Your anaesthetist determines the most appropriate anaesthetic for you and your procedure following the pre-operative consult. Your anaesthetic will be individually tailored according to your age, health, medications you take, any particular concerns you have, and the procedure you are having.
Different kinds of anaesthesia may be used for your anaesthetic and are broadly categorised into:
injected under the skin around (or local to) the area to be operated on. Used in minor procedures such as a skin tear where no sign of infection is present.
Regional anaesthesia (including nerve blocks, epidural, spinal)
Injection of local anaesthetic made with the assistance of ultrasound to pinpoint major nerve bundles in a specific location dependant on where the surgery or pain relief is required. Often causes tingling or numbness and temporary paralysis to the area during the anaesthesia and while it wears off.
There are two types of sedation. Conscious sedation reduces the patient’s level of consciousness so they are unaware and in no pain but can respond to touch or voice prompts. Procedural sedation is often used as a replacement to general anaesthesia for more minor procedures which may be painful or unpleasant to be awake for, and affects the patient by ensuring they have no memory of the procedure.
Is a state of controlled unconsciousness. A patient undergoing a general anaesthetic will not respond to any stimuli or feel any pain. It is generally administered by injection or as a gas inhaled through a mask and is most commonly used in longer procedures. Overall, general anaesthesia is very safe. Even particularly ill patients can be safely anaesthetised – it is the surgical procedure itself which offers the most risk.
Regardless of the type of anaesthetic you receive, your anaesthetist will remain by your side for the duration of your anaesthetic and procedure. Throughout this time, your anaesthetist monitors and records your vital signs and adjusts fluid and drug administration to ensure you remain as stable and comfortable as possible.
Once your procedure is completed, you will be transferred to the recovery area (or Post-Anaesthesia Care Unit) to wake up as your anaesthetic wears off. In the recovery area, a recovery nurse will take over your care – monitoring your vital signs, checking any surgical wounds and treating any post-operative pain or possible complications including nausea and vomiting.
Your anaesthetist may prescribe pain relief, drugs to treat nausea and vomiting, and intravenous fluids for your recovery nurse to manage these common post-operative issues.
Your anaesthetist remains responsible for your medical care even after your procedure. If there are any significant post-operative issues that require medical care, your anaesthetist will attend to you as soon as practical and develop an appropriate management plan.
Post-operative nausea and vomiting (PONV)
PONV is one of the common risks of general anaesthesia. The risk of PONV is approximately 1 in 3 patients but will vary depending on patient characteristics and the type of surgery undergone.
As part of your pre-operative consult, it is important to let your anaesthetist know if you have experienced PONV with a previous procedure so they can tailor your anaesthetic to minimise this risk. This may involve administering drugs that combat nausea and vomiting (anti-emetics) during your procedure.
If you do experience nausea and vomiting following your procedure, the recovery nurse will administer an anti-emetic. If you continue to vomit or feel nauseous, your anaesthetist will review you and prescribe further treatment.
Your anaesthetist endeavours to ensure you are as pain-free as possible by the end of your procedure. You will usually be administered pain relief during your procedure and your surgeon may also inject local anaesthetic to the nerves around the surgical wound. If you do experience pain once you are awake in recovery, the recovery nurse can administer pain relief to you.
If your pain is expected to be severe due to the nature of the surgery or your medical history your anaesthetist will discuss strategies to help manage your pain after your procedure.