Pre-Op Health Questionnaire – Dr Maria

Please read the following important information about anaesthesia, their side-effects and risks. This will help you to understand what will happen when you have an anaesthetic and make an informed decision as to whether or not to consent to having an anaesthetic. Once you have read the information, please confirm by ticking the box below, so that you may proceed with the rest of the questionnaire.

Should you like to read this again later, this Anaesthetics, Side-Effects and Risks document is also found on my profile page (drjomaria.com.au)

It is important to read this document before your operation/ procedure to help you be more informed and relaxed about having anaesthesia. It is a basic principle of our society that everyone has a right to determine what is done to their body and is entitled to know the implications of any treatment before it is given. Hence, it is important that you are informed before you can consent to having any anaesthesia given. You only need to read the sections that are relevant to you and your procedure.

(Note that the information in this document about anaesthetics, their risks and side-effects, is for educational purposes only. It does not replace a full discussion with your Anaesthetist, Dr Maria. It is not exhaustive and is not a legal document. If you require any further information/ clarification or have any questions at all, please ask Dr Maria.)

ALL PATIENTS: please read SECTION 1

If you are having ENDOSCOPY (Gastroscopy or Colonoscopy): you will be having a sedation, please read SECTION 1 AND also read SECTION 2, paying particular attention to the information on sedation

If you are having a CAESAREAN: you will most likely be having a spinal anaesthetic, please read SECTION 1 and the information in SECTION 3 about spinal anaesthetics

If you are having A HIP OR KNEE REPLACEMENT: please read SECTIONS 1, 2 AND 3, as you will most likely have a combination of anaesthetic techniques

If you are having ANY OTHER TYPE OF SURGERY UNDER GENERAL ANAESTHETIC: please read SECTIONS 1 AND 2

SECTION 1
What does ‘anaesthesia’ mean?

From Greek roots, it means ‘lack of sensation’. In practice, it means giving a substance to cause a lack of sensation so that a surgical procedure can be performed comfortably or without awareness. There are several different types of anaesthetic techniques that can be used, individually or in combination, depending on the type of procedure (see below). The development of anaesthetics has revolutionised the types of surgeries we can now perform and the patients that can be operated on.

What is an Anaesthetist?

An Anaesthetist is a specialist doctor who goes to medical school, does training as junior doctor, then, if selected, undertakes rigorous specialty training with the Australian and New Zealand College of Anaesthetists (ANZCA). This specialty training program takes at least 5 full-time years, requires ongoing assessment including two large, multi-day examinations spread throughout the training. When all is successfully completed the trainee obtains a Fellowship of ANZCA (FANZCA) and becomes an Anaesthetist. An Anaesthetist is trained in all the different techniques of anaesthesia, for all age groups, for many different surgical specialties, as well as highly trained in emergency crisis management for all medical emergencies, pain management and many other aspects of medicine.

Because of this rigorous training program with its focus on quality and safety, Australia is one of the safest countries in the world to have an anaesthetic.

SECTION 2
Depending on what operation/ procedure you are having, Dr Maria may suggest one or a couple of different anaesthetic techniques.

IV Cannula
All anaesthetic techniques will require the insertion of a small plastic tube into your vein to give medications and fluids – these are called an IV cannula (IVC).

(IVC risks include difficulty with insertion, multiple attempts, pain, swelling, bruising, medications going outside the vein into the tissues.)

Sedation and General Anaesthetics
Most procedures in hospital are performed under either sedation or general anaesthetic. Both types of anaesthetic use a combination of medications to reduce the level of consciousness or awareness.

A general anaesthetic uses a combination of medications via an IVC, and sometimes a gas anaesthetic as well, to cause a total loss of conscious. A patient is so deeply unconscious that they will need help with breathing, so, after the anaesthetic is given, they will have a breathing tube inserted via the mouth or nose into the throat or the trachea (the breathing tube in the body that connects the voice box to the lungs).

(Sedation and general anaesthetics are generally very safe, but every anaesthetic has risks, complications and side-effects, the majority of which are temporary, but some may cause long-term problems. These include, but are not limited to:
Common: sore throat which is occasionally severe, nausea and vomiting, drowsiness, shivering, minor lip injuries, temporary hoarse voice, being awake or aware during a light sedation,
Less Common: breathing difficulties, heart problems, dental injury, eye injury, chest infection, confusion and memory loss in older people, stomach acid going into the lungs causing mild lung injury,
Rare: nerve injury – in most cases temporary, rash or swelling from medications, stroke or heart attack, stomach contents such as food/vomit going into the lungs causing severe lung injury
Very rare: a severe allergy called anaphylactic shock caused by a medication or the antiseptic, being awake or aware during a general anaesthetic
There may also be risks specific to your individual condition and circumstances. Your Anaesthetist will discuss these with you. These will depend on:
- how simple or complex your surgery is
-the length of time your surgery will take
-whether your surgery is an emergency.
Your risks are also increased if you are elderly, smoke, are significantly overweight, or have the following: a bad cold or flu, asthma or other chest disease, diabetes, heart disease, kidney disease, high blood pressure, other serious medical conditions, have untreated reflux or heartburn.)

A sedation reduces the level of consciousness using a combination of medications injected via an IVC. It is used for procedures that are uncomfortable but not too painful. With sedation, a patient is somewhere between fully alert and completely unconscious and is still breathing without much assistance. A patient can have a light sedation, in which they are just drowsy (common for procedures like cataracts), or a deep sedation, in which they are unconscious but still breathing well and don’t require a breathing tube (common for endoscopies).

(For risks of sedation, see the risks of general anaesthetics above which are similar, but in addition, sedation has an increased risk of being aware of some or all of the procedure. This is especially so with a light sedation. The aim of a sedation is to keep you comfortable and pain-free, not necessarily completely unconscious.)

SECTION 3
Other types of anaesthetics
There are a class of medications that when injected directly around nerves, will numb those nerves temporarily. Dentists inject these to numb teeth – they are called local anaesthetics. During operations surgeons also often inject local anaesthetic around a surgical wound to provide pain relief for a short time when the patient wakes up. Anaesthetists also use local anaesthetics to perform regional blocks, spinal anaesthetics or epidural anaesthetics. Your Anaesthetist may recommend one of these.

Spinal Anaesthetic
A spinal anaesthetic is when a fine needle is used to inject a small amount of local anaesthetic into the spinal sac that contains the spinal fluid and nerves, in the lower back, below where the spinal cord has ended. The local anaesthetic will numb all of the nerves coming out of the spinal sac at that level, which numbs the nerves to the abdomen, pelvis and legs. This is used for lower abdominal surgery such as caesarean sections, some prostate operations and hip and knee surgery.

(Risks and side-effects:
Common: low blood pressure, nausea and vomiting, shivering, need for a urinary catheter, temporary bruising or pain or tenderness at the injection site, occasional difficulty with placement requiring multiple attempts, occasionally a very brief 'electric shock' sensation down one leg or into the buttocks
Rare: severe postural headache, temporary nerve damage, breathing difficulties, failure of spinal/epidural and need to re-do, the spinal/epidural doesn’t fully work, need to convert to a general anaesthetic
Very rare: permanent nerve damage, infection around the spinal cord, blood clot around the spinal cord, loss of consciousness, seizures, meningitis, cardiac arrest)


Epidural Anaesthetic
An epidural also uses local anaesthetic to numb the nerves coming out of the spinal sac in the lower back. However, this time, a needle is used to introduce a very small plastic tube into the back (called a catheter), and the local anaesthetic will be given from outside the body, via the tube, to the area outside the spinal sac where the nerves come out. It can be used for the same procedures that a spinal is used for, but an epidural enables the local anaesthetic to be infused over an extended period of time (hours or even up to days in some cases), and therefore, is also used for childbirth.

(For risks and side-effects of an epidural, please see the information for spinal anaesthetics, as the risks and side-effects are similar.)

Regional or Nerve Block
A regional block involves injecting a large amount of local anaesthetic around a major nerve or nerve bundle to provide additional anaesthesia during an operation and pain relief after the operation. Often, an Anaesthetist will use an ultrasound machine to visualise the nerve or nerve bundle to ensure the local anaesthetic is injected close to it.

(Risks and side-effects:
Common: pain at the injection site, bruising at the injection site
Uncommon: failure of the nerve block, temporary nerve damage that may weeks or months to recover, allergic reaction, lung collapse with some blocks
Rare: permanent nerve damage, serious allergic reaction, infection at the site of injection, cardiac arrest, seizures)