“I don’t like losing control”
Often patients are afraid that they might say or do things when they are unconscious that would embarrass them. It is important to remember that while you are unconscious you cannot talk or move, and hospital and clinic staff are professionals trained to treat patients with utmost dignity, respect and care.
“Could I be allergic to anaesthesia?”
No, you cannot be ‘allergic to anaesthesia’. An anaesthetic consists of as many as 15 different drugs. Often the phrase ‘allergy to anaesthesia’ is used to describe a side effect from the anaesthetic, such as intense nausea, vomiting, agitation, double vision, sore muscles, etc. These are not allergies, but exaggerations of some of the common side effects of anaesthesia or surgery. Prior to your anaesthetic, you should make sure the anaesthetist is aware of any specific drug allergies or drug intolerances you may have, and any problems you may have had with anaesthetics in the past.
“What if I wake up during the operation?”
It is extremely unlikely that you will be awake during a general anaesthetic. There have been reports of patients who can recall events that occurred during the operation when they were anaesthetised. This is called awareness. The most common memory is brief, vague, and without pain, and is related to the period at the very beginning or the end of the anaesthetic. Some patients have recalled voices or other sounds, and a very, very few have full sensation of the procedure.
“Am I too old/young to have an anaesthetic?”
There are no age limits for having an anaesthetic. It is now even possible to anaesthetise premature babies for prolonged and major operations.
Potential reasons why elderly patients should not undergo some operations relates to their medical conditions, not their age. If you are elderly or frail, a thorough medical assessment and a considered discussion of the risks should be undertaken with your family doctor, surgeon and anaesthetist to determine if having the operation is in your best interests.
In some cases where a child is less than 2 years old and the surgery is not urgent, although it is safe we would encourage a delay in the operation/anaesthesia.
“Who will be in the operating room?”
If your operation takes place in a small hospital or a private clinic, you are looked after by your anaesthetist, your surgeon, and two or three nurses, including one who helps the anaesthetist. If your operation is in a large hospital, in which medical and nursing students are taught, then other individuals could be present during your operation, such as an anaesthetic trainee.
It is not uncommon for patients to be feeling stressed or anxious around the time of surgery. Be sure to discuss your concerns with your family doctor or surgeon to allow for the most comfortable visit possible. They may be able to help you find a technique to make you feel calmer.
If you are a smoker, it is usual for your cough to be worse after the anaesthetic due to the nicotine reacting to the anaesthetic causing a build-up of phlegm and mucus in the lungs. The best thing to help prevent this problem is to stop smoking 6 weeks prior to your operation.
Sometimes patients can get confused after an operation. This may be related to anaesthetic drugs, painkillers or the surgery itself. The duration of confusion is variable and depends a lot on your general health and the nature of your surgery.
A sore throat can occur after an anaesthetic. This is a result of a breathing tube typically inserted into your airway whilst you are unconscious. The discomfort doesn’t last long and can be calmed using throat lozenges and or paracetamol.
Allergy to anaesthetic drugs is rare. The severity of allergic responses can range from mild resulting in a wheeze and rash to severe life-threatening anaphylactic reactions. If a patient is undergoing a general anaesthetic and is unconscious, the signs of an anaphylactic reaction may vary. Symptoms may include low blood pressure, wheezing, hives, rash, swelling around the eyes or in the mouth and throat, and breathing difficulties.
Anaesthetists are trained to recognise and treat allergic reactions in the operating room. However, an important part of treatment of any allergic reaction is prevention. If you have any history of swelling of the face or generalised itching, you should let your anaesthetist know.
Heart attack or stroke
The risk of having a heart attack during or after an anaesthetic is very low and depends a lot on the patient’s pre-existing risk factors for heart disease. Patients with severe hardening of the arteries of the neck are not only at risk of a heart attack, but also a stroke. Again, this is a rare but serious complication of anaesthesia.
Almost any nerve can be affected by anaesthesia and surgery. In many instances, this is related to a pre-existing medical condition, such as diabetes. During your procedure the team looking after you aims to prevent nerve damage by careful positioning and padding. In the majority of cases, nerve damage is temporary however appropriate neurological follow-up is required.
- Get a little fitter. Start an exercise regime.
- Give up smoking 6 months prior to surgery.
- Drink less alcohol.
- Eat a healthy diet. Try to lose a little weight if you are overweight.
- Consider trying relaxation exercises.
- Ensure that your anaesthetist and surgeon have been informed about all the medications you take – whether you take them regularly or intermittently. The majority of prescription drugs should be continued, but if you are on diabetic medications or blood thinners these may need to be modified or stopped altogether.
- Should you be taking oral contraceptives, keep taking them, but tell your surgeon and anaesthetist.
- Should you have any serious health problem, talk to your anaesthetist and surgeon.
- Should you have a cold or flu in the week before surgery, then contact your anaesthetist or surgeon to find out if your anaesthetic and procedure or operation should be postponed.
- Should you be anxious and have any questions, contact your anaesthetist to discuss them, or make an appointment to see him or her before admission.
Helping your child
- Tell your child what is about to happen.
- Prepare your child mentally 2 or 3 weeks prior to the procedure.
- Your child may sense your anxiety so make sure you get all questions answered so you and your partner can be as calm as possible on the day.
- Attend the preadmission clinic with your child.
- Consider using books, videos, and activities such as play-acting to help with preparation.
- Remember that open and truthful discussion is the key to successful preparation of your child for surgery and anaesthesia.
- Should your child have special needs, let your anaesthetist know in advance as there are many techniques available to make the hospital journey easier for them.
It is important before going into hospital you have a good understanding of the proposed treatment of a private patient. You have the right to ask and understand fees and out of pocket payment as well as what you are entitled to through your health fund.
Unlike other services, anaesthetists do not have a standard scale of fees. The fee charged by your anaesthetist is related to the Medical Benefits Schedule number or the Relative Value Guide number.
There will be a separate fee from your anaesthetist for the anaesthesia services provided to you. You should be aware that Medicare and health fund rebates may not cover the entire cost of your anaesthesia. This difference between what is covered and the actual fee for the anaesthesia services is known as the ‘gap’ and will be your personal responsibility to pay.
Wherever possible your anaesthetist will provide you with an estimate of your anaesthesia fees before to your procedure, as well as providing you with information such as Medicare item numbers. This will allow you to enquire further from your health fund about the level of benefits available for your procedure.
Medicare will rebate a portion of the unit value and if you have private health insurance, and your health fund will rebate a further portion.
Each health fund has its own rebate arrangement so it is essential that you contact your fund to obtain your anaesthetist’s fee estimate. The ASA has provided an information sheet with further information on fees, rebates and indexation.