesthesia?

Please Note

No food or liquids (excluding clear fluids) may be taken by mouth for at least six (6) hours before anaesthesia or sedation.
Water and apple juice may be taken up to two (2) hours before anaesthesia.

In a normal state, your body has defenses to prevent stomach content from coming up. Unfortunately when you are unconscious this mechanism does not work, so it’s best that your stomach is empty when you have general anaesthesia. In emergency surgery when you may have eaten recently, your anesthesiologist will take special precautions to reduce the risk of aspiration.
Even if you are booked to have regional anaesthesia or sedation it is important to follow the instructions about not eating and drinking, just in case it becomes necessary for you to have general anaesthesia.

Medical history

You will be required to complete a medical questionnaire before your procedure. Please bring information on any medical conditions you may have when you are admitted for your procedure.

Medication

Bring your current medication to the hospital if there is any chance that you will be staying overnight or need to take this medication while in the hospital.
Bring a list of any medication that you are currently on or have taken in the past 3 months (including homeopathic and natural products).
Take your routine medication as normal.
(If you are taking Warfarin, Aspirin, Plavix or any other blood thinners please ask your doctor when you should stop these before the operation).

I have a loose tooth. Is that a problem?

Your anesthesiologist will want to know about any loose teeth, capped teeth, dentures, bridges or crowns.
When you’re intubated, the teeth are in close proximity and there is always a possibility of a tooth being chipped or damaged, particularly if a tooth is capped or loose. By giving details of loose or capped teeth, the anesthesiologist can make extra sure to prevent damage to teeth. Sometimes, if a tooth is really loose, it is wise just to take it out before your surgery.

May I have medication to help me relax before a procedure or surgery?

In some patients, a “pre-med” is prescribed. This is normally a drug that calms the patient and reduces anxiety. For young healthy patients undergoing short procedures on a day-patient basis, this is often omitted as patients are usually eager to be discharged as soon as possible. If, however, you are at all anxious about your surgery, please ask your anaesthetist to prescribe a pre-med. This medication however are only prescribed if the anaesthesiologist deems it safe to do so. Some patients may have a contra-indication to premed for example those with sleep apnoea syndrome. It is important to remember that these drugs take about 90 minutes to take effect and can only be prescribed if the anaesthetist has seen you in the ward.

Do I really need an intravenous line? When can the IV come out?

Almost always, one intravenous (called an ‘IV’ for short) line will be placed before you go off to ‘sleep’.
This is called ‘lifeline’ and is used to give the anesthetic agents such as propofol, and as a route for fluids. In case of an emergency, drugs can be given to treat complications such as very low blood pressure.
Usually the IV will come out if you can take enough to drink by mouth and there is no need for medications such as intravenous antibiotics or painkillers.

What is spinal and epidural anaesthesia?

Spinal anaesthesia is a neuraxial block (always done in theatre) and is often used for urinary tract, genital and lower body procedures including the regular use for Caesarean sections.
Spinal anaesthesia is a commonly used technique either on its own or in combination with sedation or general anaesthetics.
With a spinal anaesthetic a very thin needle is inserted between the bones of the lumbar spine, through the dura and into the spinal canal which is full of fluid.
A small amount of local anaesthetic is injected into the spinal fluid.
A spinal block is a once off bolus injection, onset is quick and if the spinal block is successful it is complete with absolute temporary loss of sensation and movement below that level of the body.
The onset of spinal anaesthesia is much quicker than with epidural anaesthesia.

Epidurals, however are more flexable for providing analgesia for pain control and at the same time allowing patients to be able to move quite freely. An epidural can be given for specific reasons: e.g. pain relief during and after abdominal or thoracic surgery and for management of labour pain.
A special needle with a catheter is inserted between vertebrae of the back until the tip reaches the epidural space, the catheter is then threaded and left in the epidural space. Local drugs are continuously infused into the epidural space where it slowly blocks the spinal nerves traversing it.
Both spinal and epidural neuraxial blocks are performed in the awake state with the patient usually in the sitting position.

Can I be allergic to anaesthesia?

Sometimes patients may think, or be told, that they are ‘allergic to anaesthesia’ because they have an unpleasant experience that they associate with anaesthesia, for example nausea and vomiting. These are side effects of drug administration, not allergic reactions.
A true allergic reaction to a drug usually produces hives or weals on the skin, wheezing in the lungs, swelling of the mouth, throat or eyes, and sometimes a drop in blood pressure.

What are the side effects and risks associated with anaesthesia?

Side effects or events may occur due to:
Reactions to anaesthetic drugs, underlying medical diseases, complications with procedures that have to be performed or due to surgery.
Anaesthetists have been trained to manage these complications.
The following list covers some of the complications that may occur under anaesthesia, post operatively or due to side effects or interactions of post-operative medication:

Common side effects:

Nausea and vomiting
Sore throat
Shivering or feeling cold
Headache
Dizziness
Itching
Pain during injection of drugs
Swelling or bruising at the infusion site
Confusion or memory loss (common if elderly)

Nausea and vomiting
Post-operative nausea and vomiting (PONV for short) is one of the most common side-effects that occurs in the first 24 hours after your surgery. It affects 20-30% of patients. However, nearly half of all patients who do not have PONV in the hospital, experience nausea and/or vomiting in the first few days after discharge.
Can it be prevented?
It is important to inform your anesthetist that you had this problem in the past. Your anaesthetist can choose a different way of giving your anaesthesia.
When possible, a regional anesthetic (where the ‘gases’ and ‘morphine-like’ painkillers are not needed) significantly reduces your risk of having PONV in the first few hours after your surgery.
Drugs used to prevent or treat PONV are known as antiemetics and can be used to possibly prevent PONV after anaesthesia

Sore throat
This is due to the breathing tube in your throat during anaesthesia. At least 95% of all patients have some or other tube in the throat during anaesthesia. This causes friction during breathing, hence the sore throat. Please note – nothing went wrong with the anaesthesia.

Rare complications

Injuries to teeth, crowns, lips, tongue and mouth
Painful muscles
Difficulty in urinating
Difficulty breathing
Visual disturbances
Worsening of underlying medical conditions like diabetes, asthma or heart disease
Hoarse voice, vocal cord injuries.
Pressure related injuries

Very rare complications

Eye injuries
Nerve injuries causing paralysis
Lung infection
Awareness of the operation
Bleeding
Stroke
Allergic reactions/ anaphylaxis
Unexpected reactions to anaesthetic drugs
Inherited reactions to drugs (Malignant hyperthermia, Scoline apnoea, porphyria)

Does the anesthesiologist stay with me the whole time?

Your anesthesiologist remains in the operating room to monitor you during the entire time of surgery and anaesthesia. He or she also makes decisions about intravenous (IV) fluids, the need for blood products, antibiotics, pain medications, and where you will recover after the surgery.

Post operative instructions after day surgery.

You will be given a prescription for post operative medication which might include antibiotics. The antibiotic course needs to be completed and not stopped before the end of the course.
The script may be collected at either the hospital or any other pharmacy.
It is against the law to drive a motor vehicle or operate heavy machinery for 24 hours after the anaesthetic.
It is recommended that no alcohol be taken, and no important decisions made within 24 hours after the anaesthetic.