By Dr Amit Verma, MD (Anaesthesiology)
The word anaesthesia comes from a Greek word meaning absence of sensation. Anaesthesia is one of the most significant developments in modern medicine because it allows once painful surgeries to be performed while you are asleep or relaxed. One of the biggest concerns of any patient coming for surgery is if they will wake up after the surgery or if they will feel anything during the surgery. Modern anaesthesia is very safe, pleasant in experience and gives most patients the liberty to choose the type of anaesthesia for their surgery after discussion with their anaesthesiologist. This article is about how to prepare for your planned elective surgery.
Role of anaesthesiologist
After you have decided to undergo the surgery you should always discuss the ability and qualification of the anaesthesiologist who will manage your anaesthesia during the surgery. You should always see your anaesthesiologist before finalizing the date of your surgery. People often think that anaesthesia is simply putting to sleep. However, this is not strictly true. Anaesthesiology puts you into a carefully monitored and finely controlled state of unconsciousness. He or she does this with the help of available anaesthetics which are given either in your veins or which are breathed into your lungs for general anaesthesia. Another form of anaesthesia which is considered much safer is regional (spinal/ epidural) or local anaesthesia, where the small area of your body where surgery has to be performed is made numb with the help of local anaesthetics. Your bodily functions are carefully monitored during the surgery and also afterwards in the recovery area till they normalize.
Your role
There are a few things you can do to make your surgery and anaesthesia safer:
1. Exercise: Getting a little fitter does wonders for you tolerating the stress of surgery and anaesthesia.
2. Don’t smoke: Chronic smokers should stop smoking for at least 4-6 weeks before undergoing a major surgical procedure.
3. Stop drinking alcohol: Non-alcoholics always do better than alcohol addicts during recovery from anaesthesia.
4. Drugs: Discuss with your anaesthesiologist the drugs you are taking. If you have forgotten to discuss all the medications, bring them to the hospital when you come for surgery. There are some drugs which need to be stopped prior to surgery, eg, aspirin, warfarin, clopidogril, ticlopidince, etc, and then there are drugs which should be continued, like your antihypertensive medications.
5. Medical disorders: Always give information about any health-related issues which you have even if you think they are not important. Diseases like diabetes, hypertension and thyroid disorders affect the outcome of anaesthesia, and the treatment for them needs to optimize before you undergo any elective surgical procedure.
6. Stop taking any herbal medication and inform your anaesthesiologist about them.
7. Inform your anaesthesiologist about any recreational drug you use as this may interact with the anaesthetic.
8. Always discuss your previous anaesthetic experience.
9. Notify the anaesthesiologist about any known disorders in your family and also about any complicated anaesthetic experiences a family member has experienced. There are few syndromes which run in families and can affect recovery from anaesthesia.
10. Inform your surgeon and anaesthesiologist if you are a Jehovah’s Witness and what your views are about blood transfusion. Blood transfusion is always kept minimal, but if required it’s always safe to get blood donated before the surgery.
11. Inform the anaesthetist about any loose tooth or dentures you may have.
12. Inform the anaesthetist about any known drug allergies.
Fasting
We know that the pangs of hunger can be really severe, but no food or drink before the operation is a must. Not even water. Food or water consumed before an operation may be vomited and can enter your lungs when you are unconscious. Discuss the fasting guidelines with your doctor. Any default in fasting will result in the delay of your surgery for your own safety.
Type of anaesthesia
The type of anaesthesia you receive will depend on the nature and duration of your surgery. Every mode of anaesthesia has its own advantages and disadvantages. In general, local anaesthesia is safest and the anaesthesia risk is relatively high in general anaesthesia.
A thorough discussion with your anaesthesiologist will help you to get oriented to the whole procedure. If you take the time to learn about your procedure and the anesthesia, you will be better able to understand the information and instructions you are given. Knowing what to expect can help decrease tension and anxiety.
Before entering hospital
Patients who are to undergo major surgery are usually admitted one or more days beforehand, so that they can be fully examined and have any tests which are thought to be necessary. Minor cases are usually done as day cases, ie, patients are admitted and assessed on the day of surgery, and discharged on the same day. Such patients are often seen and examined at a pre-operative assessment clinic. Here any special problems can be discovered and discussed with an anaesthetist, and blood tests and X-rays can be done so that the results are ready for the day of the operation.
Going home
The best part is that most people now go home much sooner after surgery. If you are having day surgery, make sure there is someone to accompany you home and, for at least 24 hours, don’t drive a car, make important decisions, use any dangerous equipment or tools, sign any legal documents or drink alcohol.