General Anaesthesia 1. What is General Anaesthesia? It is one of 3 main categories of Anaesthetics, the others being Local Anaesthesia and Regional Anaesthesia. In general anaesthesia , you are unconscious and have no awareness or other sensations. It can be carried out using either gases and vapours through a mask, endotracheal tube or other airway device or introduced through a vein. Most commonly a combination of both gases and intravenous drugs are used. During anaesthesia, you are carefully monitored, controlled and treated by your anesthesiologist, who uses sophisticated equipment to track all your major bodily functions. The duration and level of anesthesia is calculated and constantly adjusted with great precision by your Anaesthesiologist, who is present throughout the operation and is continuously monitoring and adjusting your vital functions as needed to ensure a smooth and uneventful surgery. At the end of the operation, your Anaesthesiologist will reverse the process and you will regain awareness and consciousness in the recovery room. 2. What are the risks of General Anaesthesia? The risks are different for every individual patient depending on multiple factors such as the type of surgery and their pre-existing medical conditions. For normal healthy adults having routine elective surgery these risks are very low. Your Anaesthesiologist will normally discuss with you any special risks which are relevant to your condition or the operation you will be having. Normally they will inform you of the most common risks in your particular situation and also the most dangerous ones although these may be rare. It is impossible for them to explain or foresee every possible risk for each patient. You are welcome to bring up any other specific concerns or worries you might have about your procedure and Anaesthetic at the time that your Anaesthesiologist sees you before your operation. 3. What are some of the potential complications of General Anaesthesia? Some of the more common potential complications after General Anaesthesia include: An allergic reaction to some of the drugs given to you during the Anaesthetic. Major reactions occur in less than 1:10,000 general anaesthetics. You may experience Nausea and Vomiting when you awake from the Anaesthetic. There may be pressure on your limbs and other body parts as you are lying completely still for the duration of the operation and this can result in numbness or decrease in blood flow to some areas of the body. The result of this can range from skin redness and ulcers to nerve damage or even blindness. Your Anaesthesiologist will do his best to prevent these from happening to you. If your operation requires you to be intubated, you may experience gum or dental injuries or even sore throat in the early post-operative period. This is why it is important to tell you Anaesthesiologist if you have any loose teeth or dentures. If you have poor dental hygiene to start with, the risks for this will increase and it can be worsened if your intubation is difficult. Bleeding during surgery can be severe depending on the type of operation and in some cases you may need a transfusion during the operation. Transfusions by themselves carry risks of infections and allergic reactions. They are normally carried out only if you really need the blood to replace that which is lost during the surgery. If you have not been fasted adequately before surgery, you also increase your risk of aspiration pneumonia, which can be fatal if severe. Awareness during the surgery occurs in less than 0.3% of cases. Elderly gentlemen may also experience urinary retention after certain procedures. 4. Should I continue with my usual medications or health supplements before surgery? You may be taking long term medication for chronic medical conditions such as heart disease, diabetes or hypertension. You should alert the nursing staff and your Anaesthesiologist to the type and dose of medication you are taking. This is because not all medications should be taken immediately before surgery. In any case, you should bring enough of your normal medication with you when you check into the hospital for the expected duration of your stay. Your medication should ideally be in its original packaging which would show the name and the dose of the drug you are taking. There is increasing research that shows that some herbal or health supplements taken can affect blood clotting and pressure as well as the duration of anaesthetic drugs. 5. What about Food and drink before my procedure? As a general rule, you should not eat or drink anything for a minimum of 6 hours before your surgery . You may be given permission by your anesthesiologist to drink clear fluids up to 2 hours before your surgery. 6. Should I stop Smoking before my Procedure? If you are a long term smoker you will have damaged lungs even if you do not have any symptoms. The damage to your lungs will be made more obvious in the immediate post-operative period, depending on the type of surgery you have and also following the general anaesthetic. Ideally you should use your surgery as an opportunity to quit smoking completely. But if for some reason you do not choose this option, it is best if you can cut down or stop smoking for the 2 weeks prior to your surgery. This will give your lungs a chance to reverse some of the non-permanent damage that it might have. Some of the potential anaesthetic related effects smokers may experience include large amounts of phlegm and potentially pneumonia. This is due to the decreased ability of smokers lungs to clear secretions after anaesthesia and may be worsened by factors such as wound pain etc. 7. Does General Anaesthesia make me forgetful or less intelligent afterwards? Under normal circumstances, if your anaesthetic was smooth and uneventful, you should have the same mental ability as you did before the surgery. The most likely causes of some cases of forgetfulness or decrease in mental ability may occur if you suffered abnormally low blood pressure or severe blood loss during the operation or if you had episodes of inadequate oxygenation. These situations are uncommon. 8. I have sore throat and muscle pain after my general Anaesthetic. Why is this? Recent studies are showing that endotracheal intubation - that is, the insertion of a plastic breathing tube into the windpipe - can cause minor damage to the vocal cords in a surprisingly high number of patients. This can occur even when the intubation is performed by an expert and appears to go absolutely smoothly. Luckily in most cases patients will get better after several days with symptomatic treatment. However if your symptoms do not improve after about a week, it may be necessary to be seen by a throat specialist to rule out other causes. The problem of postoperative myalgia or muscle pain has been recognized for many years. It is most common in young female patients. Most cases are thought to be caused by the use of a certain muscle relaxant called succinylcholine. However there are cases where it is known to occur even when this drug is avoided. There may be cases when the use of this drug cannot be avoided, but these cases tend to be for emergency procedures. Telling your Anaesthesiologist if you have a prior experience of muscle pain can help him to choose an alternative drug if it is possible for you. However avoiding this drug does not guarantee that you will not have muscle pain after surgery as other factors such as positioning may also cause this problem. It is comforting to know however that this condition is harmless and can be treated with symptomatic relief and will go away by itself usually in 2-3 days after surgery. 9. Is it normal for the site where my IV was to be swollen and red after surgery? The usual cause of this is phlebitis or inflammation of the vein. Most anaesthetic drugs are very strong and can cause irritation in the walls of the vein through which it is injected. Some people are more prone to this than others. If your condition continues for more than 3 days after surgery, you should see your doctor or surgeon about it as there may be a secondary infection. If you have any other questions or concerns about your upcoming surgery regarding the anaesthetic, you should ask your Anaesthesiologist when he sees you before your surgery. The above information is very general and does not apply to all situations and procedures.