Common Concerns and FAQs

        

We have provided below a list of FAQs split into four different sections.

Questions you may want to ask your anaesthetist or the nurse at your preoperative visit or assessment


Information about anaesthesia

What happens during general anaesthesia?

The aim of a general anaesthetic is to make sure you remain unconscious and in no pain for the duration of your operation. It is a specialised medical procedure and only undertaken by Doctors and Physicians’ Assistants (Anaesthesia) who have been highly trained to do this. Afterwards you should have no memory of what happened under the anaesthetic.
A general anaesthetic is essential for a very wide range of operations. These include operations on the heart or lungs or in the abdomen, and most operations on the brain or the major arteries. It is also normally needed for laparoscopic (keyhole) operations on the abdomen.

Before the operation, drugs will be injected into a vein, or gases will be given for you to breathe.  These drugs or gases make you become unconscious and pain-free during surgery.

Find out more information here.

Will I meet my anaesthetist before the operation?

In most hospitals you will be invited to a preoperative assessment clinic some time before your actual operation. At this clinic you will see a preoperative assessment nurse specialist.  An anaesthetist may also see you then, and this is especially likely if you are having a major operation or have any significant medical problems.

Some hospitals may ask that you complete a health questionnaire and it is important that you include any medical issues you may have. The hospital needs to know about your general health, your regular medication, including over-the-counter medications and herbal medicines, and any allergies. (Please bring your tablets and any details about allergies. If you have any letters or details of medical tests from other hospitals, these can be very helpful too).

They will also be interested in any anaesthetics you have had previously and how you felt afterwards. If you are aware of any family members who have had a serious reaction to anaesthetics, please ask your relative to tell you more about it and for any details you can show to your anaesthetist.

If you have not seen an anaesthetist at the preoperative assessment clinic, you will still meet them just before your operation.  They will discuss any options with you and will tell you about what they are planning to do.  You can also ask them any questions you might have (see ‘Questions to ask the anaesthetist’).

Find out more information here.

What are the risks of general anaesthesia?

For a fit person having a planned procedure under general anaesthetic the risks are very low.

Anaesthesia has been made safer by high standards of anaesthetists’ training and by improvements in drugs and monitoring equipment. An anaesthetist stays beside you all the way through the anaesthetic. They can adjust the dose to give you just the right amount and keep you both asleep and safe.

The Royal College of Anaesthetists has produced a series of leaflets on the risks of anaesthesia that can be viewed here if you want to look at risks in more detail.

How common is awareness or waking up during general anaesthesia? Will I dream?

It is rare for anyone to be aware during a general anaesthetic. More commonly people may remember the feeling of a tube in the throat being taken out as they wake up.  Some people also have dreams around the time they wake up and are in recovery.

In 2014 the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland published a very large study of accidental awareness during general anaesthesia. This report showed that accidental awareness happens in only 1 in 20,000 patients during a general anaesthetic. Advances in equipment and in monitoring the level of anaesthesia have helped to reduce the chances of this happening. An anaesthetist will be with you all the time during your surgery and watching all monitoring equipment closely to check you are getting the right amount of anaesthetic to keep you unaware and pain free.

You can find out more about awareness during general anaesthesia here.

Can you be allergic to anaesthetics?

Allergic reactions can happen with almost any drug.

Your anaesthetist uses continuous monitoring, which helps make sure that any reaction is noticed and treated before it becomes serious.

It is important to tell your anaesthetist about any allergies you know you have. If there are any that have occurred with anaesthetic drugs, please bring in details of this with you. Some rare serious reactions to anaesthetics run in families, so if any family member has had a serious reaction you should try and find out if they have been given any information on this.

Find out more information here.

I am due to have two anaesthetics within a very short time. Is there an increased risk in having two anaesthetics close together?

There is normally no increased risk in having two anaesthetics close together. This applies whether they are general anaesthetics, local anaesthetics, regional anaesthetics (such as epidurals or spinals), sedation for procedures, or a combination of these. However, it is important to tell your anaesthetist about any recent anaesthetics of any sort and to discuss with them the options for your next anaesthetic.

A relative recently developed a problem with breathing after an operation and was told that she had suxamethonium apnoea. What is this condition, is it inherited, and should I be tested for it?

Suxamethonium (Scoline™) is a muscle relaxant drug that is now only rarely used by anaesthetists in routine operations. However, there are some emergency situations in which it is still the most appropriate choice and it may be used in urgent surgery.

A few people suffer from a condition known as ‘suxamethonium apnoea’. This is a rare, inherited condition. If someone in your family is known to be affected, it may be wise for other members of the family to be screened for it by means of a blood test. Your GP should be able to arrange the blood test after discussion with the anaesthetic department at your local hospital.
When suxamethonium is used, the muscles are profoundly relaxed and the patient is unable to move or breathe for themselves. The effect usually lasts 3-4 minutes. In patients who have suxamethonium apnoea, the effect is prolonged for anything up to 4 hours. All trained anaesthetists are aware of the condition, and in the unlikely event that a patient develops it after being given suxamethonium, breathing is assisted by means of a mechanical ventilator until the drug wears off. The patient is sedated during this time to keep them asleep. There should be no long-lasting effects once recovery is complete.

Where can I find information about epidurals and regional anaesthesia?

The RCoA has produced several patient information leaflets on regional anaesthetics for various types of surgery and associated risks. These can be found here. 

If you would like information about epidurals and other methods of pain relief in labour, we would advise that you read the information produced by the Obstetrics Anaesthetists’ Association.


Preparing for your operation

How can I prepare for an anaesthetic?

As soon as you know that you may be having an operation it is helpful to think about how you can be as healthy and as fit as possible for surgery. If you have existing medical conditions such as high blood pressure and diabetes, you may wish to discuss with your GP how you can make your condition as good as possible before your operation.

Many of the risks of having an operation are increased if you are very overweight. It is therefore important to reduce your weight, if you need to, and do some exercise to increase your fitness level ahead of the operation.

If you smoke, you should consider quitting ahead of your operation. Smoking reduces the amount of oxygen in your blood and increases the risk of breathing and heart problems during and after the operation. On average, smokers stay in hospital longer than non-smokers.

Medical staff understand how hard it can be to give up smoking, particularly at a time when you are likely to be more stressed and anxious.  However, if you can manage to do this you will greatly increase your chance of a speedy and successful recovery.

Find out more information here.

Why do I need to take off makeup and nail varnish?

Please avoid wearing makeup on the day you come in for your operation.

Lipstick can make it more difficult for doctors and nurses to see the true colour of your lips. If the level of oxygen in your blood falls, it can change the colour of your lips, so it is important for the medical staff to be able see their natural colour.

Mascara could make your eyes sore if particles of it get into your eyes during the operation.

False eyelashes should be removed before you come into hospital – during an anaesthetic your eyes are kept gently shut using tape and false eye lashes may be damaged. 

During an anaesthetic, your anaesthetist may need to secure equipment to your skin – body lotions, foundation and face cream can make this more difficult as they may prevent heart monitor pads and dressings from sticking properly.

You should also remove nail varnish and, usually, false nails. False nails and varnish may interfere with equipment monitoring the oxygen level in your blood. This is because a finger clip is used that shines a light through your finger nail.

Find out more information here.

Why does the anaesthetist want to know about my teeth?

Whilst you are anaesthetised you are less able to breathe on your own. The anaesthetist will place a breathing tube in your throat while you are unconscious. This is not always straightforward and damage to your teeth is a possibility, especially if those at the front are already loose or you have caps or crowns that are not as strong.

Ideally, if you have any loose or damaged teeth, you should ask your dentist to look at them before your anaesthetic.

If you have any problems with your jaw, opening your mouth or have a stiff neck, make sure you tell your anaesthetist.

Find out more information here and here.

Should I take my normal medication on the day of the operation?

You should continue to take your usual medicines up to and including the day of the operation unless you are told not to. You should carefully follow the instructions you have been given by the preoperative assessment clinic.

Look out for specific instructions if you take:

  • drugs to thin your blood, e.g. warfarin, dabigatran, rivaroxaban, clopidogrel, aspirin
  • drugs for diabetes
  • blood pressure pills
  • herbal remedies.

If you have not been given instructions on the above medications, please contact your hospital and remember to take your medication into hospital with you.

Find out more information here.

Why do I need to stop eating and drinking before the operation?

If there is food or liquid in your stomach while you are anaesthetised, it could come up into the back of your throat and then go into your lungs. This would cause choking or serious damage to your lungs.

The hospital should give you clear instructions about eating and drinking, which you should follow carefully. Usually you should not eat any food for 6 hours before an operation. You can usually drink water until 2 hours before your operation, but nothing thereafter.

Find out more information here.

Should I stop taking recreational drugs before my anaesthetic?

Recreational drugs such as cocaine, marijuana, heroin or the so called ‘legal highs’ can affect the way anaesthetics work, how you react to pain after your operation and can lead to withdrawal problems after your anaesthetic.

You should inform your anaesthetist/preoperative assessment clinic if you have used or regularly use recreational drugs. Ideally you should make sure you do not take any recreational drugs in the days preceding your operation.

Should I tell my child about their anaesthetic?

Unless very young, it is a good idea to have a conversation with your child about the operation and what they can expect, including the anaesthetic.

The Royal College of Anaesthetists has a section on Information for Children and Parents, which contains several useful resources to help you prepare your child for the operation, depending on the age of the child.

Do I need to let the anaesthetist know that I’m pregnant/breastfeeding?

Yes – It is very important that you let the anaesthetist and preoperative assessment clinic know if you are pregnant or breastfeeding. If you are of childbearing age you will usually have a pregnancy test before a planned operation under general anaesthetic or sedation (carried out on a urine sample).

Your anaesthetist will try to use the drugs that are thought to be the safest available for you and your baby. However, because there may be some risks to the baby of having an anaesthetic or surgery when pregnant, it is advisable only to have essential surgery when pregnant. It is generally agreed that the second trimester (3–6 months) is the safest time and it is best to avoid anaesthetics in the first trimester (up to 12 weeks) if possible.

General anaesthetics do not normally have an effect on breastfed babies. However, some painkillers can pass into breast milk and make the baby feel sleepy. It is usually recommended that you express after you have recovered from your anaesthetic and discard this milk.  The anaesthetist will make sure that you are prescribed appropriate painkillers if you are breastfeeding.


What to expect after the operation

Will I feel sick or nauseous after my anaesthetic? What can my anaesthetist do to help?

Your anaesthetist will assess your risk of sickness when they visit you before your operation. There are various ways in which your anaesthetist can reduce your chance of suffering sickness. Many people have no nausea or sickness after surgery.  Some people can feel very sick, but there is a wide range of drugs to treat this. Your anaesthetist will also prescribe you drugs to help treat any sickness in case you do develop it after the operation.

Find out more information here.

What will I feel like when I wake up?

How you feel afterwards depends mainly on the operation you have had, and on any painkilling medicine that you have needed.

When you first wake up you will feel quite drowsy and the nurse in the recovery area will be giving you some oxygen via a mask and will check your blood pressure and your oxygen levels. The nurse will give you any further drugs you need to keep you comfortable.

Find out more information here.

I have problems with my prostate – will I have difficulty passing urine afterwards?

If you have problems passing urine because of an enlarged prostate, sometimes drugs used during an anaesthetic can make things a little worse in the early period after your anaesthetic. If you are having a day case operation, you will need to pass urine before you are allowed to go home. Occasionally it may be necessary to put in a catheter (a flexible soft tube) into your bladder to drain urine before you can pass urine normally again. This may delay you going home. On occasion, you may need to be seen by a urologist (a doctor who specialises in prostate problems) if difficulties continue. 

Am I likely to be confused after my operation?

Becoming confused is not uncommon after an operation and an anaesthetic, especially in the elderly. Behaviour and memory can be affected and there may be some deterioration in more complex mental functions such as the ability to get dressed or do the crossword. Most people make a full recovery.

Find out more information here.

How long do the effects of an anaesthetic or sedation last? Do I need someone at home with me?

The effects of anaesthetic drugs may last for around 24 hours, longer for major operations. If the operation can be done as a day case you will need to have an able-bodied adult to take you home and be with you that night. People often underestimate the help that they may need after an operation as they recover.

You should not drive for at least 24 hours after an anaesthetic. This may be longer if you have had certain anaesthetic drugs or are taking strong painkillers (check with your anaesthetist), as your judgement and reaction time might be impaired. You should not look after children during this time, use any dangerous equipment or cook. You should also avoid making any important decisions and should be careful not to post anything on social media that you might later regret. 

You may feel tired or even exhausted for some days after the operation. After major surgery this can last weeks or months. This is not due to your anaesthetic, but to the fact that healing after major surgery often leaves patients feeling exhausted.


Enquiries to the Royal College of Anaesthetists (RCoA)

Can the RCoA offer advice to patients about treatment?

The RCoA cannot give advice to individuals regarding their personal treatment.  If you are writing to the RCoA please note that we are unable to reply immediately. The RCoA often uses specialist advisors to answer enquiries and this may delay a response.  For any immediate medical concerns you should contact your GP or the emergency services without delay. Should you need more specific advice regarding your treatment, you are advised to contact the hospital where you are being treated.

The RCoA publishes a comprehensive series of Patient Information leaflets offering information on the different types of anaesthetics and the likely risks. We would advise you to take a look at these leaflets as they may contain the information you are looking for. You can see the full series here.

Can the RCoA recommend an anaesthetist or advise on the competence of an anaesthetist?

No, the RCoA cannot recommend or vouch for individual anaesthetists. Information on individual medical practitioners and their registration is held by the General Medical Council and can be accessed by members of the public here.

Can the RCoA provide expert witnesses?

No. The RCoA does not hold lists of experts to provide a medico legal opinion. The role of the RCoA is to educate and train anaesthetists and to set the standards for the specialty.

Can the RCoA offer advice if I want to complain about the treatment I have received or the anaesthetist who treated me?

The RCoA is not a regulator and cannot act on complaints raised by patients. For a list of regulators and advice on how to complain about your treatment please visit the Complaints about your Doctor or Treatment page.


Questions you may want to ask your anaesthetist or the nurse at your preoperative visit or assessment

It may be helpful to try and get the answers to any questions you might have well in advance of your scheduled surgery. Below is a list of issues you may wish to discuss with your anaesthetist or nurse.

  1. If I have a cold should I let you know before I come in?
  2. Should I take my normal medication on the day of the operation?
  3. When should I stop eating and drinking?
  4. I’m rather nervous; can I have a premed?
  5. I don’t like needles; do I have to have an injection?
  6. I’ve been told I have poor veins when I go for blood tests, will that be a problem?
  7. I am a diabetic. How do I control my blood sugar before and afterwards?
  8. Are there any particular risks from the anaesthetic for me?
  9. May I leave my false teeth in?
  10. Do I need to remove my hearing aids?
  11. How soon will the feeling return after a regional anaesthesia or nerve block?
  12. What painkillers should I have at home?
  13. When can I drive after an operation?
  14. Can I go home alone following my anaesthetic?

If you have any further general requests or queries concerning anaesthesia, please contact clinicalquality@rcoa.ac.uk. However, please note that the College cannot give advice to individuals concerning their treatment.

 

 

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