What to expect from Anaesthesia

Your anaesthetic is designed to keep you comfortable, safe and free of pain during your operation or procedure. It is designed to make the operation as easy as possible for both you and your surgeon. The choice of anaesthetic technique depends on the nature of your surgery, your general health status and your own personal preference. During general anaesthesia you are completely insensible. Sedation is used for less painful and shorter procedures to relieve discomfort. Regional anaesthesia implies that a part of the body, such as the arm, lower body or part of the skin is insensate. Your anaesthesiologist will offer you the best technique suited to your wishes and circumstances, as long as it places you at the lowest risk possible.

Most anaesthetic techniques require the pre-procedural placement of an intra-venous cannula, usually in the arm or hand, through which fluid and/or drugs can be administered. There is also the need for administration of oxygen by a face mask before general anaesthesia or sedation. Positioning of the body to gain access to certain nerves may be needed for regional techniques.

THE ANAESTHESIOLOGIST

An anaesthesiologist is a medical doctor who has trained for at least 13 years, 5 of which are spent specialising in anaesthesiology.

He/she has specialised skills in:

  • The assessment and preparation of patients prior to anaesthesia.
  • The planning of the optimal anaesthetic technique for each patient and type of surgery.
  • The application of various anaesthetic techniques
  • Pain management
  • The management of critically ill patients.
  • Resuscitation and advanced life support.
THE ROLE OF THE ANAESTHERSIOLOGIST

The anaesthesiologist

 

  • Conducts a pre-operative assessment to ensure that you are fit to undergo surgery
  • Prescribes pre-operative medication to reduce your anxiety, stress or pain if appropriate
  • Administers anaesthesia to facilitate your procedure or surgery and to ensure your comfort and safety.
  • Monitors your vital signs (e.g. heart rate, blood pressure, temperature, respiration etc) throughout the surgery
  • Monitors and adjusts the depth of anaesthesia to ensure that your anaesthetic is both safe and effective
  • Manages any complications that arise during surgery e.g. drop in your blood pressure, breathing and heart problems. When your health status or the type of surgery requires special care, the anaesthesiologist sees to safe transfer to an intensive/high care unit.
  • Prescribes what treatment should be given to ensure your post-operative well being e.g. pain relief, anti-emetics etc.
INFORMATION TO BE DISCUSSED WITH YOUR ANAESTHESIOLOGIST
  • Your medical history i.e. current and previous medical conditions e.g. allergies, asthma and previous operations
  • Any problems that your relatives might have experienced with anaesthesia
  • Your current medications and those taken within the last 3 months including homeopathic and natural products
  • The use of any recreational drugs or alcohol. It is very important for the safe administration of your anaesthesia
  • The various anaesthesia techniques and post operative care options that are available to you
  • Any problems that you have experienced related to previous anaesthetics
  • Any other matters of concern. Your anaesthesiologist has experience of what you can expect both physically and mentally prior to, or following surgery
THE FASTING PERIOD
  • Do not eat for at least 6 hours before your anaesthetic. This applies to general anaesthesia, sedation or regional anaesthesia. Under certain circumstances you may drink small volumes of water up to 2 hours before your anaesthetic; however this should be discussed with your anaesthesiologist well in advance. If you have eaten less than 6 hours before surgery, please advise your anaesthesiologist and understand that your operation may be postponed for your safety. Should you require information regarding the fasting period, please contact your anaesthesiologist, especially in the case of a child or an infant.
COMPLICATIONS OF ANAESTHESIA
  • There is always a risk of complications occurring during anaesthesia and while anaesthesiologists take all the necessary precautions to avoid them, adverse events can unfortunately occur. However, anaesthesiologists are properly trained and prepared to manage them. Management of such adverse events can incur further medical expenses. The list that follows is intended to inform you properly and need to be discussed with your anaesthesiologist prior to the procedure, so that you are able to give informed consent to the procedure and anaesthesia.

 

  • Those occurring commonly (1/10-1/100 cases)
    These are usually not serious and clear up without treatment:
    Nausea and vomiting
    Sore throat
    Shivering
    Headache
    Dizziness
    Visual disturbances
    Itching
    Pain on injection of drugs
    Swelling or discomfort at the side of placement of the intravenous infusion (drip)
    Confusion or loss of memory, especially in elderly patients

    Those occurring rarely (1/1000 cases)
    These are usually not serious but sometimes require treatment:
    Injuries to teeth, crowns, lips, tongue and mouth
    Painful muscles
    Difficulty in urinating, especially male patients
    Depressed respiration
    Exacerbation of pre-existing medical conditions like diabetes or heart disease

    Those occurring very rarely (1/10 000-1/200 000 cases)
    Serious:
    Eye injuries
    Allergic reactions to drugs administered during anaesthesia
    Nerve injuries
    Lung infections, especially in smokers
    Intra-operative awareness
    Malignant hyperthermia (inherited anaesthesia related increased heat production by muscles)

    Death (1/300 000)
    This is usually caused when the heart or brain does not receive oxygen for some reason, such as problems with breathing, heart failure and allergies.

    Complications during anaesthesia with related procedures
    Certain procedures are an essential part of the anaesthetic technique, such as the placement of intra-vascular lines and airway management.

    Peripheral intravenous lines (the drip)
    Painful insertion of the cannula
    Swelling in the area of placement
    Bleeding from the puncture site
    Difficult insertion requiring repeated attempts 
    An intravenous line can become infected, especially when it has to remain in position for a few days

    Airway management

    To maintain a safe airway while a patient is unconscious, a tracheal tube or other airway device may be placed. These methods can cause injury to the lips, teeth, tongue, throat, vocal cords or trachea. It is important to relate previous complications with airway management to your anaesthesiologist, and to stick to guidelines regarding the fasting period, because of the possibility of soiling of the airway by stomach contents on induction of anaesthesia with a full stomach.

    It must be appreciated that these lists of possible complications are incomplete and are not intended to frighten you. It is important that you complete the accompanying questionnaire accurately, not withholding any information.

FEE STRUCTURE OF THE ANAESTHESIOLOGIST
  • The fees charged by anaesthesiologists fall within the Health Professions Council of South Africa
    Included in the anaesthesiologist’s fees are:

    • The pre-operative consultation
    • Anaesthesia care from the beginning of your anaesthetic until you are woken up in recovery and able to be left in the care of a nurse
    • Specific procedures to enhance safety and provide post-operative pain relief and the best quality of recovery

    Factors which can influence the fee that is charged:

    • The duration of your operation
    • If your operation takes place after working hours, is an emergency or is an addition to the surgeons list
    • If advanced techniques are used to manage your pain and post-operative discomfort
    • If your anaesthesiologist continues your care in an Intensive Care ward

    Payment by the medical aid
    Depending on your choice of medical aid or Insurance Plan, your healthcare funder may cover 30% to 100% of your anaesthesiologist’s fees. This is similar to any short term insurance situation where the level of the excess is determined by the plan and premium paid.
    You as the patient are ultimately responsible for this account and are therefore advised to consult with your medical aid and the anaesthesiologist prior to your anaesthetic.

CONSENT AND THE PRE-OPERATIVE PERIOD
  • You can request or refuse a sedative from your anaesthesiologist. Please take all home medication to the hospital and verify its use pre-operatively with your anaesthesiologist. Informed consent to the procedure and anaesthesia signed after administration of a premedication will be illegal. Please sign before taking a sedative.

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