Frequently Asked Questions
There are several types of Anaesthesia:
General anaesthesia produces a drug-induced unconscious state. You will be unconscious and feel no pain during a procedure.
Local anaesthesia involves an injection of local anaesthetic to numb a part of the body. It is usually used for minor surgery and may be combined with sedation or general anaesthesia.
Regional anaesthesia includes nerve blocks and spinal or epidural blocks. This is when local anaesthetic is injected near major nerve bundles that supply large areas like the leg, arm, shoulder or abdomen.
Procedural sedation is used for procedures where general anaesthesia is not required. It allows patients to tolerate procedures that may otherwise be uncomfortable or painful.
Conscious sedation is a medication-induced state that reduces the patient’s level of consciousness. A sedated patient does not feel pain but can respond to verbal commands or touch.
Analgesia is when a patient is given medications that act locally or generally to stop them from experiencing pain.
For procedures done under local anaesthesia, you may eat and drink as normal. For all procedures under spinal or general anaesthesia you need to be NIL BY MOUTH for at least six hours prior to the planned start of surgery. This should allow adequate time for your stomach to empty so that food does not regurgitate under anaesthesia and possibly land up in your lungs. You may however have a glass of clear (see-through) fluid such as clear apple juice or water up to 2 hours before surgery.
The above guidelines apply to children as well. Babies may have a formula feed up to 6 hours, breastmilk up to 4 hours and clear fluid up to 2 hours before surgery.
Always take your chronic medication, as well as instructions on how to use them, with you to hospital. With a few exceptions, your chronic medication should be taken as normal, even on the morning of surgery (then only with a little sip of water).
Exceptions include specific Blood Pressure medications called ACE Inhibitors (ACEI) and AR Blockers (ARB's). These medications cause a precipitous blood pressure drop during anaesthesia and should be omitted on the morning of surgery. If you are on more than one blood pressure tablet, do NOT OMIT the other tablets too. Click here for examples of ACEI, ARB's.
Diabetics on insulin should take 1/2 to 2/3 of their long-acting dose the night before surgery and omit their short-acting dose as soon as they are Nil by mouth, but continue monitoring their sugar levels. Diabetics on tablets should skip their diabetic tablet as soon as they are Nil by mouth.
You may need to stop or switch blood thinners (anticoagulation) well ahead of time and this should be discussed with your surgeon when you book your operation. Examples include but are not limited to Warfarin, Clopidogrel ( Plavix or Clopiwin), Xarelto, Pradaxa, Clexane, medications containing aspirin (Ecotrin, Cardio-disprin, Grandpa, Compral, some flu medication etc.) and over-the-counter blood thinners such as Procydin.
Please discontinue any herbal or homeopathic remedies at least ten days before surgery. Some of these such as Ginkgo, Ginseng, Chamomile and Feverfew may cause excessive bleeding while others may interact with anaesthetic drugs.
You will usually be seen by your anaesthetist in the ward before theatre, during which time he will examine you and answer any remaining questions. During this time he will also discuss the anaesthetic consent form and collect a signed copy from you. Due to time-constraints and late hospital bed occupancy we may occasionally only be able to see you in the pre-operative area.
The anaesthesiologists in Coxon and Partners are allocated to specific surgical lists on a regular basis and will therefore not be able to attend to you at your request, but you are welcome to ask your surgeon whether he/she makes use of one of your preferred choices.
Your anaesthetic is designed to keep you safe, comfortable and pain-free during surgery and is tailored to your specific health condition.
Certain procedures may be performed wholly under local or regional anaesthesia. This means that the sensation from the operated area may be blocked sufficiently for the procedure to be done while you are awake or under light sedation. Your vital signs are still monitored throughout the procedure for any adverse reactions. Examples of regional anaesthesia are eye blocks for cataract surgery, spinal anaesthesia for prostate or gynaecological surgery and Biers block for certain kinds of hand surgery. Sometimes regional anaesthesia is not enough on its own and you also need to be put to sleep, but the regional anaesthesia helps by either decreasing the amount of general anaesthesia necessary or providing pain relief after the procedure. Examples where the above are combined include general anaesthesia combined with nerve blocks or with an epidural. Your anaesthetist will discuss the different options with you that provide the least possible risk to your health.
From time to time regional anaesthesia may be employed by a pain specialist as an adjunct in the treatment of chronic pain conditions.
What is a "Spinal"?
Spinal anaesthesia, also called spinal block, subarachnoid block and intrathecal block, is a form of regional anaesthesia involving the injection of a local anaesthetic into the cerebrospinal fluid, generally through a very fine needle and below the second lumbar vertebra. It is a commonly used technique, either on its own or in combination with sedation or a general anaesthetic. Typically, it is limited to procedures involving structures below the upper abdomen, providing complete loss of sensation, thereby eliminating pain. Sedation may be provided to help you relax and pass the time during the procedure, but with a successful spinal the surgery can be performed while you are wide awake.
Spinal anaesthesia is the technique of choice for Caesarean section as it avoids a general anaesthetic and the risk of failed intubation. It also means the mother is conscious and the partner is able to be present at the birth of the child. When surgery allows, a spinal may also be useful for patients with severe respiratory disease or abnormalities of the airway, avoiding the need for ventilation.
A common complication of spinal anaesthesia is an immediate drop in blood pressure (hypotension) due to the blockade of sympathetic nerves. This is easily treated with fluid administration and certain drugs. A post spinal headache is related to a leak of spinal fluid from the tiny hole made in the membranes covering the spinal space. Fortunately it is a treatable and very rare complication nowadays, due to the use of ultra thin “blunt-tip” needles. Other complications such as epidural abscess, spinal canal haematoma, cardiac arrest and nerve injury are extremely rare.
What is an "Epidural "?
A spinal and epidural are often confused by lay people. An epidural is the injection of a larger volume of local anaesthetic anywhere along the vertebral column in the “epidural space” surrounding the spinal cord. The onset of pain relief is usually slower than with spinal anaesthesia and often an indwelling catheter is placed in the epidural space, making it possible to continue pain relief with “top ups” or an infusion, for a longer period after surgery than with a “single shot” spinal.
On its own, an epidural provides superior pain relief for pregnant patients in labour, but may also be used in combination with a general anaesthetic for certain kinds of chest and abdominal surgical procedures. Complications are similar to a spinal, but blood pressure usually drops more gradually with epidural anaesthesia.
Examples of ACEI, ARB's and combinations used in South Africa include, but are not limited to the following:
Please note that these names may be combined with other words such as Co, Adco, Hexal etc. (indicating the manufacturing company).