Anaesthetists play a pivotal role in resuscitating acutely unwell patients, including trauma victims, and help to manage patients suffering from acute or chronic pain. They also provide pain relief for women during labour and delivery. Throughout their practice, anaesthetists must continue to update their skills by regularly attending professional development sessions.
Anaesthetists must participate in a continuing professional development (CPD) program that complies with ANZCA’s CPD standard in order for them to practise. Many anaesthetists are active in research, studying how the body works, and developing new drugs and equipment to minimise error and patient harm.
They teach a range of healthcare workers, including medical and nursing students, interns, residents, anaesthesia trainees and other medical specialists. In some remote or rural communities where the workload is not sufficient to support a fulltime specialist, non-specialist doctors may give anaesthetics. These doctors undergo limited training sufficient to provide anaesthesia for healthy patients undergoing less complex operations.
Non-specialist anaesthetists often also work as family or general practitioners and undertake training to meet the requirements of the Joint Consultative Committee on Anaesthesia. This is a tripartite committee with representatives from ANZCA, the Royal Australian College of General Practice (National Rural Faculty) and the Australian College of Rural and Remote Medicine.
What is anaesthesia?
Relieving pain and suffering is central to the practice of anaesthesia, which involves administering medications to eliminate sensations, including pain
This allows doctors to perform medical and surgical procedures without causing undue distress or discomfort to the patient. Most people undergo anaesthesia at some stage in their lives, such as during the birth of a baby or during surgery.
They may be anaesthetised for a short, simple day surgery or for major surgery requiring complex, rapid decisions. Modern anaesthesia is relatively safe due to high standards of training that emphasise quality and safety.
There also have been improvements in drugs and equipment. Advances in anaesthesia have also resulted in patients being able to have more complex surgery as a day stay procedure because of more rapid recovery with modern anaesthesia; and they have facilitated many of the advances in surgery. Australia and New Zealand have one of the best patient safety records in the world, thanks to increased support for research to improve anaesthesia.
Specialist anaesthetists become involved in the patient’s care prior to surgery with assessment of their medical condition and planning their care as part of the surgical team.
They closely monitor the patient’s health and wellbeing throughout the procedure and help to ensure a smooth and comfortable recovery.
What types of anaesthesia are there?
The type of anaesthesia used will depend on the nature and duration of the procedure, your general medical condition, and your preference, your and those of your anaesthetist and surgeon or other doctor performing the procedure.
You are put into a state of unconsciousness for the duration of the operation. This is usually achieved by injecting drugs through a cannula placed in a vein and maintained with intravenous drugs or a mixture of gases which you will breathe. While you remain unaware of what is happening around you, the anaesthetist monitors your condition closely and constantly adjusts the level of anaesthesia. You will often be asked to breathe oxygen through a mask just before your anaesthesia starts.
A nerve block numbs the part of the body where the surgeon operates and this avoids the need for general anaesthesia. You may be awake or sedated (see below). Examples of regional anaesthesia include epidurals for labour, spinal anaesthesia for caesarean section and ‘eye blocks’ for cataracts.
A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched.
The anaesthetist administers drugs to make you relaxed and drowsy. This is sometimes called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anaesthetist.
How do I prepare for anaesthesia?
‘Day of surgery admission’ and ‘day surgery’
Make sure that you leave plenty of time to get to the hospital and the admissions area prior to your designated arrival time. There can often be a considerable waiting period at hospitals, so bring something to read or listen to and try to remain relaxed – as difficult as this may be! Your
Almost all patients are now admitted to hospital on the same day as their operation. Depending on the hospital’s requirements, you may be waiting for some hours. There will normally only be limited time available for you to talk to your anaesthetist before your procedure. If you are having a major procedure, or have concerns about your health or anaesthesia, it is beneficial to consult with your anaesthetist at a separate visit before the day of your surgery.anaesthetist and the hospital staff are there to look after you.
Remember, if you have any concerns or questions please contact your anaesthetist prior to coming to hospital.
What should I tell the anaesthetist?
Your anaesthetist will meet with you before your operation to discuss your health, general medical condition, any previous anaesthesia and will perform a relevant examination.
Depending on the type of operation, hospital or facility, this may not occur until immediately before your procedure. The anaesthetist will want to know:
1. How healthy you are and whether you have had any recent illnesses, with a particular focus on heart or respiratory problems.
2. What previous operations you have had and whether there were any problems with anaesthesia.
3. If you have had any abnormal reactions to any medications and whether you have any allergies.
4. Whether you have a history of reflux or heartburn, asthma, bronchitis, heart problems or any other medical conditions.
5. Whether you are currently taking any drugs, prescribed or otherwise – including cigarettes and alcohol – and whether you are taking ‘blood thinners’, otherwise known as ‘antiplatelet drugs’ or ‘anticoagulants’. These include aspirin, clopidogrel [Plavix], warfarin, Pradaxa and Xarelto. Please bring all your current medications in their original packaging.
6. If you have any loose, capped or crowned teeth or implants, have ‘veneers’ or ‘bonding’, or wear dentures or plates.
You may be given questionnaires to complete, or be asked questions by nurses, before seeing your anaesthetist. Your anaesthetist needs to have the best possible picture of you and your present condition so that the most suitable anaesthesia can be planned. Answer all questions honestly – it is really all about minimising risk to you.
There are some things you can do which will make your anaesthesia safer.
1. Get a little fitter – regular walks will work wonders.
2. Don’t smoke – ideally, you need to stop six weeks before surgery. However, stopping for even 24 hours can help. Your GP may be able to assist.
3. If you are overweight, make a serious attempt to reduce your weight before your procedure.
4. Minimise alcohol consumption.
5. Continue to take any medications which have been prescribed but remember to let your anaesthetist and surgeon know what they are.
6. If you are taking aspirin, non-steroidal anti-inflammatory agents or other blood thinning drugs, consult your surgeon or anaesthetist about whether you should stop taking them prior to surgery.
7. If you have any kind of health problem or have had problems with previous anaesthesia, tell your anaesthetist and surgeon so that they are fully informed.
8. If you are concerned about your anaesthesia, make an appointment to see or talk your anaesthetist before admission to hospital and get the answers you need.
9. For children, many hospitals can arrange a preoperative visit.
10. Discuss any herbal products you might be taking with your anaesthetist. It may be necessary to cease taking them two to three weeks prior to surgery.
11. Inform your anaesthetist if you use ‘so called’ recreational drugs as these may interact with the anaesthesia.
12. Inform your surgeon/anaesthetist if you have any issues with blood transfusions.
Is fasting really necessary?
If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety. Your surgeon,
You will usually be advised to avoid food for six hours and fluids (including water) for three hours before your operation. Food or fluid in the stomach may be vomited and could enter your lungs while you are unconscious.anaesthetist or the hospital will advise you how long to fast.
What about anaesthesia for joint replacement surgery?
The anaesthetist will consider several factors when planning your anaesthesia, including:
Past experience with surgery.
Health and physical condition.
Reactions or allergies to medicines.
Risks of each type of anaesthesia.
Preferences of your surgical team.
Regional anaesthesia is the most common form of anaesthesia used during joint-replacement surgery because it aims to provide optimal pain relief while minimising side effects such as sedation, postoperative nausea and vomiting, and leg weakness. It may be used on its own or combined with sedation or general anaesthesia. Regional anaesthesia numbs the part of the body where the surgery will happen. It involves the injection of local anaesthetic around major nerve bundles supplying body areas, such as the thigh, ankle, forearm, hand, shoulder or abdomen.
This is sometimes done using a nerve-locating device, such as a nerve stimulator, or ultrasound, so that the anaesthetic can be delivered with greater accuracy. Once local anaesthetic is injected, you may experience numbness and tingling in the area supplied by the nerves and it may become difficult or impossible to move that part of the body.
BEFORE THE OPERATION
It is important that you speak to your doctor about when you should stop eating and drinking before your anaesthetic. The anaesthetist will also need information such as:
Any recent coughs, colds or fevers.
Any previous anaesthetics or family problems with anaesthesia.
Abnormal reactions or allergies to drugs.
Any history of asthma, bronchitis, heart problems or other medical problems.
Any medications you may be taking.
WHAT TO EXPECT
Each surgery is different. How long an operation takes depends on how badly the joint is damaged and how the surgery is done. The duration of the anaesthesia depends on which anaesthetic is used, the region into which it is injected, and whether it is maintained by continual doses or repeated injections.
After surgery, you will be moved to a recovery room for a period of time until you are ready to be returned to the ward.
Typically, numbness can last several hours but may last several days. Generally, the “heaviness” wears off within a few hours but the numbness and tingling may persist much longer.
As the local anaesthetic effect wears off, numbness will diminish and surgical pain may return, in which case your doctor will prescribe alternative methods of pain relief, including injections or tablets. Because osteoarthritis is often found in hips and knees, and patients undergoing hip or knee replacements are often elderly, there may be complications.
Many joint-replacement patients have other medical conditions – diagnosed and undiagnosed – such as high blood pressure and heart problems, which require assessment and investigation.
Most patients undergoing joint replacement tend to accept the risks involved because of the potential improvement in their quality of life.
What are the risks and complications of anaesthesia?
There is no safer place in the world to be anaesthetised than in Australia.
Nevertheless, some patients are at an increased risk of complications because of health problems e.g. heart or respiratory disease, diabetes or obesity, age, and/ or because of the type of surgery which they are undergoing.
Infrequent complications include: bruising, pain or injury at the site of injections, temporary breathing difficulties, temporary nerve damage, muscle pain, asthmatic reactions, headaches, the possibility of some sensation or awareness during the operation (especially with caesarean section and some emergency procedures), damage to teeth and dental prostheses, lip and tongue injuries, and temporary difficulty in speaking.
Nausea and vomiting are quite common after certain types of surgery, and rare after other types. The type of anaesthesia used may also be a factor. Even with the use of modern medications, a small percentage of patients may experience nausea and vomiting that is difficult to control. If you have had difficulties in the past, please let your anaesthetist know.
There are also some very rare, but serious complications including: heart attack, stroke, seizure, severe allergic or sensitivity reactions, brain damage, kidney or liver failure, lung damage, paraplegia or quadriplegia, permanent nerve or blood vessel damage, eye injury, damage to the larynx (voice box) and vocal cords, pneumonia and infection from blood transfusion. Remember that these more serious complications, including death, are quite remote but do exist.
We urge you to ask questions. Your anaesthetist will be happy to answer them and to discuss the best way to work with you for the best possible outcome.
Risk of infections
Needles, syringes and intravenous lines are all used only once. They are new in the packet before your surgery commences and they are disposed of immediately afterwards. Cross infection from one patient to another is therefore not possible.
With modern surgery the requirements for blood transfusion are less common. All blood collected today from donors is carefully screened and tested but a very small risk of cross infection still remains.
Your anaesthetist is aware of these risks and only uses blood transfusions when absolutely necessary. For major surgery, your anaesthetist may supervise a system of collecting your blood during or after your operation, processing it and returning it to you. This is called blood salvage and sometimes this can avoid the need for a transfusion.
Anaesthetists have an extensive knowledge of medicine and surgery and understanding of the basic sciences. They know how the body responds to anaesthesia and surgery, and how a patient’s health affects these responses.
In Australia and New Zealand, anaesthesia training is supervised and accredited by the Australian and New Zealand College of Anaesthetists (ANZCA). The training to become a specialist anaesthetist is equal in length to that of other medical specialists, such as surgeons, and includes intensive assessments, both at the hospitals where trainees work, and by written and verbal examinations.
Doctors in the training program are called registrars. When a registrar completes their training and passes all examinations, they are awarded a diploma of fellowship of ANZCA, become Fellows of the College and may use the initials FANZCA after their name. They can then practise as a specialist anaesthetist in Australia and New Zealand.
Anaesthetists are perioperative physicians trained in all forms of anaesthesia and are members of multidisciplinary teams providing healthcare to patients. They assess patients before their procedures and play an important role in caring for the patient before, during and after surgery. They also provide anaesthetic care for patients undergoing non-surgical procedures, particularly if the procedures are long, complex or painful
Clinical anaesthesia is built on the knowledge of physiology (how the body works) and pharmacology (how medications work in the body).
A specialist anaesthetist is a fully qualified medical doctor who, after obtaining their medical degree, has spent at least two years working in the hospital system before completing a further five years of training in anaesthesia.