Anaesthetics is a medical specialty concerned with the provision of anaesthesia, pain relief and perioperative medicine.
The anaesthetist's function is to make you insensitive to pain during surgery, to supervise your recovery from anaesthesia, and to ensure you are comfortable afterwards. Many drugs and techniques may be used including
general
anaesthesia, regional
anaesthesia, local
anaesthesia and conscious
sedation together with monitoring techniques appropriate to your general medical condition and the magnitude of the surgery.
Your anaesthetist will stay with you at all times during and immediately after your operation and will carefully monitor the way your body responds to the stress it encounters.
You may have heard the terms anaesthesia and analgesia used. To clear up any confusion, the word anaesthesia means the absence of sensation, while analgesia is the absence of pain. If only unconscious the body still reacts to pain only you don't remember it. However the myriad of consequences of pain are still there including increased incidence of infections and complications.
Anaesthesia may be required for diagnostic procedures such as punch
biopsy, colposcopy
and EUA,
as well as definitive treatment including a vulvectomy
and groin
node dissection. The more minor procedures may be performed under a local
anaesthetic with or without conscious
sedation.
If your medical history is complex, vulvectomy and node dissection can
be safely performed under a spinal
or epidural
anaesthetic alone or with conscious
sedation. More usually a general
anaesthetic will be performed. These options will be discussed during
the pre-operative anaesthetic consultation.
Many people are frightened of an anaesthetic
as it involves loss of control and entry into a dark and scary place (i.e.
unconsciousness). During the preoperative visit the Anaesthetist will evaluate
the patient for any medical conditions and how they might influence the
anaesthetic. They will also try to allay the patient's fears by explaining what
is about to happen.
The patient will frequently be given a premed tablet to make them a little
drowsy before they go to theatre. When the nurse arrives to give this it is best
to leave the patient to gently settle into a relaxed state induced by the drugs.
On arrival in the operating theatre an intravenous drip will be started using a
local anaesthetic and all subsequent drugs will be given through this. When the
patient wakes up they will have been given enough painkillers to make sure they
are comfortable for the trip back to the ward.
If the operation is major then the anaesthetist will remain in contact with
the patient and supervise any advanced pain relief requirements, including patient
controlled analgesia and epidural
analgesia. The anaesthetist will also assist the surgical team with advice
regarding monitoring in the high dependency unit, intravenous fluid and oxygen
requirements.
Anaesthesia has come a long way since the days of chloroform and ether but
this is how many of our patients remember us. The modern anaesthetic causes very
little stress to a patient's health, pain is now readily controlled and post
operative nausea and vomiting are a relatively infrequent occurrence.
Prior to surgery your anaesthetist will take a medical history and perform a physical examination. Based on these findings, together with the results of any investigations deemed necessary such as
blood tests,
ECG and/or chest
X-Ray, your anaesthetist will formulate a plan of which type of anaesthetic to perform and will discuss this with you in detail.
To help with this planning process your anaesthetist will need to know about:
If you are unsure of the tablets you are taking, ask your general practitioner to write a note to your anaesthetist. Bring your tablets with you to the pre-operative visit!
If you feel unhappy or concerned about any aspects of your anaesthetist's plan you should talk this over as a plan can usually be safely modified to cater for individual concerns.
How can you prepare for your operation?
There are several simple things that can be done to improve your general condition prior to your operation:
- Moderate exercise such as walking will improve your general physical fitness.
- Cease smoking as soon as possible, ideally six weeks prior to surgery.
- Reduce alcohol consumption.
- Continue regular medication such as drugs used to control high blood pressure which have been prescribed for you.
- Do not take unprescribed Aspirin for 14 days prior to your operation. This is because it affects the body's blood clotting mechanisms and can increase the likelihood of excessive bleeding during and after surgery. Paracetamol may be used.
- Notify your surgeon or anaesthetist of any serious medical problems, such as
heart
disease or asthma well in advance of your admission as you may require an early preoperative consultation.
- If you are anxious about your anaesthesia, make an appointment to consult your anaesthetist, as this will provide you with information that may reduce your anxiety.
If your operation is planned as day
surgery then you will be discharged from hospital approximately 4 hours after the end of your surgery. Whilst you will be safe to travel home you must be accompanied by a responsible adult who should stay with you till the next day. You must not drive, operate machinery or sign any legal documents for 24hrs after your anaesthesia has ended.
There are many sources of information about anaesthesia available on the internet. Some places to start include:
