What is an anaesthetist?

Specialist anaesthetists are highly qualified medical doctors. They provide a wide range of medical services and are part of multidisciplinary teams providing health care to patients. They have completed medical school (6 years), residency and then specialist training (at least 5 years) with examination by the Australian and New Zealand College of Anaesthetists. 

Anaesthetists play an important role in caring for the patient before, during and after surgery. During your operation your anaesthetist monitors and manages your breathing and cardiovascular systems, keeps you asleep with intravenous medication and gas, manages your fluid balance (and transfusion in some circumstances) and keeps your physiology as normal as possible. They are also responsible for your pain relief following surgery. Anaesthetists play a pivotal role in resuscitating acutely unwell patients (including trauma victims), and assist with the management of patients with acute and chronic pain, as well as providing pain relief for women in labour.


Clinical anaesthesia is built on the knowledge of physiology (how the body works) and pharmacology (how medications work in the body). A thorough understanding of the ways in which the body responds to anaesthesia and surgery is required, including how these physiological responses are altered by the patient's health. Anaesthetists must have an extensive knowledge of medicine and surgery and a solid understanding of the basic sciences.

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Anaesthesia

Anaesthesia is used principally to facilitate surgery. In many cases this involves general anaesthesia; however, surgery can safely and comfortably be performed in awake or lightly sedated patients with the right type of local or regional anaesthesia.

Whatever your eventual anaesthetic, I will be present throughout your operation, from when you arrive in the operating theatre, until handover to specialist nursing staff in the recovery room. It is my job to ensure your comfort and safety is maximised at all times.

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General anaesthesia

General anaesthesia (GA) is a reversible loss of consciousness through a combination of drugs and anaesthetic gases. It includes pain relief (analgesia), loss of recall (amnesia) and muscle relaxation. It is very different from normal sleep, but you may experience dreaming during a GA.
A GA is normally initiated with intravenous medications (induction phase), and is maintained throughout surgery by an infusion of drugs or by breathing gases from an anaesthetic machine (maintenance phase). You will wake up at precisely the right moment, soon after I stop the drugs or gas (emergence). General anaesthesia normally requires the placement of a breathing tube which will be inserted and removed while you are asleep.

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Sedation

Sedation involves smaller doses of anaesthesia medications than general anaesthesia, normally given through an intravenous cannula (drip or IV bung). 
This technique is very common for minor procedures and endoscopy, as the recovery is quicker than a GA. 
Very rarely you may experience some recollection of events during the procedure, but you will be very comfortable and safe throughout.

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Regional anaesthesia

This is the installation of local anaesthetic medication to surround nerves supplying the area of the body that will be operated on, and is similar to how dentists numb teeth prior to procedures. 
Peripheral nerves are usually blocked with ultrasound guidance. Your body part may be numb for up to 36 hours, so please ensure it is protected from harm. 
Regional anaesthesia may accompany general anaesthesia, or may be used as the sole anaesthetic modality.

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Spinal anaesthesia

Local anaesthetic and a strong pain killer are injected through a very small needle between the vertebrae. As the insertion is below the level of the spinal cord, this is considered very safe. You will typically be numb from your chest to your toes for up to three hours. Compared to general anaesthesia, you will have superior pain relief and recovery. 
This procedure is commonly performed for Caesarean section and joint replacement.

We will discuss your anaesthetic  in advance; if you require further information please get in touch

 
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Common side effects

Despite our best efforts to avoid these, you may experience the following with a frequency >1:100

  • Nausea and vomiting

  • Post operative pain

  • Bruising from cannula sites

  • Dizziness, sleeping difficulties

  • Sore throat

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Rare outcomes

It is very uncommon to suffer serious or permanent harm as a result of an anaesthetic. The risks increase as we age and accumulate medical problems such as heart disease and kidney problems.

Dental damage

Very uncommonly teeth, lips or tongue may be damaged during airway placement or removal. 

Less than 1:10,000

Cardiovascular events e.g. strokes, heart attacks

Respiratory or airway events eg asthma, failure to place an airway, aspiration of gastric contents

Allergies e.g. anaphylaxis


Awareness

This is the unexpected recall of events during general anaesthesia and is one of the most feared complications of patients. Recent international research puts this risk at less than one person in every 17,000 anaesthetics with the majority of cases observed during heart surgery or following trauma. Most cases involve some vague recall only; it is even more rare to be completely awake during surgery. 

Ultrasounds

Regional anaesthesia

Spinal anaesthesia

Failure (numbness that is not sufficient for surgery) is very rare. This may be "rescued" with general anaesthesia or sedation. Permanent nerve problems or infections are thought to be less common than 1 in 100,000.  

Epidurals for labour

About one in ten epidurals need to be modified once they're inserted. One in two hundred women will suffer from a severe headache afterwards, which can be fixed by a procedure known as a blood patch. Temporary nerve problems postpartum are common (numbness normally), but less than one in one thousand of these relate to epidural analgesia. There is no association with persistent back pain, nor is there any increased risk for Caesarean section in women who have an epidural.

Peripheral nerve blocks

Failure is more common than with spinal anaesthesia, but still unlikely. These blocks may be repeated or modified to rescue a failing technique. Nerve problems are less common than 1 in 5,000, and are temporary in the majority of cases. This will present as weakness or numbness that persists beyond 36 hours. Please get in touch with me if you experience these symptoms after a nerve block.