Common Concerns and FAQs
- I am due to have two anaesthetics within a very short time. Is there an increased risk in having two anaesthetics close together?
- 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 we be tested for it?
- How long do anaesthetics stay in the body?
- What is the currently quoted risk of death under general anaesthesia?
- Where can I find information about Epidurals?
- How common is awareness and ‘waking up’ during general anaesthesia?
- Can the College offer advice to patients about treatment?
- Can the College recommend an anaesthetist or advise on the competence of an anaesthetist?
- Can the College provide expert witnesses?
There is normally no increased risk in having two anaesthetics close together. This applies whether it is two general anaesthetics, two local or regional anaesthetics (such as epidurals or spinals), or a combination of general, regional and local anaesthetics.
It is, however, important to tell your anaesthetist about any recent anaesthetics of any sort and to discuss with him or her the options for a second or subsequent 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 we be tested for it?
Suxamethonium (Scoline™) is a muscle relaxant drug which is now uncommonly used by anaesthetists. However, there are some emergency situations where it is still the most appropriate choice.
A few people suffer from a condition known as ‘suxamethonium apnoea’. This is a rare, inherited condition, and 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 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 usually sedated during this time because the experience may be frightening and unpleasant. However, there should be no long-lasting effects and recovery is complete.
How long do anaesthetics stay in the body?
Modern anaesthetic drugs are designed to be cleared from the body rapidly. The exact length of time depends on the nature and combination of the drugs used before, during and after the operation, and the nature and duration of the procedure itself. All patients differ slightly in their response to drugs and recovery after the operation will vary from patient to patient.
In general terms, although traces of the anaesthetic can be detected in the blood a few days later, most modern drugs have no noticeable effect after a few hours. Current advice is that it is not usually safe to drive or drink alcohol until at least 24 hours after a general anaesthetic.
Small quantities of anaesthetic drugs may be present in breast milk in breastfeeding mothers. In general, this does not cause a problem, but mothers should discuss the problem with their anaesthetists, who can then choose appropriate drugs and advise on the potential side-effects on the infant. It is usually possible to time surgery so as to minimise the effect, or to express breast milk for use in the immediate post-operative period.
What is the currently quoted risk of death under general anaesthesia?
Data on this question are hard to find, especially from within the UK. It is difficult to separate purely anaesthetic risk from that due to surgical skill, postoperative care and other factors, such as comorbidities in patients. Generally speaking the figure is estimated to be between 1 in 100,000 and 1 in 200,000.
The Royal College of Anaesthetists has produced a comprehensive information leaflet on anaesthesia and risk of death, which can be found here: www.rcoa.ac.uk/node/2066
Where can I find information about Epidurals?
The College has produced several comprehensive patient information leaflets on epidurals and associated risks. This can be found here www.rcoa.ac.uk/patientinfo.
If you would like information about epidurals in labour, we would advise that you read the information leaflet produced by the Obstetrics Anaesthetists Association.
How common is awareness and ‘waking up’ during general anaesthesia?
Draft: A recent study (March 2013) by The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) involving 80% of all senior anaesthetists working in the NHS has revealed that incidences of awareness are much less common in the UK than previously thought, with one episode known to anaesthetists in every 15,000 general anaesthetics. More information on the study can be found at www.nationalauditprojects.org.uk/NAP5_home.
Can the College offer advice to patients about treatment?
The Royal College of Anaesthetists is an academic institution. We regret that we cannot give advice to individuals regarding their personal treatment.
If you are submitting your enquiry to the RCoA in writing please note that we are unable to respond immediately. The College often uses specialist advisers to answer enquiries and this may delay response for several days.
For any immediate medical concerns you are advised to contact your GP without delay. Should you need more specific advice regarding your treatment you are advised to contact the hospital where you are being treated.
Information on individual medical practitioners and their registration is held by the General Medical Council and can be accessed by members of the public at www.gmc-uk.org/doctors/register/LRMP.asp.
Can the College provide expert witnesses?
No. The College does not hold lists of experts to provide a medico legal opinion, as this is outside our remit. The College is an academic institution, with the sole purpose of educating and training anaesthetists.
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