ANAESTHESIA.

This page will give you some basic information and advice about your forthcoming operation. Please take a few minutes to read it. You may also receive instructions from other sources such as the hospital. These are sent to all patients and are not specific to your condition. If they give different advice, please still follow the instructions on this sheet.

Medical conditions

Anaesthetists are perioperative physicians. We need to be aware of and optimise all other medical conditions you may have. This may necessitate further tests. In order to avoid the risk of delaying your operation, please download our questionnaire and bring it into hospital. If you have any medical or anaesthetic problems listed in bold in the questionnaire, please tell me as soon as possible.

Drugs

Please bring into hospital any drugs you are taking. If you have taken your drugs out of the original packets and put them into your own container please also bring the original packets so that they can be properly identified. Please tell me if you are taking recreational or non prescribed drugs.

I will prescribe any analgesic (pain relieving) drugs that you need to take home with you. However, mild to moderate pain is best managed with aspirin, paracetamol or non-steroidals such as ibuprofen. If you have UK insurance, you are not insured for drugs that you take out of hospital and due to the cost of dispensing these drugs it is far cheaper for you to purchase them at your local chemist before coming to hospital.

Eating and drinking

It is important that your stomach is empty at the time of an anaesthetic to avoid the risk of stomach contents passing into your lungs during the anaesthetic. You should have been told the earliest time that the operation will occur. If you do not have this information please ask the surgeon's secretary. You must have no food for 6 hours before the start of the operation. Food includes milk and pure fruit juices. You can continue to drink other fluids until 2 hours before the operation. If you find it difficult to take drinks such as tea or coffee without a small amount of milk this is permissible. Please do not go without food or drink for significantly longer as this is equally disadvantageous.

Day case surgery

Where possible we allow patients to go home the same day as their operation and this will have been discussed with you by your surgeon if it is feasible. If this is the case, it is imperative that you have an adult who can take you home after the operation and remain with you overnight. There is always a small possibility that patients may have to stay overnight and you should make arrangements so that this is possible.

Dental care

Crowns and bridges at the front of the mouth can be at risk during operations. If you have loose or damaged crowns, or if you have an abcess, please see your dentist before your operation. Otherwise dental work should not be undertaken immediately before an operation due to the small possibility of infection.

General advice prior to anaesthesia

Although it is well known that cigarettes are dangerous, it is not generally appreciated that discontinuing smoking even for one or two days before an anaesthetic can significantly reduce risk. If possible please reduce or stop smoking as early as possible before your operation. It is absolutely essential that you do not smoke for twelve hours before the anaesthetic as this can result in the monitoring equipment that is used to ensure your safety providing false readings. Alcohol in moderation is medically beneficial! All drugs should be taken as normal including on the day of admission. The only exceptions are drugs given for diabetes (insulin, metformin, glucophage) and in this case I would like to discuss your medication before admission. A general anaesthetic is generally very safe and the risks for most patients are very small. No other specific measures are needed before an operation and I would particularly discourage you from alternative drugs or homeopathy which you may see advertised as there is no scientific foundation for claims of benefit and there have been instances where patients have come to harm.

If you are pregnant or breast feeding, please contact me before admission to discuss. If you are using oral contraception, you may also find it helpful to discuss this in advance.

Sedation and local anaesthetics

Your surgeon may have discussed the possibility of sedation or local anaesthesia instead of general anaesthesia. I will discuss this with you on admission. In most cases it will be your choice unless you have other medical conditions that make a particular alternative safer. In the meantime, please still follow the advice on this sheet. more about sedation

On the day of the operation

Please arrive in plenty of time to rest before your operation. Please get changed as soon as you arrive in your room - this avoids a rush at the last minute. If you have a cold or other problems, STILL come to the hospital; such symptoms rarely necessitate postponement. If you have an advanced directive (living will) please bring a copy and show it to me.

All anaesthetics require a plastic tube to be inserted into a vein. Most of these are very small. However, if you are adverse to needles, please tell the nurses as soon as you arrive. They will place a local anaesthetic cream on the back of your hands so the injection is painless. The cream takes time to work and needs applying before my consultation.

Going home

You must have an adult to take you home if you have had either a general anaesthetic or sedation. The best way to travel is by car or taxi door to door. It is not safe to travel alone, nor to use other public transport.

You also need a responsible adult to remain with you overnight. Problems are very rare but may need assistance. If you have nobody to take you home and stay with you, please tell me in advance. Insurers will normally cover an overnight stay in hospital.

You should rest quietly indoors. Have plenty of fluids and eat if you wish to. Do not cook for yourself, as kitchens, along with open fies and stairs, can present a risk if you suddenly become dizzy. Please do not rest outside. If you fall asleep in the sun you may burn your skin, even in this country.

From an anaesthetic perspective you can consider yourself recovered the following day, but your surgeon or surgery may impose longer restrictions. You can otherwise go to work. Please be aware that UK insurers have unilaterally imposed a 48 hour ban on driving after a general anaesthetic, and deliberately flouting this means you are uninsured and at risk of prosecution. Some other professions may also need approval to return to work; if you hold a pilot's license you are required to notify the CAA and gain permission before exrercising its privileges.

Recent studies have shown that some people may have reduced memory or executive functions after an anaesthetic. These are mostly seen in the elderly, are frequently temporary, and may be so minor that they can only been identified by special tests. I am happy to discuss this with you. However, taking important decisions either in your home life or at work should be delayed for at least 24 hours, and longer in some patients.