Patients' concerns about anaesthesia:

A general anaesthetic in the UK is very safe. All anaesthetics are administered by specialist doctors, and in the private sector by medical consultants. The risk increases if you have other illnesses, which is why this website asks you about your health so I can minimise any problems. It also increases in the very old, but we commonly anaesthetise patients in their eighties and nineties! In fact if you are having an elective or planned anaesthetic, the risk is on a par with the risk of having a fatal accident involving a car or lorry. Of course, most of us drive or walk along streets every day, but we dont have an anaesthetic every day, and we are all more worried about the unusual - myself included.

I am very happy to show patients data on specific risks, and I will always explain what I am going to do when I consult with you on admission. Nevertheless, in my experience long lists of rare complications cause more anxiety than benefit, so in this section I want to concentrate on the three commonest questions or concerns.

Nausea and vomiting

Sickness after an operation or anaesthetic can be caused by many different factors and not just the 'anaesthetic' itself. It will vary from operation to operation, with day case gynaecologial operations having a higher incidence than podiatry for example.

Modern anaesthetic drugs cause much less nausea than older drugs we no longer use. New techniques have also reduced this complication and the introduction of serotonin 5HT antagonists, the commonest of which is the drug ondansetron, gives us a specific drug to counter the problem.

The majority of patients have no nausea or vomiting after an operation. I routinely give ondansetron to reduce the risk still further. If you do have some nausea, please tell your nurse as I will have prescribed further drugs, and if necessary I will come and review you.

A small number of patients suffer from postoperative nausea and vomiting (PONV) which is a syndrome where the sufferer always has nausea. It can be severe and last several days. To make the diagnosis the patient has to have had several operations and no other specific reason for the nausea. Unfortunately I rarely have the complete notes from previous operations to know with certainty. The good news is that ondansetron specifically helps a proportion of sufferers, and if it works for a particular patient it will work again in future. It is important for me to know if you think you may be a sufferer.

Awareness

A couple of films have caused a lot of concern amongst patients that they may be aware during an operation. Awareness, where a patient is awake but unable to move, does occasionally occur. A lot of cases arose twenty years ago during caesarian sections because anaesthetists gave very low levels of anaesthetic drugs to avoid damage to the baby. We now know this is not the case, and obstetric anaesthesia now employs more 'normal' doses of anaesthetics.

To be aware, the patient has to be paralysed and given an inadequate amount of anaesthetic drugs. In my practice, I use less and less muscle relaxants which are the drugs used to paralyse patients in order to connect them to a ventilator as I use a newer drug called remifentanyl which allows the use of a ventilator without paralysis. Even if you did have an inadequate 'depth' of anaesthesia, you would be able to move and open your eyes although in practice I would see responses well before you actually woke up.

A few anaesthetics still require muscle relaxants, but the risk of awareness is quite low. I often use special monitors which record the electrical activity of the brain as a further method of ensuring you are unconscious. However, please remember that sedation, unlike general anaesthesia, does not make you unconscious. If you are having sedation for foot surgery, investigations or injections in the back, you will be calm and pain free, but not unconscious.

Not waking up

Thre risk of death under general anaesthesia is very very low - about 1 in 50,000 to 1 in 100,000 and similar to the risk of being killed on the roads. Most patients have anxiety about operations, but this should not be a concern. Some patients also dislike 'losing control' and this is something for which I have considerable empathy, as it is something that I dislike. You can be assured that patients do not say strange things under an anaesthetic and that we ensure your dignity is preserved at all times.

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