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PREFACE

The anaesthetists of BARC hospital want you to feel safe,

comfortable and pain free during your surgery and make it a pleasant experience for you. This information booklet will help you and your family better understand what modern anaesthesia is and answer many of your questions. It may not answer all your queries, for which you may contact your anaesthetist.

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ACKNOWLEDGEMENTS

We would like to thank the following people for their invaluable suggestions without which this booklet would not have been possible – Dr Ragini Suchak, Dr V Karira, Dr A Misri, Dr Pratibha Toal, Dr Shrividya and Dr Pritee Padwal.

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Who is an Anaesthetist? Most people think of the anaesthetist as the “Doctor behind the mask” who puts them to sleep through the surgery and wakes them up when surgery is over. Let us lift the mask and take a look at the responsibilities of the anaesthetist. Anaesthetist is a specialist doctor who is trained to administer Anaesthesia, to give pain relief, to take care of critically ill patients in the Intensive Care Unit (ICU) and to resuscitate patients in emergencies. Your Anaesthetist is responsible for: • Your wellbeing and safety throughout the surgery. • Planning and administering Anaesthesia. • Relieving pain. • Care in the Intensive Care Unit post surgery (if required). What is Anaesthesia? • The word ‘anaesthesia’ means ‘loss of sensation’. • It stops you from feeling pain and other sensations. • It can be administered by various routes (General, Spinal, Epidural, etc.) • Not all types of anaesthesia make you unconscious. • It can be localised for different parts of the body (Blocks). Drugs that cause anaesthesia work by blocking the signals going to the brain. When the action of these drugs wear off, normal sensations return.

What are the different types of Anaesthesia? Local Anaesthesia: Local Anaesthesia numbs a particular part of the body which is to be operated. It is used when the nerves can easily be reached by drops (topical Anaesthesia), spray, ointment or injection. You are conscious but do not feel the pain of the surgery. Regional Anaesthesia Regional Anaesthesia is used for operations on larger or deeper parts of the body. Local anaesthetic drugs are injected near the bundles of nerves which carry pain signals from that area of the body to the brain. The most common regional Anaesthesia is spinal and epidural Anaesthesia. These are used for operations on the lower part of the body. You are conscious but free from pain. You will be given a sedative too if required. General Anaesthesia General Anaesthesia is a state of controlled unconsciousness during which you are unconscious with no awareness or memory of the surgery. Anaesthetic drugs are injected into a vein or anaesthetic gases which are administered through the lungs by a face mask.

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What precautions should I take before surgery? • If you are a smoker, you should give it up for several weeks before the

surgery. Smoking reduces the amount of oxygen in your blood and increases the risk of breathing problems during and after an operation.

• If you are very overweight, the risks of Anaesthesia are increased.

Weight reduction will be beneficial. • If you have loose or broken teeth, or crowns that are not secure, you

may visit your dentist for treatment. The anaesthetist may need to put a tube in your mouth to help you breathe and any loose teeth may fall off and can enter the wind pipe.

• If you have medical problems such as Diabetes, Asthma or bronchitis,

Thyroid dysfunction, Heart disease or High Blood Pressure, they should be controlled before the surgery.

What is pre-Anaesthesia checkup? Before surgery, we need to know about your general health. This will be done in the pre-Anaesthesia check up (PAC) OPD. Here enquiry is made about: • Your general health. • Past or present illnesses and any allergies. • Family history of Anaesthesia problems. • History of chest pain, breathlessness. • Any medicines you are taking, including herbal remedies. • any loose teeth, dental caps, crowns or bridges. • History of smoking, alcohol intake, etc. Physical examination will be done and reports of blood tests, X-ray, ECG and other tests will be reviewed. If required a specialist reference may be advised. You can make queries regarding the Anaesthesia or surgery here and get you doubts cleared. The decision of the route of Anaesthesia depends on: • The type of surgery. • Your medical condition and fitness. • Your choice will also be considered. Why does the anaesthetist postpone some operations? Medical illnesses affect the safety of the Anaesthesia. If these are not well controlled it could increase the risk of Anaesthesia and surgery. It might be prudent to postpone the surgery until the illness is well controlled or treated. The reason for delay for the surgery would be discussed with you. The surgery might be delayed if proper fasting is not done prior to the surgery. Your well being is our concern

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BEFORE THE SURGERY Why do I have to sign the consent form? Your consent for the surgery and Anaesthesia is mandatory. This booklet and the doctor who speaks to you in the pre Anaesthesia check-up will explain to you the options as well as the risks associated with Anaesthesia. Your or the guardian’s signature (in case of minors, mentally retarded and invalid patients) implies that you have understood and are willing for the procedure. If I am fasting, what about my routine medicines? You should take your regular medications on the day of surgery with sips of water. If you are taking drugs to thin your blood (such as warfarin, aspirin or clopidogrel) or drugs for diabetes, hypertension etc, you will be given specific instructions. Will I need blood? During most surgeries, there is some blood loss. The anaesthetist will usually make up for this blood loss by giving fluids. If there is significant blood loss, blood transfusion might be necessary. What preparations are done before taking to the operation theatre? • You will be changed to an OT gown • Any nail paint will be removed, as it can interfere with oxygen monitoring • Jewellery will be removed or covered with tape. • Your glasses, dentures, hearing aid can be removed in the OT. IN THE THEATER Getting ready for Anaesthesia. You will be shifted onto the operation table. The anaesthetist will insert a needle with a fine tube into a vein, usually in the hand. Your anaesthetist will then start your Anaesthesia.

What is done after Anaesthesia? The anaesthetist is present throughout the operation - monitoring and regulating the body functions like breathing, heart rate, blood pressure, brain and kidney functions. They also diagnose and treat any medical problems that might arise during surgery. At the end of surgery, the anaesthetist ensures you wake up safely. Will I get up during surgery or feel pain? You will not feel pain or awaken during surgery. What happens to me after the operation? On waking up if your physical condition is stable, you will be transferred to the recovery room.

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AFTER THE OPERATION What about pain relief? All operations cause pain which is treated with analgesics. Ask for pain relief if you experience pain after the surgery. When can I resume eating? The type of surgery and Anaesthesia will decide how long it will be before you can resume drinking or eating. You will be given specific instruction for the same. When will I be shifted back to the ward? The doctor must be satisfied that you have safely recovered and that all the vital parameters (pulse, blood pressure, etc) are stable before you are shifted back. Is Anaesthesia safe? Yes, it is very safe. The risk of serious complications from Anaesthesia for a healthy person is rare.