FAQ - Anaesthesia

Anaesthesia Types Pre and Post – Operative Care

Why is physical examination done before deciding about surgery ?

Physical examination helps to decide about the fitness of the patients to undergo surgery. To begin with, information is collected from the patient through questioning about any surgery undergone by the patient before, smoking or drinking habits, history of jaundice during last 6 months, epileptic fits, cough, breathlessness on walking or climbing staircases or at night, excessive bleeding from cuts and wounds, allergy to certain drugs and sun. In the case of a woman, pregnancy details are to be collected.

Why are patients advised to undergo blood, urine examination etc. prior to surgery ?

Pathological examination prior to surgery is conducted mainly for two reasons:

1)    To confirm clinical diagnosis through blood examination, X-ray etc, if required.

2)   To judge patient’s ability and condition to withstand the stress induced due to surgery and / or anaesthesia. The types of tests required in the first category usually depend upon the type of the suspected illness. In case the operation directly involves vital organs such as the heart, kidney, liver etc. specific and special test are required to determine the conditions of these organs. In case of general operations, some common essentials tests are needed. The type of these routines, essential tests depends upon 3 things:

1) Nature of the operation and type of anaesthesia required

2) Patient’s age and

3) Past and present illness. 

Nature of operation and anaesthesia

No surgery should be taken lightly. However, there is certainly a qualitative difference between a heart surgery and a surgery to remove a corn.

In surgical operations which do not exert much stress on the patient’s physiology (e.g. excision of corn or small superficial tumors, tooth extraction, cataract, vasectomy etc) it is enough to conduct blood and / or urine examination to detect diabetes and only the affected part of the body is rendered numb using ‘local anaesthesia’. But this requires good co-operation from the patient.

Although some operations take only 10-15 minutes, they do not require general anaesthesia. (e.g. correction of simple fracture, curetting, and fissure). Minor surgeries like removal of tonsils, operation for hernia or cataract or curetting of the uterus do not exert any stress on the body’s physiology. Yet some laboratory investigations are necessary to assess the body’s capacity to cope with the stress due to anaesthesia and to rule out a disease like diabetes which can cause complications in any surgery.

Anaesthesia can exert a lot of stress on the body and therefore additional pathological examinations are needed like determining the level of chemical substances in blood called creatinine, determining if kidney function is affected and knowing the blood group of the patients. 

Age of patient

If the patient does not have any other health problem or symptoms, It is difficult to decide which laboratory test are needed. The advantages of various tests, their utility, the cost involved – all these have to be considered. 

Past and present illnesses

If the patient had jaundice during six months prior to operation, a specific blood test- liver function test is necessary to know the condition of liver function. The same is true for kidneys.

In case the patient is suffering from high or low blood pressure, certain test are done to understand theconsequences of it during operation. If the person is obese, alcoholic, smoker or has any genetic disorders, certain test are also needed.

Are all these tests essential ?

Although dozens of test are available in medical science, only the essential ones have been given here.

These have the maximum statistical possibility of elucidating adequate information in comparison with expenditure involved. These are of a generalized nature and can sometimes vary according to the nature of surgery and patient’s condition

Which operations are risky or difficult?

The risk during surgery depends upon the type and sensitivity of the illness and patient’s health. Major, emergency surgeries are risky. E.g. operation for twisted or perforated intestines. However well-planned heart and brain operations have also become comparatively safe.

As a rule of thumb, surgery is done only when the probable operative risks are less than the probable risks of not doing that operation. (i.e. risk due to illness it self ). However, one should always remember that any surgery has an element of unknown and unexpected risk.

What is anesthesia?

What are the different types of anaesthesia?

The ‘anaesthesia’ means loss of sensation. But the term is commonly used to mean loss of consciousness. Whenever any operation is being performed it involves cutting or stretching of the tissues of the body, which would cause pain. So it is necessary to provide some form of pain relief. For very small surgeries like removal of sebaceous cyst etc. the surgeon can give injection of local anesthetics at the site and make it numb. But for most of the other surgeries providing pain relief involves use of specialized techniques and potent medicines and it is the job of skilled postgraduate doctor in anaesthesia. There are three main types of anaesthesia: general, regional and monitored anaesthesia care.

General Anaesthesia

In this the person is temporarily made unconscious so that no pain is perceived from the entire body. It is a carefully balanced combination of both inhaled and intravenously injected agents, which can be used for all operations.

Regional Anaesthesia

This can only be used for surgery on selected regions of the body. An injection of local anaesthetic medication adjacent to large groups of nerves temporarily prevents pain signals from reaching the brain. For example for surgery of hip, prostate, or removal of uterus, spinal or epidural anaesthesia can be used.

Monitored Anaesthesia Care With Sedation :

This is also called as standby anaesthesia. It means that a local anaesthesia is administered and the anaesthetist gives sedatives, pain killers, and other medications while also monitoring patient’s vital signs. Cataract surgery, for example, is frequently performed with this type of anaesthesia. Before determining the most appropriate anaesthetic plan, the anaesthesiologist reviews patient’s medical condition, type and duration of operation and preferences.

Patients will meet and talk with the anaesthesiologist during the preanaesthesia check up. This check up can be few days before surgery if patient are admitted in hospital or on the day of patients admission. If patient has significant medical problems bring these problems to the attention of surgeon well in advance.

Spinal / epidural anaesthesia General information :

Of the variety of operations performed a major percentage involves operations below the waist. All these operation can be safely done under spinal or epidural anaesthesia.

The technique involves injection of local anaesthetic medicine at appropriate site to block the nerves, as they exit the spinal cord. This prevents the pain sensation due to surgery from reaching the brain & relaxes the muscles of the area making it easy for the surgeon to operate.  

Procedure of spinal anaesthesia :

Once in the operation theater the saline drip is started & blood pressure is measured. Other monitors are connected if necessary. The position for giving injection can be sitting or curled up on one side depending on the choice of anaesthesiologist. The area of the injection is cleaned using antiseptic solution. The local anaesthetic is injected at the appropriate location. Initially there is tingling and numbness which is gradually replaced by complete loss of sensation of lower limb & sometimes lower abdomen.

Sedation is given to make the person comfortable unless the person wants to stay awake.

Epidural anaesthesia :

In epidural, all the initial steps are similar except that the needle remains in a superficial plane. Through the needle a very fine catheter is passed into that plane & injections of local anaesthetic are given through it. This way the anaesthesia can be prolonged by giving the doses of medicines through the catheter for as is long as desired.

Recovery :

After the surgery is over, the sensations & the power in the  lower limbs returns back to normal within few hours.

Side effects :

The only side effect of these techniques is possibility of headache in an occasional patient. However it is self-limiting & can be managed with pain killers. The remaining side effects are exceedingly rare. It has been conclusively proved that spinal or epidural does not cause long term backache.

Advantages :

The advantages of spinal or epidural over general anaesthesia are

  • Overall risk is less
  • There is less blood loss during the surgery
  • For caesarean section, the baby is less likely to remain sleepy after birth
  • As less number of medicines are used the chances of side effects & drug interaction are less.
Why are patients advised not to take even water for eight to ten hours before operation?

 Anaesthesia tends to cause vomiting. On an empty stomach, chances of vomiting due to anaesthesia are reduced. Vomiting, when unconscious, may obstruct breathing and cause bronchitis or pneumonia. Therefore, no solid or liquids including water should be consumed at least six hours before operation.

What happens on the day of operation?

Sometimes premedication injections are given a short while before the surgery to help the person to relax. A small plastic cannula is inserted in the vein to start saline drip. In the operation theatre blood pressure is checked & if necessary monitors are connected. The anaesthetist remains with the patient throughout the procedure, adjusting doses of drugs as needed.

What care should be taken just after surgery?

A patient is taken out of the operation theatre only after confirmation of the normal functioning of the heart and lungs.

  • Periodic examination of pulse and blood pressure is done depending upon the nature of surgery. The following are to be observed.
  • Patients having nausea should be made to sleep on the sides and not flat on the back to prevent vomit from entering the wind pipe. At least the head should be positioned sideways. A tube is placed in the mouth to prevent the patient from swallowing his/her tongue. The tube should not be removed till the patient becomes conscious.
  • The patient does take time to fully recover from anaesthesia. One should not panic if the patient groans in his/her sleep.
  • When a patient is given an intravenous saline drip, the hand or leg through which the injection needle is inserted is not allowed to be moved so as to prevent the dislodging of the needle and the consequent piercing of the vein.
  • After a major operation, when the patient recovers from anaesthesia, he / she is advised to move legs. This should be complied with as such movements prevent the possible formation of clots in the blood vessels in the calf muscles.
  • A patient who is given general anaesthesia for a longer duration is advised to take deep breaths periodically. This helps to circulate fresh air throughout the lungs which is necessary to reduce the risk of lung infections.

Why should nothing be given to the patient by mouth for some time after operation?

The reason is to avoid vomiting and related problems as explained earlier. However, if there is excessive dryness in the mouth, mere moistening of lips is helpful. In case of abdominal surgeries, this period of “fasting” extends a bit longer. This is because even mere handling or manipulation of intestines stops its usual involuntary contractile movements for some time. If it is a surgery of intestine, it takes still longer. Passing of gas or stools is taken as an indication of restoration of these intestinal movements

Why and how much of saline or glucose is given intravenously?

This is done to fulfil the patient’s daily requirement of water after the operation, when oral intake is not allowed for a variable period which is from a few hours to a few days, depending upon the surgery. Four to six bottles are required for an adult in a day. The amount of saline or fluids containing other salts, to be given depends upon the type of surgery and anaesthesia, patient’s condition, frequency of vomiting and prevailing climatic condition.

What care should be taken to avoid stress on the stitches of the wound?

Several misconceptions exist regarding stitches. The number of stitches is not important. What is important is the type of surgical problem and the organ operated upon. Secondly, normal limited movements do not snap the stitching. On the other hand, such movements help the healing process, reduces toughness and sourness of the wound and pain. It is not always necessary to stay in the hospital till the stitches are removed. When other bodily functions are restored and post-operative problems (such as bleeding) are not present, the patient can go home. It depends upon the type of surgery, patient’s health condition, other facilities and cleanliness at home, etc. It is advisable to take rest at home. An increased intake of lentils or “dal” is helpful. Unnecessary costly tonics do not hasten recovery or strength. It is wrong to think that some types of food items cause pus in the operation wound.

How long does it take for the wound to heal after an operation?

If there are no complications, the wound heals within 7-8 days. It takes almost six months for the damaged muscles to become perfectly normal. Although there is no danger in doing simple, limited, normal movements, lifting of weights and the like should be avoided for 4 weeks.

 

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