Anaesthetics

About general anaesthesia

General anaesthesia is an extremely common form of anaesthesia that we use for a variety of surgical procedures including general surgery, orthopaedics, trauma, urology, gynaecology, ENT, breast, vascular, maxillofacial, cardiothoracics and neurosurgery.

General anaesthesia is a state of controlled unconsciousness where medications are used to send you to sleep so that you are unaware of surgery and don’t move or feel pain while it is carried out. An anaesthetist will meet you before your operation to decide with you if a general anaesthetic is the most appropriate choice.

The anaesthetic is most commonly given as a liquid injected into your veins through a cannula (a small plastic tube) but can also be given as a gas that you breathe through a mask.

At the end of the operation the anaesthetic is stopped and you will gradually wake up. Depending on your surgery you will need to stay in hospital for a few hours or a few days after your surgery.

Anaesthetics can affect your memory, concentration and reflexes so it is important to have adult supervision for at least the first 24 hours after a general anaesthetic.

On the day of your surgery

The following video showing your operating theatre journey may answer a lot of your questions about what will happen on the day of surgery:

You should have been given clear fasting instructions before coming in to hospital and it is important to follow these. Following admission by the nursing team on the ward an anaesthetist will come to talk to you about your medical history and also to talk through the anaesthetic plan. This will depend on:

• The operation you are having and your physical condition
• Your preferences and the reasons for them
• The recommendation of the anaesthetist
• The equipment, staff and resources available at the hospital

A member of staff from the operating team will go with you to theatre. They will conduct some final checks such as your name, the operation you are having, when you last ate or drank and your allergies. Don’t be concerned that you are being asked the same questions several times, the routine checks are normal in all hospitals.

Side effects and complications

In modern anaesthesia, serious problems are uncommon. As with any medical procedure risk cannot be completely removed but modern equipment, training and drugs have made anaesthesia a much safer procedure in recent years. Please see more information on the types of risks on this infographic here.

Your anaesthetist will talk through any specific concerns they have, but make sure you ask any questions if you have any worries.

Further information

Further information about general anaesthesia can be found at https://www.nhs.uk/conditions/anaesthesia/ or in the following leaflet produced by the Royal College of Anaesthetists: You and Your Anaesthetic.

See the the following patient leaflets for more specific information depending on the surgery you are having:

• Epidural pain relief after surgery – this leaflet is useful if you are considering having an epidural placed for pain relief during or after your operation. This may be suitable for major abdominal surgery, upper gastrointestinal surgery, vascular surgery or complex lower limb surgery.
• Your anaesthetic for major surgery – this leaflet is useful if you are having major surgery of any kind and you have been informed or think that your postoperative care may take place on the high dependency or intensive care unit.
• Caring for someone who has had a general anaesthetic or sedation leaflet – this is essential reading for anyone who has been asked to look after a friend or relative who has had a general anaesthetic.

What is regional anaesthesia?

If you are having an operation on an arm or a leg it may be possible to have this done under regional anaesthesia. When performing regional anaesthesia we use ultrasound to find the nerves that supply the limb being operated on and inject some local anaesthetic around the nerves which numbs the area allowing you to have the operation performed awake.

A needle can also be inserted into the back to provide numbness to the whole lower body. This technique is called a spinal or epidural anaesthetic and can be used for some urology, gynaecology, obstetric, general, orthopaedic and vascular procedures performed on the lower body and limbs.

Sometimes regional anaesthesia is used alongside general anaesthesia as a form of pain relief. It may also be possible to have sedation following your nerve block so you are not completely conscious for your operation.

The main benefits of a regional anaesthetic come from the avoidance of a general anaesthetic. This is good for you because:

• You avoid side-effects such as nausea and vomiting or confusion
• You avoid the need for strong painkillers which may make you drowsy
• It reduces the stress on the body associated with a general anaesthetic
• You may eat and drink earlier

Side effects and complications

Our anaesthetists are experienced in placing blocks and most patients won’t have any, or only minor, temporary complications. However, any medical procedure carries a risk:

• Nerve damage: about 1 in 5 patients report numbness or tingling up to 5 days after the procedure. Permanent nerve damage from a block is rare
• Bleeding: bruising around the injection site is rare and will clear up on its own. Bleeding from larger blood vessels is uncommon and is easily controlled at the time
• Infection: as the injection is performed in a sterile environment in the operating department this is uncommon, but any infection may need treatment with antibiotics
• Inadequate block: if you become uncomfortable the anaesthetist or surgeon can add more local anaesthetic. If this is ineffective you may need conversion to a general anaesthetic.

Further information

The leaflets below have some useful information:

• Nerve blocks for surgery on the shoulder, arm or hand – this leaflet is useful if you are having surgery on your upper limb that may require regional anaesthesia. The leaflet discusses the procedure itself in more detail as well as pre and postoperative instructions.
• Regional anaesthesia for foot and ankle surgery leaflet – this leaflet is useful if you are having surgery on your lower limb that may require regional anaesthesia. The leaflet discusses the procedure itself in more detail as well as pre and postoperative instructions.
• Regional anaesthesia for perineural catheters leaflet – this leaflet is useful if you are having an infusion of local anaesthetic around a nerve. This would be used for preoperative or postoperative pain relief.
• Anaesthetic choices for hip or knee replacement leaflet – this leaflet discusses the different anaesthetic options for hip and knee replacement surgery which include regional and general anaesthesia.
• Your spinal anaesthetic leaflet – this leaflet describes the process, benefits and risks of a spinal anaesthetic in more detail.
  
• Headache after an epidural or spinal anaesthetic leaflet – a headache is a common risk of a spinal or epidural anaesthetic. This leaflet describes in detail the characteristics of this headache and the potential treatment options.

What is sedation?

You may have been told that your procedure will involve sedation. Sedation techniques include anything from some medication to relax you a little all the way through to deep sedation which will make you sleep through most of your operation.

It is important to note that any level of sedation is not the same as a general anaesthetic and you may remember your surgery, this is normal and expected.

Further information

• Sedation explained leaflet is a leaflet from the Royal College of Anaesthetists explains a little more in detail about different types of sedation including the benefits and risks.
• Enhanced sedation for GI endoscopy leaflet – this is a BSUH specific leaflet for anyone having an endoscopy under enhanced sedation.

Do I need to see an anaesthetist before I give birth?

Anaesthetists are an integral part of the labour ward team and are often involved in planning deliveries.

To ensure the safest delivery for you and your baby we want to see you in clinic if you have any of the following:

• Weakness or numbness in the legs because of a back problem
• Past history of surgery for scoliosis, or have moderate to severe scoliosis currently
• Metalwork in the back following surgery
• Any history of brain surgery or a brain tumour, multiple sclerosis, spina bifida, neuropathy, myopathy or poorly controlled epilepsy
• Severe breathing problems that needed hospital admission. Or any problem that requires you to see respiratory specialists e.g. severe asthma, cystic fibrosis, bronchiectasis
• Previous anaesthetic problems such as failed spinal or known intubation difficulties
• Unexplained severe allergic (anaphylactic) reactions
• Any other severe systemic disease such as severe SLE, systemic sclerosis, liver disease, renal failure etc

If you think you fall into any of these categories or have another reason you think you need to see an anaesthetist please let your midwife know so you can be referred to our clinic.

Often people worry about back pain in pregnancy and their ability to have an epidural. If you have a simple slipped disc, mild scoliosis or have developed back pain during pregnancy you do not need to see an anaesthetist and your anaesthetic choices should not be limited. Please see our leaflet regarding anaesthetic information for those with back problems in pregnancy for more information.

Pain relief in labour

There are many options available to help you manage your contractions. Please see the section on pain relief in labour on our maternity website for more information and the table below for comparison on anaesthetic options. Please note that this is not an exhaustive list and your midwife will be able to talk through your options in more detail to help you make a birth plan.

An anaesthetist is always present on the labour ward so let your midwife know if you have any questions regarding pain relief in labour and would like to speak to an anaesthetist regarding them.

	Etonox (Gas and Air)	Pethidine injection	Epidural
What is it?	A mix of oxygen and nitrous oxide	A morphine like injection given by the midwives	A fine tube inserted into your back which delivers a numbing solution to surround your nerves
How do you use it?	It is breathed in using a mask or mouthpiece	It is given as an injection into the muscle of your arm or leg	Sit still or lie on your side while the tube is inserted. Once in place you will have a button to control the doses given
How much pain relief does it give?	Moderate help	Mild to moderate	Excellent. Though there is a risk that it may not work well and need replacing
How long does it take to work?	Immediately	From when it is injected about 30 minutes. The effects last for a few hours	Up to 20 minutes to set up and perform the epidural then another 20 to 30 minutes before the epidural will be working
Any extra procedures?	None	None	You will need an intravenous line to be inserted and may need to have a urinary catheter. You will have a period of continuous foetal monitoring after epidural insertion
Are there risks to the baby?	None	The baby may be slow to breathe when born. The baby may be drowsy and have difficulty in feeding at first	Your blood pressure can become low after an epidural which can affect your baby’s heart rate if not treated
What are the side effects?	Some people can feel nauseous, tired or “spaced out”. The gas can make your mouth feel dry	You can feel sleepy or sick or have slow breathing following the injection. It can slow down digestion leaving you with a full stomach	See further below in this section for full risks

Anaesthesia for caesarean section

There are different forms of anaesthesia available for a caesarean section, which involve either going to sleep or staying awake for the operation. A leaflet describing your anaesthetic choices in full can be found in the patient information leaflets below.

If you have time we would also advise taking 5 minutes to watch the following video which will guide you through what will happen during and after your anaesthetic. Please be aware that some of the information in this video is not applicable to BSUH, your anaesthetist will go through the whole process again with you on the day of your surgery.

Risks of an epidural

See the table below for an overview of the risks.

Type of risk	How often does this happen?	How common is it?
Significant drop in blood pressure	One in every 50	Occasional
Not working well enough for labour pain so that other ways to reduce pain are also required	One in every 8	Common
Not working well enough for a caesarean section so you need a general anaesthetic	One in every 20	Sometimes
Severe headache	One in every 100	Uncommon
Temporary numb patch on leg or foot or a weak leg	One in every 1,000	Rare
Risk of this lasting longer than 6 months	One in every 13,000	Rare
Epidural abscess	One in every 50,000	Very rare
Meningitis	One in every 100,000	Very rare
Epidural haematoma (blood clot)	One in every 170,000	Very rare
Accidental unconsciousness	One in every 100,000	Very rare
Severe injury including paralysis	One in every 250,000	Extremely rare

Recovery from a spinal or epidural

After a spinal is inserted or after an epidural is removed it takes around 6 to 8 hours for your sensations to come back. If it is safe to do so at this point you can mobilise and have your catheter taken out. It can take up to 24 hours for your sensations to return.

It is common to have itching or pins and needles for 24 hours after a spinal or an epidural, medications will be available to help you with this.

You may have a small dressing on your back which can be removed a few hours after the spinal injection or removal of epidural.

An anaesthetist will always try and review you the day after to make sure your recovery is uncomplicated. However if this does not occur and you have concerns about your recovery you can always contact labour ward or your midwife who will be able to get in touch with an anaesthetist.

If you have a headache which is worse on sitting or standing or have concerns that your sensation or muscle strength is not what you would expect it to be then we want to hear from you.

Further information

• Anaesthesia for Caesarean Section - this leaflet is useful if you are having, or are considering, a caesarean section. It describes the different methods of anaesthesia available in detail along with their risks and side effects.
• Epidural information card - this leaflet is for anyone having or considering an epidural.
• Management of a headache after a spinal or epidural - if you are experiencing headaches after a spinal or epidural then it is essential to speak to your midwife or GP about these. You should also read through this leaflet by the Obstetric Anaesthetists' Association.
• Anaesthetic information for pregnant women with a high BMI - this leaflet has more detail on the increased anaesthetic risks in having a high BMI during your pregnancy and delivery.
• Anaesthetic information for back problems in pregnancy - this leaflet offers advice for people with back pain in pregnancy

We understand that English may not be your first language. Much of the material and leaflets found on this site can be found translated into multiple other languages at the following site found here: https://www.labourpains.com/International_Translations