Preassessment
The anaesthesia preassessment would be done sometime before your operation, to decide if you are fit to have an anaesthetic. A nurse will take your full medical history. It is very important to mention all your past medical problems (including past operations, hospital admissions and allergies). Some conditions, which might seem unimportant for you can be crucial for the good outcome of your anaesthetic. It is also important to mention any anaesthesia-related problems among your blood relatives. You might need some extra tests, depending on your age and health status. The preassessment clinic in located on the 1st floor.
In the morning of the operation you will be seen by the anaesthetist, the doctor who will actually perform your anaesthetic. He/she will ask again about your full medical history to ensure nothing has been missed and will examine you. They will listen to your chest and look at your mouth. He/she will also explain how your anaesthetic will be performed, what pain relief you’ll be given afterward and will answer to any question you might have about your anaesthetic.
Standard anaesthesia
Once in the theatre, you will be asked again some basic questions: if you have any allergies, dental problems etc. Then, you will be put under continuous monitoring for your blood pressure, heart activity and amount of oxygen in the blood. You will also have an intravenous catheter (a small plastic tube) put in a vein. It will be used to inject anaesthetic drugs and any subsequent medication. In certain cases, you might need some extra monitoring which will be explained to you by the anaesthetist.
You will be given an oxygen mask to breathe and after a few puffs, the anaesthetist will inject the drugs which will make you unconscious. He/she will then put a device which will enable you to breathe safely during the general anaesthesia. Then, the surgeon will proceed with the operation.
Children can be anaesthetised by encouraging them to breathe a mixture of gases instead of having this injection. This sometimes takes a little longer to work and is not always quite so pleasant but it still works very well.
After the operation has finished, you will “wake-up” usually within 10 minutes and will be taken to the recovery room. There you will be closely monitored and will receive pain relief. Some patients do not remember that period altogether.
Important Recommendations Before an Anaesthetic
Preoperative fasting
If you have food or drink in your stomach when you have an anaesthetic then you may be sick while you are unconscious. The anaesthetic depresses the body's normal protection defences (like coughing) that prevent this vomit from going into your lungs so that, if you had been eating or drinking recently, you might choke on the food or 'drown' in the liquid. Hunger and thirst before an operation may be unpleasant but it is safer for you. It is normal not to eat for 6 hours before an operation but small volumes of clear, non-alcoholic non-fizzy fluids may be allowed up to 2 hours before. You will be given advice about this from the doctors or nursing staff and you should follow their guidance. If you are not sure what to do, then ask.
If you have some unexpected medical condition e.g. a cold, a sore throat, a severe stomach upset, another specialist appointment within days of your surgery please contact Preassessment to get special instructions.
If you are on regular medication
If you have a medical condition that requires regular medication e.g. hypertension, heart disease, asthma, it is generally advisable to continue these medications without disruption.
It is alright to take regular medications with water even though you are “nil by mouth”. If you are unable to take your usual medication e.g. medication normally taken with food, the anaesthetist may ask you to have the same or similar medication via another method, e.g. injection, suppository or under the tongue.
THERE ARE SOME IMPORTANT SPECIAL EXCEPTIONS WHICH ARE LISTED BELOW:
Water tablets/diuretics: These should normally not be taken on the day of operation unless your anaesthetist requests you to take them.
Diabetic medications: Diabetic medications taken by mouth should not be taken on the day of operation and should be restarted once you are eating and drinking again after the operation. Depending on your blood sugar and the type of surgery performed, you may be given insulin at some stage.
If you normally require insulin you should stop taking it on the day of your surgery, unless you are advised to have a light breakfast, in which case reduce the insulin dose by half (approximately). Remind the medical staff on admission that you take insulin as your blood sugar level will need regular monitoring and you may require further insulin or dextrose.
Monoamine oxydase inhibitors: These drugs are occasionally used in the treatment of depression: examples are phenelzine (Nardil) and tranylcypromine (Parnate, Parstelin). If you are taking these drugs you will need to consult your doctor. Depending on the planned operation, it may be necessary to switch to another medication for at least two weeks prior to
Anticoagulants (blood thinning drugs): If you are taking warfarin tablets you must mention this to your surgeon. It may be necessary to stop this medication three or four days before the operation, possibly switching to an alternative drug. This decision depends on your medical condition, the proposed operation and anaesthetic. The decision should be made jointly between the relevant specialists. The same advice applies if you are taking clopidrogel.
If you are taking anticoagulants by injection e.g. Clexane. it is suggested that the last dose is taken on the evening before the operation.
Social and Recreational Drugs: Smoking prior to surgery increases your risk of respiratory problems and infections. The longer you can go without smoking before the operation the better.
Consumption of large quantities of alcohol prior to your operation is not recommended, as you will feel very unwell afterwards. Alcohol consumption can cause dehydration with subsequent kidney and liver problems.
The use of substances such as ecstasy and cocaine prior to the operation is potentially lethal. Patients who have recently consumed such substances should not undergo surgery.
Day Surgery
If you are planning to go home after your surgery, you should be accompanied by a responsible, reasonably fit, English-speaking adult for 24-hours. You should also have a phone available.
Some people tend to be forgetful and clumsy for 24-hours after a general anaesthetic. It is therefore recommended to avoid doing any important paperwork or any potentially dangerous activity, even cooking, as you can cut or burn yourself.
Loose Teeth and Dentures
Always mention any loose teeth or dentures to your anaesthetist. If you have a general anaesthetic, a device will be put into your mouth once you are unconscious to assist your breathing. However, if you have loose teeth or teeth of a certain shape there is a risk for them to be damaged or even fall. Therefore, it is important to discuss these issues with your anaesthetist beforehand.
Nail varnish/make-up
Please avoid wearing any make-up or nail polish for your operation. Some of the monitoring devices we use rely on your skin color to assess the amount of oxygen you have in your blood and any extra color applied to your skin might make these monitors unreliable. Besides, devices which help you to breathe during a general anaesthetic have sometimes to be taped to your face and it is impossible with cream or foundation. Eyeliners and mascara tend to run into your eyes when you are asleep and become irritant.
Contact lenses
It is not advised to wear any type of contact lenses during an anaesthetic. When you are unconscious, you produce far less tears than during a normal sleep and your lenses can dry up and damage your eyes.
Hearing Aids
Please inform the theatre staff if you need your hearing aids at all time. Hearing aids have sometimes electrical interferences with theatre equipment and produce continuous background noise.
Jewellery
It is not advised to wear any jewellery during an operation. There is a slight risk of burn by metallic pieces of jewellery interfering with the electrical equipment. There is also a risk of compression and damage by tight-fitting rings and studs during a general anaesthetic. Nose and tongue studs can also make your breathing difficult.
Hairstyle
The standard position for an operation is usually lying on your back and to optimise your breathing during a general anaesthesia, you need to have your head slightly extended. It is therefore not advised to have any voluminous bun, or any headgear protruding at the back of your head. Hair knotted at the top of the head or in a low ponytail are fine.
