An anaesthetic is used to temporarily reduce or take
away sensation, usually so that otherwise painful procedures
or surgery can be performed.
There are two types of anaesthetics:
• General, which make the patient unconscious.
• Local, which numb the part of the body that would
otherwise feel pain.
Anaesthesia-induced sleep is not the same as ordinary
sleep but a form of temporary unconsciousness that is
carefully controlled by the anaesthetist. This involves
administering the right quantity of anaesthesia for each
kind of operation. Throughout the procedure, different
types of medicines are added or removed to relieve the
pain and maintain the right level of unconsciousness.
For some operations, the best option is to combine a
local anaesthetic such as spinal or epidural anaesthesia
with medicines to make the patient sleepy. The anaesthetist
can explain these details in advance.
Who is the anaesthetist?
A consultant anaesthetist is a specialist doctor who,
after qualifying in medicine, spends about six years training
in the specialty of anaesthesia. Anaesthetists see patients
while being trained, but a consultant supervises them
during all procedures.
What does the anaesthetist do?
The anaesthetist takes a careful look at the history
of the patient's general health and uses this information
to decide how best to offer care. The various options
will be discussed with the patient before the operation;
patients are encouraged to ask questions and speak about
any worries they may have. During the operation, the anaesthetist
stays with the patient at all times to make sure they
are comfortable and safe. This includes controlling pain,
replacing body fluids and measuring and controlling all
the vital functions of the the body such as the heart
beat, blood pressure and brain and kidney function. This
process continues after the operation, when the anaesthetist
will organise the control of any pain or sickness and
advise on when it is safe to eat and drink again.
Why is eating and drinking not allowed before an operation?
If there is food and drink in the stomach, the patient
may be sick while under the anaesthetic. The vomit can
pass into the lungs but the body, which is depressed by
the medicine, loses its ability to cough it up. This can
cause serious lung damage. Eating is usually not allowed
from six hours before surgery but in some cases clear
fluid may be taken up to two hours beforehand.
What about crowns and loose teeth?
During the operation, it is often necessary to pass a
tube into the throat to permit normal breathing. The instrument
used to pass this tube into the gullet can easily damage
loose teeth and crowns, so the anaesthetist will ask if
you have any so that extra care can be taken to avoid
them. The same problem applies to dentures, which are
removed to prevent them interfering with breathing.
Are anaesthetics safe?
Anaesthetics are almost entirely safe, but every operation
carries a very slight risk. A recent survey in the UK
showed that death due to anaesthesia occurred in about
five in every million anaesthetics given. People who are
in poor health run a higher risk than those who are fit
and well. This can be discussed with the anaesthetist.
What is a 'premed'?
While waiting for their operation, patients are given
a medicine known as a 'premed' to make them them feel
slightly drowsy and stop them becoming anxious. They might
not even remember going to the operating theatre or being
put to sleep.
Where and how does the patient go to sleep?
Patients are given a small injection in the hand to make
them go to sleep. This usually takes place in a room next
to the operating theatre. Some patients - especially children
- have an anaesthetic cream rubbed onto the skin beforehand
so that they won't even feel the injection. Others are
given a mixture of gases to put them to sleep very quickly.
Day-case patients are usually taken straight to the operating
theatre. Parents are encouraged to stay with their children
until they are asleep.
How and where does the patient wake up?
After the operation, the anaesthetist stops giving the
medicines that were keeping the patient unconscious and
he or she is taken to a recovery room where there are
specially trained staff. The longer the operation, the
longer it takes to wake up. When the patient has woken
up completely, they are taken back to the ward. Occasionally,
people recover consciousness in the operating theatre
once their operation is over. This is quite safe.
How do people feel when they wake up?
Patients often feel cold and slightly confused. They
may have pain or feel a bit sick, but these symptoms can
be treated when the anaesthetist visits the patients to
check that they are all right.
What is it like after the operation?
How people feel after the operation depends on the kind
of surgery they have had. They will be encouraged to get
out of bed as soon as possible and will be usually be
allowed to eat and drink in the first few hours after
a minor operation.