YOU AND YOUR ANAESTHETIC

YOU AND YOUR ANAESTHETIC Information Leaflet Your Health. Our Priority.

of 8 This leaflet aims to answer some of the questions you may have about your anaesthetic and contains fasting instructions. PLEASE READ IT and keep it safe. Any additional questions you may have can be discussed with your anaesthetist when they visit you before your operation. Am I allowed to eat and drink before my operation? Morning operations Afternoon operations All day operations Food, chewing gum & drinks No food after midnight Light breakfast (tea and toast) before 7.00am No food after midnight Still water 6.00am 10.30am 6.00am It is important for you to stop eating and drinking in plenty of time before your operation ( Nil by Mouth ). The reasons for this are: Food takes many hours to digest in the stomach. If there is food in your stomach, you have a higher chance of being sick as you are anaesthetised This can be very dangerous as food may enter the lungs and cause pneumonia In general, food should not be eaten for a minimum of 6 hours before surgery (but you are encouraged to drink a glass of still water up to the time set in the table above before surgery). If you are coming into hospital on the day of surgery, please comply with the following fasting instructions.

of 8 Morning operations If your operation is in the morning, do not eat after midnight. Please drink a glass of still water before 6.00am Afternoon operations If your operation is planned for the afternoon you should have a light breakfast (e.g. tea and toast) before 7 o clock in the morning. You may continue to drink water still water up until 10.30am All day operating lists We have several theatres that run all day operating lists and it is not always possible to predict whether you will have your operation in the morning or afternoon Please drink a glass of still water before 6.00am If on admission it is clear that you will be on the afternoon list, the nursing staff will be able to offer you a drink of water until 10.30am Am I allowed to smoke or drink alcohol before my operation? Chemicals from smoking lower the amount of oxygen that can be carried in the blood, so try not to smoke for as long as possible before your operation. At the very least don t smoke for 24 hours before your operation. This will help with your anaesthetic and the operation The hospital operates a no-smoking policy. A nicotine patch may help you to give up smoking. These can be obtained from the hospital when you come in, a chemist or from your GP Alcohol and anaesthetics do not react well together. Therefore, please avoid alcohol for 24 hours before and after your operation Should I take my tablets before coming to hospital? You should continue to take most prescription medicines as normal until you come into hospital. On the day of your operation take your prescription medicines as normal with the last drink before you are nil by mouth It is important to continue with most heart or blood pressure medicines There are some medicines which may need to be stopped several days before your operation (e.g. blood thinning tablets such as Warfarin/Clopidogrel), and replaced with alternative medicines. You may be asked to omit some tablets before your operation (e.g. blood sugar lowering tablets). It is therefore important to tell the doctor or nurse at the preassessment clinic about your medicines so that they can give appropriate instructions to you. Please consult yellow drug slip (Pre-operative medication instructions) given by preop nurses, before you omit your tablets

of 8 If you are a diabetic on tablets or insulin tell the doctor or nurse at the pre-assessment clinic, so that arrangements can be made to manage your diabetes while you are not allowed to eat and drink Bring your usual prescribed medication into hospital with you when you come in for your surgery (including any inhalers) Will the anaesthetist see me before my operation? Normally an anaesthetist will visit you before your operation. They will ask you questions about your health, past anaesthetics and answer any questions you may have related to your anaesthetic The anaesthetist will discuss with you what type of anaesthetic is appropriate for you, taking into account the type of operation, your general health and your views Type of anaesthetics General Anaesthetics During a general anaesthetic you will be unconscious throughout the procedure In order to anaesthetise you (put you to sleep for the duration of the operation) a cannula a small plastic tube, will be placed in the back of your hand or arm (this may cause some bruising when it is removed). The anaesthetic drugs are administered via this cannula. Some tingling in the arm may be experienced during the injection; this is normal Some patients have very difficult veins, and very occasionally you may be anaesthetised using anaesthetic gas via a mask You are kept unconscious throughout your operation with anaesthetic. Waking up during the operation is a common fear. This is extremely unlikely; the anaesthetist is present throughout your anaesthetic and monitors your anaesthetic levels continuously Local anaesthetics Many operations can be done using an injection to numb the area of the operation with you awake during the operation. The technique will be explained in more detail by your anaesthetist if they apply to you A regional anaesthetic is where local anaesthetic drugs are placed in the back (spinal or epidural). This will make your legs and tummy numb and heavy. Sometimes you may also be given medicine to make you feel more relaxed/sleepy during the operation Nerve blocks are where an injection is placed around the nerve that supplies feeling to the area for the operation, this will numb that area A local anaesthetic can also be used with general anaesthesia to provide pain relief

of 8 What happens before I go to the operating theatre? When you are getting ready to come to the operating theatre you will be given a gown to wear and depending on the operation you are having, you may be allowed to wear clean cotton pants or briefs All jewellery must be removed if possible. This includes earrings, tongue studs and any other type of body piercing. The only exception is a plain wedding ring or items of jewellery you are unable to take off, these items will need to be taped up Nail polish and false nails must also be taken off. These items can interfere with how well some of the routine monitoring equipment works that you will have for your anaesthetic If you wear glasses, have dentures, a hearing aid etc. you may wear these to theatre if you wish. You will be asked to remove these before going to sleep so please bring a container marked with your name and ward with you to theatre (these will be supplied by a member of the nursing staff) Pre-meds are no longer given as a routine. If you are very anxious then tell the anaesthetist who may prescribe you some medication to help you relax Female patients (aged 10 to 55 years) To comply with national guidance all female patients of childbearing age will be asked sensitively whether they could be pregnant. This is carried out for safety purposes for patients undergoing any operation or x-ray investigation. A pregnancy test will only be carried out with the patient s consent where doubt exists. What happens when I arrive in the operating theatre? When you reach the operating theatre a member of staff in reception will ask you a few questions in preparation for your operation You will be taken to the anaesthetic room when the operating theatre is ready for you. The staff will explain what is happening It is routine for you to have your blood pressure and heart monitored, you will also have a finger peg to measure the oxygen in your blood For more major operations special monitoring may be used such as arterial or central cannulas. If this is necessary, your anaesthetist will explain these procedures

of 8 What happens after my operation? After your operation is finished you will be taken into the recovery room. The staff there will look after you until you are fully awake, comfortable and ready to go back to the ward Some patients, having major surgery, may need to go to our High Dependency Unit (HDU) or Intensive Care Unit (ICU) post-operatively for special monitoring and care. If this is the case it will be discussed with you For some operations, you may need to have a drip. This is to stop you from becoming dehydrated. You may also have a tube drain from the operation site Not everyone feels sick after an operation. If you have felt sick after an operation before, then the anaesthetist will usually give you an anti-sickness injection while you are asleep Common minor side effects following a general anaesthetic are: - Muzzy headache. -Temporary blurred vision. -Sore throat. -Nausea. Anaesthetics- Are there any risks? Generally, modern anaesthetics are very safe and your anaesthetist is a highly trained specialist doctor. Major complications from anaesthesia are very rare but can be serious and permanent Very occasionally, a patient can have an unpredictable response or allergic reaction to anaesthetic drugs. It is therefore important to let the pre-assessment nurse and your anaesthetist know if you have had a bad anaesthetic experience in the past or a close member of your family (blood relative) has had a bad reaction Patients with chest problems can experience a worsening of their condition and breathing problems after anaesthesia and surgery. For this reason, your anaesthetist may advise a spinal or local anaesthetic for some types of surgical procedures if they feel it appropriate Patients with pre-existing heart and circulation problems are also at slightly higher risk. Heart attacks and strokes occurring under an anaesthetic are rare, but can occur if your heart is not functioning well. If you have severe problems involving your heart or circulation your anaesthetist will discuss your anaesthetic with you, explaining any risks During general anaesthesia when you are asleep, the anaesthetist will take over control of your breathing. In some patients, there can be anatomical problems (problems related to your shape and build) that make control of the breathing more difficult. Loose teeth, caps and crowns can cause difficulties, which is why your anaesthetist will ask about your teeth. Occasionally, this will pose a risk of damaging teeth or dental work

of 8 Death occurring due to anaesthesia is very rare (1 in 200,000). Problems are more common if you are already ill with an existing medical condition and require an operation. The risks are also increased as you get older or if you are overweight. In these circumstances the anaesthetist will discuss your individual risk. If you have any particular concerns, you should discuss them with your anaesthetist before coming to theatre so that you may make an informed choice What if I have any pain or sickness after the operation? Your anaesthetist will discuss methods of pain relief with you on the ward before you come to the operating theatre. For major operations you may be offered an epidural or a PCA (patient controlled analgesia) pump or a specific local anaesthetic nerve block that numbs the area (separate information leaflets are available) During the operation the anaesthetist will give you painkillers that will last until after you are awake. Sometimes patients wake up with some pain and will need further painkillers in recovery We will try to ensure you are comfortable before going back to your ward Some patients will experience nausea after surgery, anti-sickness drugs are given as routine in theatre. Further medication will be written up for you post-operatively. Some patients are more prone to nausea than others and unfortunately it is not possible to guarantee that you will not be sick Information on mobilising, eating, drinking and returning to work will depend on your procedure and should be discussed with your surgeon. If you need any further information please contact us at the Department of Anaesthetics, Stepping Hill Hospital, or at the anaesthetic pre-assessment clinic on 0161 419 5684. Alternatively, look on the following websites: Royal College of Anaesthetists Website www.youranaesthetic.info The Association of Anaesthetics of Great Britain & Ireland: Pre-operative Assessment and Patient Preparation The role of the Anaesthetist 2 (2010) Stockport NHS Foundation Trust website: http:///patients-and-services

of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678 Information Leaflet. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number CC21 Publication date August 2014 Review date August 2015 Department Critical Care Location Stepping Hill Hospital