Information For Patients

You need an anaesthetic to enable the surgeon to successfully operate.

The anaesthetic keeps you pain free, comfortable and stops you from remembering what happened during the operation. Depending on the type of operation, you can be completely asleep (a general anaesthetic) or sedated (usually with a regional or local anaesthetic) – these options are discussed below.

You may remember some things if you have sedation rather than a general anaesthetic.

The Anaesthetist is a specialist doctor who plans and administers your anaesthetic.

Each anaesthetic is planned for each individual. Throughout the operation your anaesthetist monitors your vital signs, with the aid of specialist monitors. He/she will ensure you are receiving the correct amount of anaesthetic necessary to keep you asleep or correctly sedated during the procedure. Once the operation is finished, the role of the anaesthetist continues.

He/she will ensure all your medications are prescribed (painkillers, anti- sickness drugs, antibiotics, fluids, etc). 

Anaesthesia is a very safe procedure, considerably safer than crossing the street, for instance. However, it is not totally risk free. The type of risks will depend on whether you are having a local anaesthetic, regional anaesthetic, sedation or general anaesthetic. Your anaesthetist will discuss further any questions you may have. 

Below you can see an infographic detailing some of the risks associated with anaesthesia and their frequency in everyday practice.  This information is provided by the Royal College of Anaesthetists (RCoA).  If you wish to read about these risks in more detail, you can do so by visiting the RCoA website, which can be accessed by clicking here.

Not eating and drinking ensures that your stomach is empty and so decreases the chance of vomiting during surgery. Vomiting during surgery can cause vomit to enter the lungs (aspiration), which can result in serious pneumonias. In general, your hospital will advise you:

• Last meal/solid food: 6 hours before surgery.
• Last clear fluid: 2 hours before surgery.

Solid food includes milk, coffee/tea with milk and juice with particulate matter. Clear fluids include water, squash or juice without particulate matter, black tea, and black coffee. One cup or glass of the above is usually enough. Chewing gum and fizzy drinks are ‘grey areas’; the simplest advice is not to have these before surgery.

Usually not. It often depends on the type of surgery you are having and the amount of strong painkillers you will need afterwards. We use the most modern anaesthetic drugs and techniques that have the lowest risk of post-operative nausea and vomiting (PONV).

We also will routinely give you anti-sickness drugs before you wake up, so this is usually not as big a problem as many patients anticipate.

Yes. Some types of nail varnish can interfere with the monitors we use (a clip on your finger) to keep you safe during your operation. However most false nails do allow the monitors to function normally and it may be possible to place the monitoring elsewhere, depending on the operation you are having.

Makeup – particularly lipstick – can mask subtle colour changes in your face that your anaesthetist needs to observe during your procedure, so must be removed. 

If you are having a general anaesthetic, your anaesthetist will usually need to place a small tube into your mouth to help you breathe normally. Crowns and bridges are usually not as strong as normal teeth so there is a very small risk of damage to these when having an anaesthetic. Damage to your teeth is very rare but you should be aware of this risk.

Yes. Piercings can get caught on surgical drapes etc during your operation and in some circumstances metal bars and studs can heat up because of the electrical devices used during your operation. It is best to remove all piercings before surgery. If you have piercings that are at risk of closing up in a short space of time – for example tongue piercings – it would be better to replace these beforehand with a plastic bar. 

Yes and no. Homeopathic medicines contain only a tiny amount of active ingredient and you can continue taking these throughout the period of your surgery. Herbal medicines however may contain substances that can affect your body significantly. Some herbal preparations can affect your liver and change the way your blood clots – this can cause excessive bleeding during and after surgery.

You should stop all herbal remedies for 2 weeks before your operation. This may seem surprising, but remember, many of the strongest drugs we use in medicine today occur naturally in ‘herbs’.

Alcohol and street drugs cause effects that can interfere with our anaesthetic drugs. The combination can produce unpredictable and potentially dangerous effects. It would be best not to drink alcohol for 24 hours before your operation. If you do take any recreational drugs it is imperative that you tell your anaesthetist – in absolute confidence – so that we can plan any necessary changes to your anaesthetic management together. 

Premedication or ‘premed’ drugs are occasionally given to you before your operation to make you feel relaxed or to help with the anaesthetic. However, modern anaesthetic techniques mean that this effect is usually not needed. As the effect of tablet premeds given on the ward can be unpredictable it is usually better to give you a ‘calming’ drug once you arrive in the anaesthetic room, just before your operation. You will have the opportunity to discuss this with your anaesthetist on the day of surgery. 

Unfortunately, yes. It is essential that we can give you drugs though a drip to keep you comfortable, asleep and safe during your operation.

The best approach is to place the drip into a vein using a small needle before you go to sleep. We can usually use local anaesthetic first, to make placing the needle quite painless. This will hurt a lot less than having body piercings or tattoos for example. In some cases it may be possible to start your anaesthetic by breathing in and out some anaesthetic gases, but you will still need a needle placing into a vein before you wake up. 

A mild sore throat is relatively common after a general anaesthetic. This is because a tube is placed in your throat to allow you to breath oxygen and anaesthetic gases. Any discomfort usually settles within hours, especially after starting drinking again, although it occasionally remains sore for a couple of days. 

General anaesthesia (GA): 
You are given mediation to gently send you off to sleep. You will be getting pain relief and anti-sickness drugs. You will not be aware of anything until the end of the operation. Potential issues arising from a general anaesthetic (after awakening) include sore throat, sickness and drowsiness. In practice, the modern anaesthetic technique usually means you wake up only a few minutes after the operation, with a clear head and little drowsiness. You occasionally will need extra pain relief and anti-sickness drugs in the recovery room before you return to your room (discussed below). 

Regional anaesthesia (RA): 
This is another name for a nerve block. It involves giving a local anaesthetic injection around a single nerve, group of nerves or the spinal cord. This numbs the area to be operated upon. The area can remain numb for up to several hours. Sometimes this regional anaesthetic is given in conjunction with some intravenous sedation. 

Local Anaesthesia (LA):
This involves injecting some local anaesthetic directly into the site to be operated upon, thus numbing the operating site. This numbness can last from several minutes to a few hours. The surgeon usually injects this local anaesthetic, with occasional top-ups when necessary.

Intravenous Sedation: 
Drugs are given into your drip to make you feel comfortable and relaxed but usually not fully unconscious. Sedation covers a spectrum of states from feeling awake but relaxed (like after a glass or 2 of wine) to feeling very sleepy in which case you may not remember much of your time in the operating theatre. How much sedation you have may depend upon what operation you are having, but can be discussed with your anaesthetist beforehand. 

Whether you have a local anaesthetic, regional anaesthetic, sedation or general anaesthetic will depend both on your choice and on the complexity of the operation. Your surgeon and anaesthetist will discuss this with you. 

Your general anaesthetic is designed to keep you asleep at all times during the operation. It is very rare for someone to wake up during his or her operation.

If you are having a general anaesthetic, it is designed for you not to remember what happened during the operation. Remembering what happened during a general anaesthetic is very rare. If however you are having intravenous sedation (along with a nerve block or local anaesthetic), then yes, you may remember some of what happened during the operation.

The sedation is just that, sedation. It is not designed to send you off to sleep completely. However remember that the area being operated on will be numb, so you should not feel any pain. 

This obviously is a very concerning and important question. It is exceedingly rare for someone not to wake up quickly after the type of anaesthetic and surgery we practice.

If you are concerned about other medical issues you may have, then our Practice Manager can arrange for you to see one of our anaesthetists at a clinic appointment prior to your operation, to assess your fitness for the surgery. There is a small additional charge for this appointment. 

Before Going to Theatre:
On the day of your surgery, your anaesthetist will visit you to review your pre-assessment anaesthetic questionnaire, your general medical history, medications and allergies (among other things). The anaesthetic plan will be discussed, as well as what to expect after the operation. Once your questions are answered, you will be taken to anaesthetic room. 

In the anaesthetic room, you will meet the full anaesthetic team.

In the Anaesthetic Room or Theatre:
A ‘safety checklist’ (your name, operation, allergies etc.) is performed and then we connect our monitoring equipment. A drip will be inserted and your vital signs measured. Oxygen and intravenous medication will be given to drift you off to sleep. Once fully asleep, a small breathing tube will be inserted in your mouth, if necessary. This is the reason that some patients experience a mild sore throat after they wake up. If a nerve block is planned, you will get a drip, followed by intravenous sedation and then the nerve block. We will then take you to the operating theatre, where the surgery will be performed. 

Your anaesthetist will be with you at all times, closely monitoring your vital signs, giving you essential drugs, pain relief etc.

After Theatre:
After surgery, you will be moved to the recovery room. Here your anaesthetist will care for you along with a specially trained recovery nurse. During this time, you will wake up from the operation. The recovery nurse will give you any additional pain relief and anti-sickness medication that you require. 

Once you are fully awake, pain free, comfortable and not feeling sick, you will be taken to your room. If you are going home on the same day as your operation, you will be assessed for ‘street fitness’ before you leave. Once you are pain free, eating/drinking and not feeling sick etc., you should be able to go home. You must have someone to drive you home and look after you for the next 24 hours after the operation. The ward nurses will fully discuss this with you. 

Pain control is very important to us. Pain following surgery depends on the type of surgery, the amount of tissues operated upon and any tissue drains you may need afterwards. No two people are alike; for the same surgery the amount of pain will vary. We will give you painkillers during and after surgery, as well as to take home. Once you are awake, the recovery nurse will monitor your requirements and give you as much pain relief as needed. We aim to keep you as pain free as possible.

Some side effects of painkillers are constipation, nausea, itching and drowsiness. Inform your nurse if you have any of these symptoms. Also, it is very unlikely that you will get addicted to the painkillers in such a short period of time.