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Southern DHB Anaesthesia - Otago

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    What is Anaesthesia?
    You are given an anaesthetic when you have surgery so that you don’t feel pain during the operation. There are different types of anaesthesia and the type you receive will depend on the type of surgery you are having and how long it will take.
    Your anaesthetic will be given to you by a specialist doctor called an anaesthetist.

    Anaesthesia care falls into three parts: pre-operative visit, care during surgery and postoperative care in the recovery room. 

    Pre-operative Visit
    The anaesthetist will visit the patient on the morning of surgery or the night before. It is their job to assess the patient's suitability for an anaesthetic. They will ask questions on the following:

    • general health
    • previous medical history
    • previous anaesthetics received
    • allergies
    • smoking habits
    • previous heart problems.

    The ideal candidate for anaesthesia is within normal weight range, is well oxygenated, has a normal and regular heartbeat and is conscious.
    A physical examination of your heart and lungs will be carried out. Your neck will be checked for shape and your mouth for loose teeth or caps. These are checked because if a breathing tube is to be inserted, it can sometimes be difficult to insert depending on the shape of the neck and mouth and also to prevent damage to teeth in the process.

    The anaesthetist may prescribe a pre-med, which is a medication taken prior to surgery, designed to aid in relaxation and help keep the patient calm.

    Care During Surgery
    During the operation the anaesthetist's main roles are as follows:

    • to prevent pain - achieved by administration of pain relief agents appropriate for you and for the extent and duration of the operation
    • to monitor oxygenation - this means ensuring that all vital organs are being adequately supplied with oxygen. This is assessed by skin colour, heart rate and your level of consciousness
    • to monitor ventilation - assessed by the respiratory rate, volume of each breath and the inhaled and exhaled carbon dioxide concentrations. The anaesthetic gas and oxygen are delivered together either via a mask or breathing tube. If a mask is used the patient usually breathes on their own. If a tube is used the patient may breathe on their own or be mechanically ventilated using an artificial ventilator
    • to monitor circulation - during the operation, intravenous fluids and/or blood products are administered if necessary. Circulation is assessed by blood pressure, urine output and skin temperature.

    Postoperative Care
    When your operation is over, you will be taken to a special recovery area where your condition will be monitored as you wake up from the anaesthetic.

    Practitioners

    • Dr Lindsay Autio

      Anaesthetist
    • Dr Sheila Barnett

      Anaesthetist
    • Dr Estibaliz Blazquez Basarrate

      Anaesthetist
    • Dr Robyn Chirnside

      Anaesthetist
    • Dr James Clark

      Anaesthetist
    • Dr Benjamin Gmelch

      Anaesthetist
    • Dr Michael Hamilton

      Anaesthetist
    • Dr Sarah Henderson

      Anaesthetist
    • Dr Jason Henwood

      Anaesthetist
    • Dr Charlotte Hill

      Anaesthetist
    • Dr Justin Holborow

      Anaesthetist
    • Dr Lisa Horrell

      Anaesthetist
    • Dr Claire Ireland

      Anaesthetist
    • Dr Matthew Jenks

      Anaesthetist
    • Dr David Jones

      Anaesthetist
    • Dr Joseph Koh

      Anaesthetist
    • Dr David Koskuba

      Anaesthetist
    • Dr Geoffrey Laney

      Anaesthetist
    • Dr Jochen Maierl

      Anaesthetist
    • Dr Gonzalo Millan Montoya

      Anaesthetist
    • Dr Chen Ong

      Anaesthetist
    • Dr Ursula Reymann

      Anaesthetist
    • Dr Priya Shanmuganathan

      Anaesthetist
    • Dr Andrew Smith

      Anaesthetist
    • Dr Everhardus Strauss

      Anaesthetist
    • Dr Paul Templer

      Anaesthetist
    • Dr Damon Thompson

      Anaesthetist
    • Dr Julie Thompson

      Anaesthetist
    • Dr Cara Thomson

      Anaesthetist
    • Dr Maartje Tulp

      Anaesthetist
    • Dr Pieter van Ammers

      Anaesthetist
    • Dr Edwin van Broekhoven

      Anaesthetist
    • Dr Christopher Walker

      Anaesthetist
    • Dr Duncan Watts

      Anaesthetist
    • Dr John Wilson

      Anaesthetist
    • Dr Timothy Wright

      Anaesthetist
    • Dr Patricia Yelavich

      Anaesthetist
    • Dr Campion Read

      Anaesthetist
    Procedures

    General Anaesthesia

    You are put into a state of unconsciousness either by the injection of an anaesthetic medication into a vein or by breathing in a mixture of gases. You will be unaware of what is happening around you and you feel no pain from the surgery. You will be constantly monitored and the anaesthetic adjusted as necessary throughout the operation.

    A muscle relaxant may also be administered, which relaxes muscle and allows easier surgical access to the operation area.

    Local Anaesthesia

    Following local anaesthesia, you are awake but the part of your body being operated on is numb.  Local anaesthesia is administered via an injection; it takes effect quickly and lasts a long time.  During the surgery you will be aware of touch and pressure, but not pain.  If this type of local is being used, it is common practice to be looked after only by the nursing staff and the surgeon, an anaesthetist does not need to be present.  The surgeon will generally administer the local anaesthesia.

    This type of anaesthesia can also be given with a sedative through an IV line, which means you will just be drowsy and semi-alert. This type of procedure is called local anaesthetic with sedation.

    Nerve Block
    This type of local anaesthesia is achieved by injecting an anaesthetic that blocks nerve impulse transmission. It can involve one or more nerves that are associated with the area to be operated on. A nerve block is often done for hand surgery.

    Epidural Block
    An epidural block involves injection of local anaesthetic and pain medication into the epidural space, blocking the transmission of nerve impulses in the spinal cord. It usually involves insertion of a small tube (that stays in place in the back) that can allow regular small doses of pain medication to be administered, depending on the amount of pain you are feeling. An epidural takes around 10-20 minutes to take effect and takes about the same amount of time to set up and be administered.
    Sensation is decreased or lost (dependent on the amount administered) below the level of the block (usually around the mid stomach region). This should take effect on both sides of the body, but sometimes can be varied.
    An epidural block may be used as the only anaesthetic given for an operation that is carried out below the level of the diaphragm, but a sedative can also be administered with it.
    An epidural is commonly used for pain relief during labour and also for caesarean section.

    Spinal Block 
    This involves an injection of a local anaesthetic and pain relief.  A spinal block is a one-off injection, unlike an epidural which is used for regular/continuous administration. The injection is given directly into the cerebrospinal fluid and takes effect very quickly.  Patients have a risk of headache that may be related to a leakage of cerebrospinal fluid from the hole made by the injection.

    Complications from Anaesthesia

    Complications may include: the patient is allergic to the anaesthetic, the dose given may be too high, or the anaesthetic effect has taken effect faster than wanted. Most complications occur with general anaesthesia.

    Airway obstruction:
    Irritation to the breathing passages causing spasms and interfering with breathing.

    Incomplete reversal:
    Inability of the muscle relaxant to wear off properly by the time that the patient has woken up. The patient is aware, but paralysed, this is easy to detect and breathing can be assisted.

    Nerve damage:
    Some local anaesthetics can cause long term nerve damage, while some general anaesthetics can inflict brain damage. Brain damage will also result from depressed blood circulation.

    Malignant hyperthermia:
    An uncommon severe reaction to a general anaesthetic that results in extremely high body temperatures, blood pressure and heart rate. This rare reaction has a tendency to run in families.

    Awareness:
    A much talked about, but in fact a very rare, occurrence. This happens in only one percent of all surgeries involving a general anaesthetic. It means that the patient appears asleep, but is not fully unconscious. This only happens when muscle relaxants are given. The patient cannot talk, move or speak. Newer technology can help an anaesthetist to reliably monitor for signs that this is happening.

    Complications of Epidural and Spinal Blocks:

    decrease in blood pressurehaving to remain still for administration (very difficult when in labour)problems in bladder emptyingbackachemore serious complications are rare, but include convulsions, infection and death.