Orthopaedics

Arthroscopy

This will be performed as a day case under general anaesthesia. You will have local anaesthetic instilled into the joint space and will be discharged home on oral analgesia.

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Anterior cruciate ligament repair

Normally one night in hospital. Performed under general anaesthesia, with a femoral nerve block and local anaesthetic to the hamstring graft sites and joint space.

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Joint replacement

Both hip and knee replacements are performed under spinal anaesthesia with local anaesthetic around the joint tissues and sedation. You may be as awake or asleep as you want during the sedation. International research has confirmed this as the safest and most effective anaesthetic for joint surgery. For a knee replacement we also provide a femoral nerve block.

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General surgery

Laparoscopic procedures

These are performed under general anaesthesia. For minor procedures, oral analgesia and a short hospital stay is expected. For more major procedures (e.g. gastric sleeve, hiatus hernia repair), I will prescribe you a Patient Controlled Analgesia (PCA) infusion which allows you to titrate your own intravenous pain relief. You can expect discomfort in your shoulders for a couple of days; this is referred pain from the diaphragm and resolves spontaneously.

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Laparotomy

Larger procedures in which an open abdomen is required have more extensive anaesthetic requirements. You may require a spinal injection of morphine. Additional monitoring may include a cannula in the artery in your wrist (arterial line), and an intravenous cannula in your jugular vein (central line). Pain relief will be a combination of PCA and local anaesthetic catheters placed during surgery.

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Hernia repair - inguinal, umbilical, incisional

These are usual minor procedures performed laparoscopically or open. You may go home the day of surgery if you are comfortable. You should only require oral analgesia post-operatively.

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Endoscopy - gastroscopy/colonoscopy

This procedure is performed under sedation, utilising small amounts of intravenous anaesthetic to reduce awareness and make the time pass quickly; compared to general anaesthesia, this ensures you can eat and drink within minutes of your procedure ending. It is very uncommon to recall events during the procedure, and I will ensure your comfort throughout.

 

Ear, Nose and Throat Surgery

 

Grommets

Performed under general anaesthesia, and normally a mask (gas) induction, this procedure is quick and relatively painless. You/your child can expect to be discharged within a couple of hours on simple pain relief.

Adenoidectomy/adenotonsillectomy/tonsillectomy

This usually takes 30-40 minutes. There is very low pain and nausea in the first 24 hours due to regular anti emetics. Adenoids can normally go home the same day.

Sinus procedure/rhinoplasty/septoplasty

Performed under general anaesthesia, we utilise local anaesthetic liberally to ensure you wake up numb. You may have packs in your nose afterwards, necessitating overnight admission. Please let me know if you have blood pressure issues as this needs to be carefully managed in the perioperative period.

Anaesthesia for your child

Children present unique challenges to anaesthetists. Many times we can "induce" anaesthesia without the need to place a needle first - your child will breathe an anaesthetic gas to go off to sleep. It is very helpful to have a calm parent in the theatre with us as we start the anaesthetic, after which time a staff member will guide you out. Kids really benefit from a comforting toy or blanket, while video games on the phone can also provide a distraction. Please ensure your child wears short sleeves to theatre as this will make cannulation easier once they are asleep.

Children (especially preschoolers) may experience "emergence delirium" following an anaesthetic, due to the rapid washout of the anaesthetic and quick wake up in unfamiliar surroundings. Medication given in theatre, or as a pre-med can mitigate but not entirely prevent emergence delirium; it often improves once the child is reunited with the parent.