Who is the anaesthetist?

A consultant anaesthetist is a specialist doctor who has spent at least six years, and usually longer, after they have qualified in medicine, training and taking a series of examinations in the speciality of anaesthesia. This training allows anaesthetists to make decisions on the best care for you, not only during your operation but also in the time before and afterwards. You may be seen and cared for by an anaesthetist who is still being trained but a consultant will always supervise them and no one will provide care for you unless he or she is adequately trained to do so.

What does an anaesthetist do?

The anaesthetist finds out about your general health, past and present and, knowing what operation or investigation is being planned, decides what is the best way to look after you. He or she will see you at some time before your operation and talk to you about what will happen. It is possible that, before you are seen by your anaesthetist, you will be seen by another doctor or nurse who will ask about your general health and fill out a simple questionnaire. This information will then be seen by your anaesthetist who may ask you for more details.

During the operation, the anaesthetist will stay with you all the time to make sure that, whatever is being done to you, you are kept comfortable and safe. Anaesthetists look after every part of the normal working of your body, taking away pain, replacing body fluids, keeping you warm and carefully measuring and controlling all the vital functions of your body, such as your heart beat, blood pressure, breathing, brain and kidney function. In other words, your anaesthetist looks after you and, once the operation is over, he or she will organise the control of any pain and/or sickness, and advise on when you can start drinking again and what postoperative drugs and fluids you will require.

Who chooses my anaesthetist?

Surgeons and anaesthetists usually work together as a team in Great Britain and Ireland and are thus able to plan and work together to provide the best care for you.

Do I get any choices or say in what happens to me?

Of course you do. The doctors who are looking after you always take your wishes into account. Nothing will happen to you until you understand and agree with what has been planned for you. There may be important medical reasons why you cannot have or do everything you want to, relating to any operation or investigation. These will be explained by the surgeon or anaesthetist and nothing will be forced upon you.

What sorts of anaesthetics are there?

They are usually classified into general and local. Under a general anaesthetic, you are unconscious and so do not know what is happening to you. A local anaesthetic numbs part of your body so you cannot feel any pain while something is done to you.

Doctors often talk to you about anaesthetics sending you off to sleep during and operation because this may be the closest similarity for you to understand, but anaesthesia is not like normal sleep. It is a form of temporary unconsciousness that is carefully controlled by the anaesthetist. This is why your anaesthetist is a highly trained doctor with special skills to look after you at this time.

You may have heard about 'deep' or 'light' anaesthetics. This is a way of trying to explain what sorts of drugs are being used and how long it will take for you to wake up afterwards. Longer and more complicated operations used to require more time to wake up but this is becoming less true with the introduction of more modern anaesthetic drugs that can wear off very quickly, after their administration is stopped, leaving you clear-headed. The anaesthetist will give you as much anaesthetic as you require for the procedure that is planned, no more and no less. This changes during the procedure and is one of the reasons why your anaesthetist stays with you all the time and constantly watches over you, controlling the anaesthetic by adding or removing certain drugs.

Sometimes you will be given 'sedation' which means that drugs will be administered to make you very sleepy but you will not be completely unconscious, so that you will be able to hear conversations and respond to questions. The sedation may be given by an anaesthetist or sometimes may be controlled by you through a special machine. Your anaesthetist will explain this to you.

Nowadays, it is becoming more and more common to combine local and general anaesthetics together. This has many advantages and your anaesthetist will talk to you about the possibilities of these combinations if it is appropriate for the surgery you are about to have.

What sort of drugs will be given?

During a general anaesthetic your anaesthetist will give you many different sorts of drugs. Some take away the pain, some block certain reflexes, some make you sleepy and some stop you feeling sick. In providing a general anaesthetic, there are many different 'mixes' of drugs used by different anaesthetists.

Why does the anaesthetist cancel some operations?

Sometimes the anaesthetist may find out something about your general health that is significant to the anaesthetic and operation that has not been realised by other doctors. Their specialised knowledge about this many mean that it is better to delay your operation until the problem has been treated or improved in some way. Any delay will always be explained to you at the time. The anaesthetist's main concern is your well being and to ensure that you are in the best possible state of health before you have any operation.

When will I meet my anaesthetist?

This varies from hospital to hospital and depends on the sort of operation you are going to have. If you are a 'day case' then you may be seen in a special assessment clinic some time before the day you come in for the operation or you may be seen on the day itself. Many people are now admitted on the same day that they are due to have their operation, even if they are staying in the hospital afterwards. This may make it difficult for your particular anaesthetist to see you as he or she may be working in the operating theatre at the same time you are admitted to the ward. An anaesthetist will see you, however, and you will always have the chance to talk to your anaesthetist before the operation.

If you are admitted the day, or several days before the operation then you will normally be seen well in advance by the anaesthetist.

Why does the anaesthetist need to ask me so many questions?

Every patient is different and your anaesthetist will choose the anaesthetic to suit you. Each anaesthetic is carefully tailored to your health and the requirements of the surgery. The anaesthetist therefore needs to know a great deal about your previous health and any medicines you take, whether you smoke or drink alcohol, whether you are allergic to any medicines and whether you have had an anaesthetic before and how it affected you.

Why do I have to stop eating and drinking before an operation?

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 six hours before an operation but small volumes of clear, non-alcoholic fluids may be allowed up to three 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.

Why do I have to take off my glasses or take out my contact lenses?

At some point during the operation, your anaesthetist may need to put a mask of some sort over part of your face, to give you oxygen or an anaesthetic gas. Your glasses or contact lenses could become damaged or be in the way and this is why you are asked to remove them.

Why am I asked about crowns, bridges and loose teeth?

While you are unconscious, your anaesthetist makes certain that you can breathe properly and this sometimes means that a special 'breathing tube' needs to be place in your throat or windpipe. Sometimes your anaesthetist uses a special instrument to place this breathing tube in a very exact position and this instrument may press on your teeth and could damage loose ones or crowns. In addition when you wake up it is possible that you might bite your teeth together very hard or grind your teeth and this too could damage artificial crown or loose teeth. Your anaesthetist will do his best to keep your teeth safe but sometimes they can become damaged. You will be warned if there is a danger of this.

Why do I have to take out my dentures?

While you are asleep, your anaesthetist ensures that you can breathe comfortably even when you are unconscious. Normally, when you are unconscious, your neck and your mouth relax and can obstruct your breathing - the anaesthetist makes sure you are able to breathe freely by supporting your jaw or by using special tubes or airways. False or loose teeth can interfere with these processes and that is why they may be removed, to keep you safe.

Why do I have to take off my rings and watch?

This is only done to protect your personal jewellery. Sometimes rings cannot be easily removed and, provided that their presence will not interfere with the operation, they can usually be taped over to protect them. For some operations on the hand, rings have to be removed or they could cause problems.

Are anaesthetics safe?

Yes they are but of course any operation and anaesthetic carries a slight risk. In a recent survey of operations in the United Kingdom, death due to anaesthesia occurred in about five in every million anaesthetics given. This is obviously a very low risk.

People who are very ill with certain medical problems have a higher risk than those who are fit and well. You should ask your anaesthetist if you or member of your family are concerned about this.

What is a 'premed'?

While you are waiting for your operation you are sometimes given some medicines which start to prepare you for your anaesthetic and the surgery; these drugs are often called 'the premed' (which is short for premedication). There are different 'premeds' for different operations and patients and each anaesthetist develops their own combination of medicines that help their anaesthetics. This 'premed' is not always given to every patient as its effects are not always needed. Some will make you feel sleepy, some will make your mouth feel very dry and some may not seem to have had any effect at all. If you are given a 'premed' you may not be able to remember everything that then happens to you before you have your anaesthetic, such as moving to the operating theatre. Children are more likely to be given one of these 'calming premeds' than adults.

Where do I go to sleep?

You will be moved from the ward area to a room near the operating theatre either on your own bed or on a special trolley. If you are only staying in hospital for that day, it may be that you will walk to the operating theatre. You will have someone with you at all times. You will be given your anaesthetic either in a special room next to the operating theatre, the anaesthetic room, or in some hospitals you may have to be moved on to another bed at some time during this process. It may be possible for you to have a friend of relative stay with you at this time if you like and you should ask your doctors and nurses about this. In the same way, parents can usually stay with their children at this time.

How do I go to sleep?

You will usually be given an injection in your hand or arm to send you off to sleep. This injection can be a little uncomfortable like a pinprick but it is only for a few seconds. For those who are particularly anxious or children, then this brief discomfort can be reduced by putting an anaesthetic cream which numbs the skin on the hand or arm before this injection is given.

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. Adults who are very worried about injections can also go off to sleep this way. You should ask your anaesthetist more about this if you wish.

What happens if I am having a local anaesthetic?

You will probably be moved to the operating theatre as already described and then your doctor will give you the local anaesthetic. There are so many different ways that this can be done that it is best to ask your doctors and nurses exactly what will happen to you. Sometimes, local anaesthetics are given to the area just around the place that will be operated on. In other cases, the local anaesthetic will be placed close to the large nerves which supply sensation to the area of the surgery and these may be quite some distance from the point of surgery; for example, you might have local anaesthetics placed around your collar bone to numb your hand.

Sometimes, the anaesthetist will decide that you would benefit from a spinal or epidural anaesthetic. In this case, the local anaesthetics are injected into your back and thus spread out around the nerves as they leave the spinal cord. The needles through which the local anaesthetics are given have to be placed very carefully in all of these cases and sometimes you will be asked to lie in a particular way to help the anaesthetist find the exact position to give you the local anaesthetic. Frequently, your anaesthetist will set up an intravenous drip before he starts his work. It is usually still necessary to stop eating and drinking before a local anaesthetic just as if you were having a general. You should ask your doctors and nurses about this.

Once the local anaesthetic has been injected, the area of the surgery will become numb. You will still be aware that something is going on during the operation but you will feel no pain. Sometimes your anaesthetist will give you some other drugs to make you feel sleepy at this time. You can ask for this 'sedation' if you would prefer it to being wide awake. The local anaesthetic will wear off slowly once the operation is over until normal sensation is restored.

What happens once I am asleep?

You are never left alone during an operation. Your anaesthetist stays with you and keeps you safe, pain free and unaware of what is going on. Drugs are constantly being given to you throughout the operation to make sure you are kept safe and then, once the operation is over, that anaesthetist will wake you up. As well as giving you a wide variety of drugs such as pain killers, anti-sickness drugs and drugs to block certain reflexes, your anaesthetist ensures that you are given appropriate fluids through drips, as well as maintaining your body temperature and comfort. Your anaesthetist will explain these special treatments to you if they plan to use them. Your anaesthetist is also concerned that you should wake up as comfortable as possible after the operation and, for some operations, this will require some special treatment like an 'epidural'. These too will be explained to you beforehand so that you know what to expect.

What does monitoring mean?

There are many different functions of your body that the anaesthetist wishes to watch while you are anaesthetised. This process of watching is often referred to as monitoring. The extent of the monitoring depends on the complexity of the operation and on your general health so that someone who is having a minor operation but who is seriously ill may require very complicated monitoring. There are machines available which monitor your heartbeat (an ECG), others which measure your blood pressure at set time periods and further machines which can measure your pulse and amount of oxygen in your body from a small clip which is usually placed on your finger. Devices like this will often be attached to you before you are given any to the anaesthetic drugs; none of them is painful.

Some more complicated operations will need more detailed monitoring which will be explained to you by the doctors or nurses who will be looking after you.

How do I wake up?

Many of the drugs that keep you asleep are given continuously throughout the operation. Once the surgery is finished these are stopped and then you will start to wake up. Your body either destroys the drugs or gets rid of them in your breath or urine and, when enough has been removed, you will reawaken. Some drugs that are given during the operation are neutralised with other drugs. The speed at which you wake up after the operation will depend on many things, including the drugs used, the length of the operation and your state of health.

Where do I wake up?

You will usually wake up in a recovery room near the operating theatre where a specially trained member of staff will look after you. Sometimes, you may wake up before you arrive in the recovery room, either in between the operating theatre and recovery room or sometimes, once the operation has been finished, actually in the operating theatre itself. Do not be worried by this; your anaesthetist will only wake you up when it is safe to do so and they will not want you to be unconscious for any longer than you need to be.

After making sure you have woken up, know where you are and are comfortable, you will be taken back to your ward. If you are only staying in hospital for the day, then you will be moved to an area where you can make yourself ready to go home. This time while you are waking up is often a slightly 'muzzy' time and you may not be able to remember it fully afterwards.

How will I feel when I wake up?

This will depend on what has been done to you during the operation. All anaesthetics and operations require a period of recuperation afterwards. Short operations require a shorter period of convalescence than long operations, as you would expect. You may have some pain or discomfort but the anaesthetists and staff in the recovery area and wards will treat this.

Some people feel, or even are sick after their operations and this can be due to some of the drugs they are given, like painkillers and antibiotics, or may be due to the surgery itself. There are many anti-sickness drugs available and these will be given to you if needed.

Will the anaesthetist be there when I wake up?

You will wake up in a recovery room where you will be watched over by a specially trained member of staff. Your anaesthetist will have stayed with you until he or she was happy that you were waking up normally and will still be nearby if needed.

Is the anaesthetist's job over once I have woken up?

Most anaesthetists normally take responsibility for making sure you are comfortable and pain free when you wake up and also look after the intravenous fluid and drug requirements during your early recovery.

Will I be involved in teaching or research?

Most anaesthetists are involved in teaching medical students, nurses and trainee doctors about the things they do. This teaching often occurs in hospitals that are not normally described as 'teaching hospitals'. If you are worried about this, you should ask your doctors about what happens at your hospital. Some anaesthetists are also involved in research to improve even more the safety of operations. It may be that you will be asked to join this sort of activity. If you do wish to help then ask a doctor who will then ask you to sign a special consent form and will explain all the details of the research to you.

How soon can I get up after my operation?

This will depend on the type of surgery and anaesthetic you have been given. Your doctor and nurses will let you know what to expect but normally you will be encouraged to be up and about as soon as possible after the operation.

When can I eat and drink again?

This too will depend on the surgery. Some operations like those inside the stomach prevent the normal activity of your intestines and, if you were given things to eat and drink, you would become very sick. After these operations, you will be fed through a drip until everything settles down and then you will be allowed to drink small amounts which will then gradually increase if all is well. After some operations it may be all right for you to eat and drink straightaway. Again, your doctors and nurses will let you know what to expect. You should not eat and drink a large amount straightaway or you may feel sick.

When can I get back to normal activity again?

Here again, it is a question of what operation have you had and how long have you spent in hospital? Everyone will need some time to recover from any surgery and any anaesthetic (and this applies to local anaesthetics). Most hospitals will provide written advice for some day cases as to what they should and should not do when they go home. If you have any doubts, then ask your surgeon and your anaesthetist what you should do.

Copyright : The Royal College of Anaesthetists
Reproduced by kind permission of the President; Prof. Peter Hutton