You and Your Anaesthetic

Transcription

1 You and Your Anaesthetic Information to help patients prepare for an anaesthetic 0536/J Alper/June11reviewJune13

2 KEY INSTRUCTIONS Notes FOOD & DRINK BEFORE YOUR OPERATION EATING & DRINKING INSTRUCTIONS Food or liquid in your stomach at the time of anaesthesia may cause life-threatening complications. That is the reason why you must obey these instructions before surgery. If you are to be admitted in the morning for surgery on the same morning Food - Nothing to eat from am. Fluid - You should drink clear fluids* to finish by am. If you are to be admitted for surgery that afternoon Food - A light breakfast to finish by 8.00 am. Nothing to eat after that. Fluid - You should drink clear fluids* to finish by midday. If you are admitted the day before your proposed surgery, you will be told by the ward staff about the times for eating & drinking. *Clear fluids include water, squash, dilute fruit juice without pulp, black tea & coffee, but nothing that contains milk or alcohol. Chewing gum and sweets are potential hazards that may cause choking or vomiting. They must not be chewed or taken for 6 hours before surgery. IT IS ABSOLUTELY ESSENTIAL THAT YOU STICK TO THESE INSTRUCTIONS ABOUT EATING & DRINKING. FAILURE TO DO SO MAY RESULT IN CANCELLATION OF YOUR OPERATION 1 14

3 This booklet has been written to give you basic information to help you prepare for your anaesthetic. It has been prepared by patients, patient representatives and anaesthetists. It was produced by Dr. Jonathan Alper & Dr. Michael Walburn in association with the Department of Anaesthesia, Musgrove Park Hopital, Taunton & Somerset NHS Foundation Trust, Taunton. It is a modification of the booklet produced jointly by the Association of Anaesthetists of Great Britain and Ireland (AAGB&I), and the Royal College of Anaesthetists (RCA). Fourth edition June 2011 review 2013 WHEN TO TAKE YOUR MEDICINES BEFORE SURGERY It is important to take all your usual medicines before you come into hospital unless mentioned below. On the day of surgery you can take your tablets with a sip of water. Medicines not to take: Please contact the Pre-operative Assessment Clinic (POAC) on telephone: with any further queries about your medication. BLOOD CLOTS (THROMBOSIS OF THE LEGS & LUNGS) Patients undergoing surgery are at risk of developing thrombosis. What you should do to reduce the risk: Keep active before and after your operation. Keep well hydrated (drink plenty) before and after your operation. What we will do to reduce the risk: Assess your personal risk. Take appropriate action, for example: asking you to wear special stockings, which we will supply, or blood-thinning injections. KEEPING WARM You may become cold before, during, and after your operation. This can lead to serious complications. What you should do to reduce the risk: Before your operation, stay warm, wear extra clothing, and walk around. Bring warm clothing with you e.g. vests, a dressing gown, slippers and socks. If you feel cold at any time you must tell a member of staff. What we will do to reduce the risk: Measure your temperature and keep you warm throughout your operation. 13 2

4 Before coming to hospital Preparing yourself - things that you can do to prepare yourself for your operation in the weeks or months before coming into hospital: If you smoke, giving up for several weeks before the operation reduces the risk of breathing problems. The longer you can give up beforehand, the better. If you cannot stop smoking completely, cutting down is still very important. If you are overweight, reducing your weight will reduce many of the risks of having an anaesthetic. If you have loose teeth or crowns, treatment from your dentist may reduce the risk of damage to your teeth if the anaesthetist needs to put a tube in your throat to help you breathe. If you have a long-standing medical problem such as diabetes, asthma, thyroid problems, epilepsy or high blood pressure (hypertension), your GP should give you a check-up. MEDICAL PRE-OPERATIVE ASSESSMENT Useful organisations for more information Royal College of Anaesthetists (RCA) This is the organisation responsible for the training and standards in anaesthesia, critical care and pain management throughout the UK. Phone: Website: Association of Anaesthetists of Great Britain and Ireland (AAGB&I) This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland. Phone: Website: General information about anaesthetics You can find out more from the internet by visiting this website: You will be asked questions to check your health before your operation. This may be at a pre-operative assessment clinic (POAC) by filling in a questionnaire, by talking to doctors or nurses on the ward, or when you meet your anaesthetist. It is important for you to bring a list of: all the pills, medicines, herbal remedies or supplements you are taking, both prescribed and those that you have purchased over the counter. any allergies you may have. 3 12

5 Stroke: This is uncommon, but more likely in certain kinds of surgery. People who have diseased blood vessels, have had a stroke before, have high blood pressure, or who are diabetic may be more likely to suffer a stroke. The effects of a stroke may range from being relatively minor to very serious. Confusion: Some people may experience a degree of confusion after their operation. In most patients, this gets better in a few days. Very rarely it may last longer. Elderly people, those in poor general health or who have dementia, and those with high alcohol intake are more likely to experience confusion. The ward staff are trained to detect confusion and help manage the problems. Heart attack: People who have diseased blood vessels, have had a heart attack before, have high blood pressure, or who are diabetic may be more likely to suffer are more likely to be at risk for this. It is very unlikely in those who are fit and healthy. Awareness under anaesthesia: This may occur in about 1 in 3000 cases. Of these, about one third may experience actual pain. Your anaesthetist will take the utmost care to prevent this from happening. Your anaesthetist will continually monitor the amount of anaesthetic given to you throughout. Allergy: Minor temporary reactions to drugs and latex may occur. More serious forms of reactions occur between 1 in to 1 in anaesthetics. Most people will recover fully from these. Occasionally the reaction may be so severe as to be life-threatening. Your anaesthetist is trained to recognise and treat these. Death: Most deaths that occur around the time of surgery are due to a combination of circumstances and events. This is more likely as a result of emergency surgery, especially in older patients, and those who are unwell before their surgery. Fortunately deaths due directly to anaesthesia itself are very rare, about 4 or 5 deaths for every million general anaesthetics given each year in the UK. ON THE DAY OF YOUR OPERATION FOOD & DRINK BEFORE YOUR OPERATION EATING & DRINKING INSTRUCTIONS It is absolutely essential that you stick to the instructions about fasting on page 1. Failure to do so may result in cancellation of your operation. If you feel unwell when you are due to come into hospital, please telephone the ward to which you are due to be admitted for advice. What is anaesthesia? Anaesthesia stops you feeling pain and other sensations. It can be given in various ways and does not necessarily make you unconscious. General anaesthesia is a state of controlled unconsciousness. It is essential for some operations. You are unconscious and do not feel anything at all. Local anaesthesia involves injections that numb a small part of your body. You stay conscious but free from pain. Regional anaesthesia involves injections that numb a larger or deeper part of the body. You stay conscious but free from pain. Sometimes sedation is given with local and regional anaesthesia to help relax you. Anaesthetists Anaesthetists are doctors with specialist training who: discuss types of anaesthesia with you and find out what you would like, helping you to make choices. discuss the risks of anaesthesia with you. 11 agree a plan with you for your anaesthetic and pain control after surgery. 4

6 are responsible for giving your anaesthetic and for your wellbeing and safety throughout your operation. plan your care, if needed, in the Intensive Care Unit. Choice of Anaesthetic The choice of anaesthetic depends on: your operation. your physical health. your preferences and the reasons for them. your anaesthetist s recommendations for you and the reasons for them. the equipment, staff and other resources at your hospital. Premedication (a premed ) is the name for drugs which are sometimes given before an anaesthetic. Some premeds prepare your body for the anaesthetic, others help you to relax. They may make you drowsier after the operation. Because of this, they are not usually given if you are being operated on as a day case. If you think a premed would help you, ask your anaesthetist. If you are having a local or regional anaesthetic, you will also need to decide whether you would prefer to: be fully alert. be relaxed and sleepy (sedation). have a general anaesthetic as well if it is safe to do so. Sedation is the use of small amounts of anaesthetic or similar drugs to produce a sleepy-like state without losing consciousness. 5 Feeling sick and vomiting after surgery: This can be caused by certain drugs and more likely in certain people and certain operations. This may be very common, especially if you have experienced it before. We can give drugs to try to relieve it. Headache: This is not often severe. It usually gets better with painkillers such as paracetamol and increased fluid intake. Sore throat: (caused by instruments in the mouth & airway).this too, is minor and usually gets better very quickly. Paracetamol may help this. Much more rarely, there may be actual damage to the vocal cords, and this may require specialist treatment. Other aches & pains including back pains: These may occur for a variety of reasons, are usually temporary, and get better with painkillers. Teeth & lips: (caused by instruments in the mouth & airway). Minor damage to the lips or tongue may be common and also gets better quickly. Damage to the teeth is less common, but may be more severe and might require treatment from your dentist. Chest infections: People who smoke are more likely to develop this. It is also more common after certain types of surgery. Chest infections may become serious. Some less common complications Eyes: Damage to the lining of the eye may occur in about 1 in 600 cases and may require specialist treatment. Other damage to the eyeball itself and its main nerve is rare, but may be more severe. Nerve injury: This may occur as a result of the way you are positioned during the operation. It may occur in about 1 in 600 patients. Certain nerves are more vulnerable than others for example, the nerve that runs behind your elbow. It may also occur as a result of certain types of procedure such as spinal and epidural techniques, and certain local anaesthetic nerve blocks. Injury may occur in about 1-2 patients per 5000 procedures for spinal or epidural anaesthetics. The chance of a nerve injury with a peripheral nerve block is about 1-2 in In all cases, damage is usually temporary, but sometimes it may be permanent 10

7 Patient-controlled analgesia (PCA): This is a method using a machine that allows you to control your pain relief yourself. It is connected to your drip. The machine contains a powerful painkiller, and is set so that you cannot give yourself an overdose. Local anaesthetics and regional blocks: These types of anaesthesia can be very useful for relieving pain after surgery. Your anaesthetist will discuss this with you, and explain the procedure. Risks In modern anaesthesia, serious problems are uncommon. Risk cannot be removed completely, but modern equipment, training and drugs have made it much safer. The risk to you as an individual will depend on: whether you have any other illness. personal factors, such as smoking or being overweight. surgery which is complicated, long or done as an emergency. In order for you to assess the risk of a procedure, it is helpful to know how doctors interpret the words and numbers to describe risk. They use this scale: Very common Common Uncommon Rare Very rare 1 in 10 1 in in in 10,000 1 in 100,000 Patients patients patients patients patients Some very common & common complications or side effects Your anaesthetist will be able to explain further about any of these side-effects or complications 9 Discussion with the anaesthetist Your anaesthetist will meet you before your operation and will: ask you about your health. discuss with you which types of anaesthetic can be used. discuss with you the benefits, risks and your preferences. decide with you which anaesthetic would be best for you. decide for you, if you would prefer that. Nothing will happen to you until you understand, and agree with what has been planned for you. You have the right to refuse if you do not want the treatment suggested. Going to theatre When you are called for your operation: You can wear your glasses, hearing aids and dentures until you are in the anaesthetic room. Discuss with your anaesthetist whether you may keep your dentures in. Jewellery and decorative piercing should ideally be removed and in some instances, it is essential. If you cannot remove your jewellery, it can be covered with tape to prevent damage to it or to your skin. If you are having a local or regional anaesthetic, you may take a personal tape or CD player with you to listen to music through your headphones. Most people go to theatre on a wheelchair, bed or trolley. For some operations you may be able to walk to the theatre. You will be 6

8 accompanied by a member of staff at all times. Theatre staff will check your identification bracelet, your name and date of birth, and will ask you about other details in your medical records as a final check that you are having the right operation. Having the Anaesthetic The operating department ( theatres ) Most anaesthetics are started in the anaesthetic room. The anaesthetist will attach machines which measure your heart rate, blood pressure and oxygen levels. When the anaesthetic has started, you will go through to the actual operating theatre for the operation. General anaesthetics There are two ways of starting a general anaesthetic: anaesthetic drugs may be injected into a vein through a cannula (a hollow plastic needle inserted into a vein). you can breathe anaesthetic gases and oxygen through a mask. This method is used more commonly for children rather than adults. Once you are unconscious, an anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised. As soon as the operation is finished, the drugs will be stopped or reversed so that you regain consciousness. Local and regional anaesthetics Your anaesthetist will ask you to keep quite still while the injections are given. You may notice a warm tingling feeling as the anaesthetic begins to take effect. Your operation will only go ahead when you and your anaesthetist are sure that the area is numb. 7 If you are not having sedation you will remain alert and aware of your surroundings. A screen shields the operating site, so you will not see the operation. Your anaesthetist is always near to you and you can speak to him or her whenever you want to. After the operation Recovering After the operation, you will be taken to the recovery room to recover fully from your anaesthetic. When the recovery staff are satisfied that you have recovered safely from your anaesthetic, you will be taken back to the ward. How you will feel afterwards will depend on the type of anaesthetic and operation you have had how much pain-relieving medicine you need, and your general health. Pain relief afterwards Good pain relief is important and some people need more pain relief than others. It is much easier to relieve pain if it is dealt with before it gets bad, so you should ask for help when you feel pain. Occasionally, pain is a warning sign that all is not well, which is another reason why you should ask for help if you are in pain. Pain relief can be increased, given more often, or given in different combinations. Types of pain relief These are some ways of giving pain relief: Pills, tablets or liquids to swallow: These are used for all types of pain. They take at least half an hour to work. You need to be able to eat, drink and not feel sick for these drugs to work. Injections: These are often needed, and are given either into a vein for immediate effect, or into your leg or buttock muscle. If in a muscle, they may take up to 20 minutes to work. Suppositories: These waxy pellets are put in your back passage (rectum). The pellet dissolves and the drug passes into the body. They are useful if you cannot swallow or if you might vomit. 8