General anaesthetics
Many procedures require a general anaesthetic, which means you are given some medicines to aid becoming unconscious, along with some medicines to relieve pain and help you remain still during the surgery. This is usually given through a drip (IV cannula) in your hand or arm. You will also get a breathing tube for assisting your breathing whilst you are asleep. The medications are stopped at the end of the procedure to allow you to wake up.
Sedation
A number of procedures (such as endoscopies) require a “light” anaesthetic i.e. sedation, where you will not be completely asleep during the procedure. You will be given medications to make sure you are comfortable, although you may remember some of the procedure.
Regional anaesthesia
Some procedures (such as caesarean sections or some operations on a limb) can be done under regional anaesthetic. Here, your anaesthetist gives an anaesthetic only to the area having the surgery (e.g.an epidural, or an injection to the particular limb.) You will likely be aware and awake during the procedure, but comfortable with pain relief.
Local anaesthesia
Procedures such as eye operations are often done with local anaesthetic only which is applied to the relevant part of the body. These are chosen where the procedure can be done safely and comfortably with the particular body part being “blocked” by local anaesthesia.
Combination anaesthetics
Many operations require a combination of techniques to achieve a safe and high quality outcome. For example many patients having complex operations often need and benefit from both regional anaesthesia to provide pain relief as well as a general anaesthetic for the procedure. For patients having limb procedures it is also common to use a regional technique as well as sedation so you may not have any memory of the procedure.
Resuscitation and emergency measures
Whilst many procedures are done with little challenges to the patient, there are some situations where we need to help revive a patient either before, during or after surgery. In this situation we may need to place extra lines and monitoring as well as undertake further investigations and care such as intensive care.
There also may be a need to use a blood transfusion in cases of major bleeding. This is only utilised as a last resort but blood in Australia is very safe and well tested. If you have any objections to receiving blood, please communicate this to the team prior to the procedure.
Additional procedures
In some situations we have to use more invasive techniques to ensure that you are as safe as possible. For surgery where there is a significant bleeding risk, central venous lines and arterial lines may need to be placed prior to the commencement of surgery. Whether these are done prior to starting the anaesthesia depends on the operation, your current health and your background health issues. Your anaesthetist and surgeon will decide on a case by case basis with your safety being the top priority.
A central venous line is a long intravenous cannula which is placed in a central vein, most commonly in the side of the neck, chest or groin. In most settings it is placed under anaesthesia. Once placed, it can be utilised for giving medications and monitoring fluid status. This is very useful in complex operations and recovery. In the post operative setting most patients do not find a central venous line uncomfortable, therefore it can be used for giving medications without the need for multiple smaller IV lines. Rare risks of bleeding, clots and infection exist, however in the correct setting, central venous lines are very safe.
An arterial line is similar to an IV cannula, but is placed into an artery such as one in the wrist. Local anaesthetic is given to the skin just before placement. The arterial line is used to monitor blood pressure continuously through the operation as well as to take blood samples as needed without a need for further needles.
Fibre optic intubation is a rarely utilised technique for ensuring we can place a breathing tube safely prior to the commencement of anaesthesia. With the various new techniques available, it is only utilised where there is significant concerns about starting anaesthesia before placing the tube to provide oxygen during the operation. When done by those of us who do and teach this frequently, it is normally not painful but may be uncomfortable. Lots of local anaesthetic is utilised to help numb the nose, mouth and throat before the breathing tube is placed. Often the taste of the local anaesthetic and the coughing from the local anaesthetic are the undesirable aspects. Some sedative medication may also be used to make it more comfortable for you.
Peripheral nerve blocks are utilised for pain relief. Often they are used as adjuncts to general anaesthesia. Where safe, they are done under general anaesthesia although occasionally they are done under local anaesthetic for safety and efficacy reasons.