Anaesthesia – what do you need to know? 

Australia is the safest place in the world to have an anaesthetic. 

Why is that? 

Australian specialist anaesthetists are amongst the most highly trained doctors in the world. 

After completing a medical degree, your anaesthetist will have spent several years expanding their knowledge and experience in general hospital positions before embarking on specialist training in anaesthesia. This involves at least 5 years of apprenticeship, working directly under expert supervision, in anaesthesia, pain management, critical care skills, life support, resuscitation and the management of medical emergencies. Anaesthesia training in Australia also involves passing rigorous examination processes. On completion of their training, Australian anaesthetists are required to commit to a professional lifetime of continued learning and skills maintenance. Many anaesthetists are also active teachers. 

You should feel confident that you are in good hands during your procedure. 

What is anaesthesia? 

‘General anaesthesia’ involves a controlled state of unconsciousness during which you will be unaware and will not feel pain. This is different to simply being ‘asleep’. Your anaesthetist will be by your side during this time, observing your vital signs and other parameters constantly. 

Some procedures do not require general anaesthesia and another anaesthetic technique may be used. 

‘Local’ and ‘regional’ anaesthesia involve the injection of local anaesthetic solution into an area of skin, around a nerve or a group of nerves to numb a specific area of the body so that surgery will be able to proceed comfortably. 

‘Sedation’ involves the use of intravenous medications to produce a lowered state of consciousness and is often combined with local or regional techniques. During ‘conscious sedation’, the patient remains calm and able to communicate while feeling relaxed and drowsy. Examples of procedures for which conscious sedation is used include cataract surgery under an eye block and superficial skin surgery with local anaesthetic infiltration. ‘Deep sedation’ resembles general anaesthesia and is used for procedures such as colonoscopy. Some recall of events is usually possible during light sedation and may also occur under deeper sedation. 

After your procedure, your anaesthetist will help to minimise and manage any discomfort you may experience. 

What do you need to do before an anaesthetic? 

Medical issues are common in the population and you do not need to be in perfect health to have a safe anaesthetic. Ideally, however, your general health and any medical issues you may have should be stable and managed optimally prior to elective surgery. 

Ways you can help: 

1. Get a bit fitter 
2. Stop smoking 
3. Make a dedicated effort to lose weight before your surgery if you are currently overweight and time permits 
4. Reduce your alcohol intake 
5. Continue to take your regular medications unless you have been told otherwise. Make sure your surgeon and anaesthetist are aware of what these medications are. If you take aspirin, anti-inflammatories, warfarin or other blood thinners, ask your surgeon for advice about whether or not they should be stopped prior to your procedure. Some herbal products can also increase the risk of bleeding during and after surgery. You may be asked to cease herbal products for a couple of weeks prior to your surgery. When you are admitted for surgery, please bring all of your medications, in their original packaging, with you. 
6. If you have had an adverse reaction or allergy to any medication. Make sure you know the name of the medication and can describe the reaction you had. 
7. Make sure your surgeon and anaesthetist are fully informed about health issues you have had in the past 
8. Make sure your surgeon and anaesthetist are fully informed about any previous problems you may have experienced with anaesthesia 
9. Recreational drugs and medicinal cannabis can interact with anaesthesia. Tell your anaesthetist if you use them. 
10. If you have sleep apnoea and use a CPAP machine, please bring it with you on the day of your surgery. 
11. Make sure your surgeon and anaesthetist are aware of any special issues you may have regarding blood transfusions or the use of blood products. 
12. Pay special attention to your pre-operative fasting instructions and follow them carefully. 
13. If you are worried about your anaesthetic, ask the surgeon’s rooms to contact your anaesthetist so you can talk to them or meet prior to your admission. 

What does my anaesthetist need to know about me? 

You will meet your anaesthetist prior to your surgery and discuss your current health and your medical history. Any relevant physical examination will be performed. You will then talk through what to expect from that moment through to the post-operative period and your later recovery. You should ask any questions you may have and together you will decide what anaesthetic technique may be best for you. It is crucial that you answer all questions honestly so that the anaesthetic technique can be tailored to your needs, minimising any risks. 

Your anaesthetist specifically needs to know about 

• Your current state of health, with a particular focus on heart and breathing problems 
• Your past medical history 
• Your past surgical history 
• The names and contact details of any medical specialists who may be caring for you. 
• All medications you take 
• Any allergies you may have to medications, lotions, tapes and latex. 
• Any problems you may have experienced with an anaesthetic in the past. 
• Any serious problems your relatives may have experienced under anaesthesia in the past. 
• The extent and nature of any significant dental work you have had performed eg. caps, crowns, veneers and implants, or current dental issues such as loose or rotten teeth. If you wear dentures, your anaesthetist will need to know whether you are using any products to secure them in place. 

Why do I need to fast before anaesthesia for a surgical procedure? 

You will usually be asked not to eat or drink for 6 hours prior to a procedure, although water up to 2 hours prior is ok. This is to make sure there is as little as possible in your stomach and reduce the chances of these stomach contents coming up (like vomit) and entering your lungs while you are unconscious under the anaesthetic. This is an uncommon, but potentially serious, complication of anaesthesia. You may also be given an antacid drink or tablet prior to the procedure as an added precaution. If you have had weight loss surgery in the past and have had a lap band inserted, you may need to refrain from eating solid food for longer. Some newer weight loss medications eg. Ozempic, Wegovy, Mounjaro, may significantly increase your risk of getting vomit into your lungs during anaesthesia. Please ask for advice as soon as possible about if, and when, these should be ceased prior to surgery and whether you need to modify your pre-operative fasting regimen. Remember to specifically mention these medications to your anaesthetist before your surgery so you can be protected from harm. 

Admission to hospital before your surgery 

In order to minimise waiting time and inconvenience for you, your admission time may be after the operating list has started. This may mean that the time available to see your anaesthetist is limited. Rest assured that your anaesthetist will have reviewed your medical records and patient health questionnaire. Occasionally, due to unexpected circumstances like equipment issues, your place in the order of the list may change. Always make an effort to allow enough travel time to be punctual, and be prepared with something to entertain yourself (like a book) should you find yourself with an unexpectedly long wait. 

If you are having major surgery or have special health issues, you may be seen by your anaesthetist prior to the day of you surgery. 

What sort of anaesthetic will I have? 

Your anaesthetic is like a recipe designed specifically for you. The choice of technique will be determined by the requirements of the surgery, your specific health issues, the anaesthetist’s experience and your preferences and concerns. Your surgeon will often have given you an idea of what to expect and your anaesthetist will discuss the pros and cons of the options available to you. Together, you will decide what is likely to be the best option for you. Your safety and comfort are the priorities. 

After your procedure 

When your surgical procedure is completed, your anaesthetist will transfer you to the theatre Recovery Room where you will continue to be monitored carefully by a nurse while you wake. You will continue to receive oxygen through a clear facemask. It is normal to feel drowsy and ‘out of it’ initially. Occasionally, people have some throat discomfort or feel sick. These feelings usually soon pass. You will be taken back to your hospital room or the day surgery ward when you are alert and comfortable. If you experience any worrisome after-effects of your anaesthetic, you should contact your anaesthetist. 

Looking after yourself when you get home 

Fortunately, with modern advances in both surgery and anaesthesia, many procedures can be safely performed as day-stay cases. If you are going home the same day as your procedure it is important that you have a relative or friend accompany you home and stay with you, or close nearby, for the rest of the day. 

For 24 hours after an anaesthetic, you should not: 

• Drive a car or operate machinery or tools 
• Sign legal documents 
• Make important decisions 
• Drink alcohol 

Anaesthesia – risks and complications 

The majority of patients have their anaesthesia safely, comfortably and without incident. However, as with many things in life, problems can occur. 

Some patients will be at increased risk due to health problems such as obesity, smoking, heart disease, respiratory disease, diabetes, very old age, extreme frailty or the complexity of the surgery they are undergoing. 

Occasionally, complications may occur, including: bruising and pain at the site of injections, temporary breathing issues, temporary nerve damage (leading to a patch of numbness or weakness), aching muscles, the possibility of some sensation during the operation (especially during caesarean section and some emergency surgeries), damage to teeth, dental prostheses, lips and tongue, sore throat and temporary vocal changes. 

Nausea and vomiting is one of the more common, distressing complications of anaesthesia. Some surgeries are considered ‘high risk’ for this and your anaesthetist will take precautions to help prevent it. Some patients are also at higher risk, especially if they have experienced post-operative nausea in the past and suffer motion sickness when travelling in cars and on boats. Please let your anaesthetist know if you have had these issues before. Despite our best efforts, a small percentage of patients will have nausea that is difficult to control. 

Every care will be taken to protect you from cross-infection from another patient. Intravenous equipment and lines are provided in sterile packaging, designed for single-patient use and used only once before being discarded. 

Blood transfusions are required less frequently than in the past. The Australian Blood Bank screens donors and tests its blood products carefully, however a very small risk of cross-infection remains. 

Rare, but serious, complications include: severe allergic reactions, heart attack, stroke, brain damage, permanent nerve injury, paraplegia or quadriplegia, eye injury, liver, kidney or lung failure, permanent damage to a blood vessel, permanent vocal cord injury and voice changes, pneumonia, and infections and transfusion reactions related to blood transfusions. These more serious complications, including unexpected death, are extremely rare. 

If you remain concerned, please ask questions when you meet your anaesthetist about how these risks may apply to you. Your safety is of the highest priority and every effort will be made to achieve a good outcome for you.