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An operation involves many highly specialized people... Apart from the nursing
and technical staff, there are a number of specialist physicians who may
operate or assist, depending on the nature of the surgical procedure that you
are about to undergo.
The Anaesthesiologist
Having an operation whilst being under anaesthetic is a very worrying and
stressful situation for many patients. This brief overview of what being an
anaesthetist entails should help to put those concerns to rest as well as give
additional understanding as to what it is exactly that anaesthetists do.
Anaesthetists are fully qualified doctors who have completed an additional five
years of specialist training after their primary qualification. This additional
training involves general and regional anaesthesiology, intensive care
medicine, and pain management. Rigorous examinations must be passed at both the
primary and final level. After this has been achieved, the candidate then
receives a specialist qualification and is then eligible for registration as a
specialist Anaesthesiologist with the Health Professions Council of South
Africa.
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Scope of Practice:
Patients that are scheduled to have surgery will be referred to a specialist
anaesthetist for planning and implementation of their anaesthetic care. This
entails optimization of the patient's condition, selection of an appropriate
anaesthetic technique for that patient as well as suitable preparation of the
operating theatre equipment.
For many patients the choice will be either "general anaesthetic" where the
patient is "put to sleep" or "regional anaesthetic" such as a spinal or
epidural block.
These options are usually carefully explained to the patient prior to their
anaesthetic.
When emergency operations are undertaken for trauma or acute surgical illness,
the anaesthetist's special skills in resuscitation and advanced life support
are called upon.
In their wider role, anaesthetists have been called peri-operative physicians
because they provide care throughout the peri-operative period. This period can
be divided into three parts:
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Pre-Op: Before surgery
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Intra-Op: During surgery
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Post-Op: During your recovery after the operation; in recovery room, back in
the ward, or in the high-care/intensive care ward.
YOU AND YOUR ANAESTHETIC
So, you are scheduled to undergo surgery. We hope that the following pages will
help answer any questions that you may have and alleviate any fears. We have
tried, as far as possible, to write this section in "layman's terms". Please
remember that these are only generalized guidelines. If any of your questions
still go unanswered, please feel free to discuss them with your attending
anaesthetist. Alternatively, you could contact us here.
HOSPITAL ADMISSION
Prior to your surgery, you will be admitted to a hospital or day clinic. This
admission process will include an administrative aspect (the hospital will need
to take down all your details including name and address, contact persons and
medical aid details) as well as a nursing aspect (taking your medical history
and preparing you for the surgery). This can all be a time consuming process
and you should ensure that you arrive at the hospital timeously. As an
alternative, most modern hospitals offer a "pre-admission" facility where most
of the paper work can be completed days or weeks in advance and the admission
on the day of surgery is much smoother and less rushed. Please ask your surgeon
if your hospital has such a facility and make use of it. It really makes the
day of your surgery far less stressful.
Some medical aids are reluctant to permit admission to hospital the night
before major surgery. For minor procedures in a healthy patient, this is
usually not a problem. However, if you are having a major surgical procedure or
you have serious medical problems, it would be in your interest to be admitted
to hospital the day before surgery. Should your surgeon or anaesthetist
recommend that you be admitted the day before surgery and your medical aid
refuses you this right, we would recommend that you insist that they supply you
with written confirmation that they accept responsibility for this decision.
Most medical aids require patients to obtain a pre-authorization number before
any surgical procedure. Please remember that you should do this well in
advance, as the lack of this number can lead to delays in your admission and
surgery. Also, please remember to bring your medical aid card and identity
document to the hospital with you. For more information on the "do's and
don'ts" before surgery, please click on the Pre-op guidelines link on our home
page.
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PRE-OPERATIVE VISIT AND PREMEDICATION
All patients undergoing surgery should be seen by the anaesthetist prior to
surgery. The pre-operative visit will entail the anaesthetist taking your
medical history. This will normally include previous anaesthetics and any
complications and side effects, your current and past medication and any
relevant medical history. If you are taking any medication whatsoever, please
bring a list of these drugs with you to the hospital. There are literally
thousands of "little blue blood pressure pills" and it is vitally important for
the anaesthetist to know exactly what you are taking. Also remember that
"herbal" or "natural" medications can have an affect on your anaesthetic and
these should also be mentioned to the anaesthetist. Alcohol and tobacco use are
also important factors. Your anaesthetist will not judge you if you drink or
smoke (or use "recreational drugs"), but it is extremely important for him or
her to know about these in order to administer a safe and appropriate
anaesthetic.
Following the history, the anaesthetist will then examine you. In healthy
patients, this process may only take a few minutes. However, in medically
complicated cases presenting for major surgery, this process may take up to an
hour. The next time you see your anaesthetist, you will be in theatre. So now
is the time to ask any questions you may have. Remember, the only stupid
question is the one you don't ask!
Ideally, we would like to see all our patients in the ward before they go to
theatre. However, please bear in mind that for a theatre list starting at 7.30
in the morning, the anaesthetist needs to be in the theatre by 7.00 to prepare
the equipment and do a whole series of safety checks. Once the list has
started, the anaesthetist is unable to leave the theatre as he / she is
constantly monitoring other patients. If you have a late admission to the ward,
you will then only be seen by the anaesthetist once you are transported to the
theatre. Patients often find it frustrating to be admitted to the ward at 6
o'clock in the morning if they are only due for surgery much later in the day.
Please bear in mind that this is done for your own safety.
Finally, in some patients, a "pre-med" is prescribed. This is normally a drug
that calms the patient and reduces anxiety. For young healthy patients
undergoing short procedures on a day-patient basis, this is often omitted as
patients are usually eager to be discharged as soon as possible. If, however,
you are at all anxious about your surgery, please ask your anaesthetist to
prescribe a pre-med. It is important to remember that these drugs take about 90
minutes to take effect and can only be prescribed if the anaesthetist has seen
you in the ward. So the bottom line ….. get admitted as early as possible if
you require a pre-med.
CHILDREN AND ANAESTHESIA
Anaesthesia for children can be a very traumatic situation, not only for the
little patient, but also for the anguished parents.
Please remember that a child undergoing an anaesthetic is nothing strange.
Experienced anaesthetists may literally anaesthetize hundreds of children every
month. While it may be something terrifying for the family, it is an everyday
occurrence for the anaesthetist.
Be honest with your little one. Explain to them what is going to happen. Don't
mislead them by saying that it "won't be sore" after the surgery. It is far
more important to tell them that they may have some discomfort after the
operation, but that they will be given more than enough medicine for the pain.
It is very important to make them feel comfortable in the hospital. Bring along
a favourite toy. Most hospitals are quite happy for one of the parents to
accompany the child into the theatre while the anaesthetic is administered.
Please discuss this with the hospital and the anaesthetist.
Most children are anaesthetized with gas. A small mask is placed over the
child's face. It takes a while for them to go to sleep, and just before they do
so, they may go through a phase where they wriggle around on the theatre bed.
Do not be alarmed by this. It is quite normal, they are not suffering at all
and they don't remember this.
Rules for being without food and drink are slightly different in children.
Please check our Pre-op guidelines link for more information.
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TRANSFER TO THE OPERATING THEATRE
You have now been through the process of admission to the hospital and the ward
routine and you are ready to be transferred to the operating room. In most
hospitals, you will be accompanied by a porter and a nursing staff member from
your ward.
Upon arrival in the operating suite, you will be met by a member of the
recovery room staff. This staff member, along with the ward staff, will verify
your personal information. They will confirm with you the nature of your
surgery and, in the case of limb surgery, whether it is to be performed on the
left or the right. Do not be alarmed by this. It is merely a system of checks
and double checks to ensure your safety
IN THE THEATRE
Welcome to the theatre!!! This is where we, as anaesthesiologists spend our
days …. and often our nights. To you, it may be a foreboding place. To us, it
is merely our place of work just like your office.
You may be surprised to see so many people in the room, but rest assured that
each member of the team is there to look after you. Apart from the
anaesthetist, there will be an anaesthetic nurse. This is a specially trained
member of the nursing staff whose sole role it is to assist the anaesthetist.
The "scrub" sister is a highly qualified person who helps the surgeon by
preparing all the necessary instruments and having them on hand. By the time
you enter the theatre, she will often be "scrubbed" and wearing her gown,
gloves, mask and cap. Assisting the "scrub" sister is the "floor nurse" whose
job it is to fetch any additional equipment the surgical team might require.
Finally, in certain types of surgery, a technician may also be present in the
theatre.
The anaesthesia team will now prepare you for your anaesthetic.
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MONITORING DURING THE ANAESTHETIC
By the time you arrive in the theatre, the anaesthetist and his / her nurse
will have already spent a great deal of time checking and double checking all
the equipment. Throughout your anaesthetic, the anaesthetists will never leave
your side. He / she is constantly monitoring your vitals signs every few
minutes and these are recorded on the anaesthesia case record.
The anaesthesia team will now connect you to various monitors. These are
absolutely routine and are nothing to be alarmed about. Three (sometimes five)
stickers will be placed on your chest. These are connected to the ECG machine
which will be used to monitor your heart during the anaesthetic. A blood
pressure cuff will be placed on one of your limbs and a small peg called a
pulse oximeter placed on a finger. This clever little machine measures the
oxygen concentration in your blood stream. Once you are asleep, a multitude of
other monitors may be used. These include capnography, LOC (level of
consciousness) monitors, temperature monitors and various forms of "invasive"
monitoring.
All these bits of machinery are there to ensure your safety.
RECOVERY ROOM AND THE POST-OPERATIVE PHASE
Once the surgery is completed, you will be transferred to the recovery room.
Here your anaesthetist will hand you over to a member of the nursing staff who
is specifically trained to manage patients recovering from anaesthesia. The
intensive monitoring you enjoyed in the theatre will be continued in the
recovery room. Once you are physically awake and able to meet certain criteria,
the recovery room sister will consult with the anaesthetist who will then
authorize your discharge from the operating suite back to your ward.
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PAIN MANAGEMENT
Most forms of surgery are associated with some form of discomfort. Your
anaesthetist is the best qualified person to help you in controlling this pain.
Please click on the pain management link for more information on this important
issue.
PAIN MANAGEMENT AFTER SURGERY
Most surgery is associated with some degree of post-operative discomfort. Your
anaesthesiologist is the most suitably qualified person to advise you on the
various methods available to control your pain.
Please click on one of the links below to access more information:
HOW MUCH PAIN WILL I HAVE? WHAT METHODS ARE USED TO CONTROL PAIN? IS
ADDICTION AN ISSUE? PAIN LINKS
HOW MUCH PAIN WILL I HAVE?
Most surgery is associated with some degree of post-operative discomfort. Your
anaesthesiologist is the most suitably qualified person to advise you on the
various methods available to control your pain. Please feel free to discuss
this important issue with him / her.
The amount of pain is affected by numerous factors.
These include:
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The size of the surgical incision (the "cut")
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The extent of tissue trauma
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The individual patient's personal pain threshold
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The area and nature of the surgery
Minimally invasive surgery (or "key-hole surgery") is gaining in popularity and
is associated with less pain, quicker recovery and often earlier discharge from
hospital. Your surgeon will be able to advise you on this matter.
Patients are often led to believe that taking "herbal" or "natural"
preparations will decrease the level of post-operative pain. Do not heed this
advice. Many of these preparations, including arnica, st. John's wort and
preparations containing garlic and ginger may greatly increase the risk of
post-operative bleeding and should be discontinued 10-14 days prior to surgery.
Even though you may not regard them as "medicines", it is extremely important
to let your anaesthesiologist know if you have been taking any of these
remedies.
With currently available technology and pharmacological advances, there is no
reason why any patient should suffer unnecessary pain following surgery.
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METHODS AVAILABLE TO CONTROL YOUR PAIN
The anaesthesiologist is armed with a vast array of methods to control
post-operative pain. These range from the administration of systemic analgesics
(painkillers) to the performance of various forms of regional anaesthesia.
Regional anaesthesia involves the science of injecting local anaesthetics
around the nerves which supply the area upon which surgery is to be performed,
thus "numbing" the area.
This website cannot contain detailed descriptions of all these methods. It is
the right of our patients to discuss the pro's and con's of each with the
anaesthesiologist prior to surgery.
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To access more information on systemic analgesia, click here
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To access more information on regional anaesthesia, click here
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If you are concerned about addiction to painkillers following your surgery,
click here
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To access more information on p.c.a, click here
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IS ADDICTION AN ISSUE?
In the past, many patients have been hesitant to accept pain killers because of
a fear of "addiction". The good news is that numerous well-conducted
international studies have proved that without any doubt, the use of pain
killers in the acute post-operative phase does not lead to addiction.
Post-operative pain should normally disappear after approximately 8 weeks.
If you find that you are still suffering from pain 3 months after surgery, the
possibility exists that you are suffering from what is referred to as chronic
pain.
In this situation, you should not still be using normal pain killers. You
should then contact a unit that specializes in the management of chronic pain.
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REGIONAL ANAESTHESIA
Regional anaesthesia is the science of injecting local anaesthetic drugs around
the nerves that supply sensation to the area of your surgery. This is referred
to as a "nerve block". Nerve blocks can be performed as the sole form of
analgesia (in other words, the "block" is performed with the patient awake and
provides sufficient pain relief for the surgery to be performed with the
patient awake) or as supplemental analgesia (the patient is given a general
anaesthetic for the surgery and the "block" is performed purely for post
operative pain relief).
Please click on one of the links below to access more information on various
forms of regional anaesthesia:
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Epidural Anaesthesia
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Spinal Anaesthesia
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Peripheral Nerve Blocks
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EPIDURALS
Epidural anaesthesia involves the placement of a needle between two of the
vertebrae of the spine to reach the so-called "epidural space". This is the
area just outside of the fibrous sac that surrounds the spinal chord. All the
nerve roots leaving the spinal chord pass through this space, and by injecting
local anaesthetic drugs into this space, the anaesthesiologist can "numb"
certain areas of the body. Often, an epidural catheter (a very tiny plastic
tube) is placed through the needle before the needle is removed. This catheter
enables us to keep the epidural working for as long as it is needed.
Although it sounds fairly daunting, an epidural is generally a painless
procedure as the skin is anaesthetized with local anaesthetic prior to the
epidural injection. Patients are normally only aware of some pressure on the
spine. Epidurals can be performed with the patient either awake or asleep.
Epidurals are widely used for:
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Labour pains and epidural caesarean sections
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Post operative pain control following knee or hip replacement surgery
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Post operative pain control following surgery to the major body cavities (e.g
abdominal surgery of chest surgery)
Epidurals generally have a very high safety profile. Minor complications
include a moderate decrease in blood pressure and occasionally headache. Your
anaesthesiologist will be more than happy to answer any question you may have
regarding epidurals.
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SPINALS
Spinal anaesthesia involves the placement of a small needle between two of the
vertebrae of the spine to reach the so-called "spinal space". This is the area
inside the fibrous sac that surrounds the spinal chord and it is filled with
fluid. By injecting local anaesthetic drugs into this fluid, the
anaesthesiologist can "numb" certain areas of the body. This usually leads to
muscle weakness in the area anaesthetized. However, this weakness is temporary
and normal muscle strength returns as soon as the spinal wears off after a few
hours.
As is the case with epidurals, spinals are generally painless procedures as the
skin is anaesthetized with local anaesthetic prior to the spinal injection.
Patients are normally only aware of some pressure on the spine. Spinals can be
performed with the patient either awake or asleep and are often used as the
only form of anaesthetic so that the patient can be awake during the surgical
procedure.
Epidurals are widely used for:
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Labour pains and epidural caesarean sections
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Knee or hip surgery
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Many urological procedures such as prostate surgery
Your anaesthesiologist will be more than happy to answer any question you may
have regarding spinals.
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PERIPHERAL NERVE BLOCKS
Peripheral nerve blocks are the latest and fastest growing form of regional
anaesthesia.
Here, local anaesthetic is injected around specific nerves that supply the
sensation to various body regions. Unlike spinals and epidurals (where the
numbness is usually experienced on both sides of the body), peripheral nerve
blocks are normally one-sided and "more focussed" on the area of surgery. To
find the nerve, the needle is connected to a device known as a nerve locator
which sends tiny electrical impulses enabling the anaesthesiologist to
accurately find the nerve.
There are a vast number of uses for peripheral nerve blocks. For example, a
sciatic nerve block gives excellent pain relief for ankle surgery while an
interscalene block enables patients to undergo effective physiotherapy
following shoulder surgery. Although used most commonly in orthopaedic surgery,
certain forms of peripheral nerve blocks are extremely useful in breast surgery
and surgery of the head and neck.
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P.C.A.
"PCA" stands for patient controlled analgesia.
Following surgery, the patient is connect to a P.C.A machine. This piece of
equipment constantly provides the patient with a sustained level of pain
relief. However, what makes P.C.A. unique is that the machine has a push
button. When pressed by the patient, this push button asks the machine to give
the patient an additional dose of pain killer.
This leaves the patient truly in control of his/her own pain treatment. There
is no need to ask nursing staff to administer pain medication. The P.C.A.
machines are individually programmed by the anaesthesiologist in theatre. This
programme includes certain safety mechanisms so that it is virtually impossible
for the patient to administers "too much" medication. The controls of the
P.C.A. machine are also locked electronically by the anaesthesiologist so that
the settings cannot be changed by anyone else.
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SYSTEMIC ANALGESIA
Systemic analgesics are any pain killing drugs administered by intravenous
methods, intramuscularly, subcutaneously (under the skin), rectally or by
mouth. Drugs that are commonly used include morphine, tramadol, pethidine,
paracetamol, aspirin, codeine, anti-inflammatories and numerous others.
For acute pain, morphine still remains the most trusted drug on the market.
Many patients believe they are "allergic to morphine". However, what they have
experienced in the past is not an allergy, but normal side effects of morphine.
These include itching, nausea, constipation and vomiting. A number of drugs are
available to counteract these side effects and these can be prescribed for you
by your anaesthesiologist. If, however, you have experienced any difficulty in
breathing following the administration of morphine or any of its derivatives,
please tell your anaesthesiologist.
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PRE-OPERATIVE GUIDELINES
What should I do before my surgery?
Before being admitted to hospital for surgery it is important to ensure that
there are no medical conditions or other factors which may put you at
unnecessary risk from the procedure, or cause your operation to be delayed or
cancelled. On admission you will be assessed firstly on your medical history
and later by the anaesthesiologist; it is crucial for your safety that you give
accurate information about your pre-existing medical conditions, your
medications, whether or not you are a smoker and how long since you last ate or
drank. If your surgery is urgent then while there may not be time to implement
the suggestions below, it remains important for the anaesthesiologist to have
the information needed.
Existing medical conditions:
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1. Respiratory(lung) disease
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Asthma: If you have severe asthma this may be life-threatening
without proper preoperative preparation.
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You should be taking your medications regularly
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You should not undergo anaesthesia and surgery if you are presently having an
asthmatic attack, even if mild.
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A cold or flu will markedly increase your risk of complications; if you have
contracted flu you should postpone your operation for at least two weeks.
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Chronic lung conditions such as emphysema or bronchiectasis:
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Your lung condition should be optimised. Does your regular physician know of
your impending surgery and is he satisfied with your chest condition?Have you
been taking your medication?Has your condition recently deteriorated or do you
have a chest infection?
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If you have a severe chronic lung condition you may need to be admitted days
before your surgery for preparation. Please contact us at least a week before
admission to discuss this.
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Cardiac disease
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Hypertension(high blood pressure)
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It is extremely important your blood pressure is controlled. Untreated
hypertension may lead to cancellation of your surgery or post-operative
complications such as stroke or heart attack.
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Blood pressure medications may have severe effects when combined with
anaesthetic drugs. Do not stop taking your medications because you re not
allowed to eat before surgery. Rather check with us by phone or visit to plan
which medicines should be continued and which omitted on the day of surgery
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Angina, previous heart attack or cardiac surgery, cardiac rhythm disturbances,
venous thrombosis and lung embolism; previous cardiac failure:
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Does your cardiologist know of your impending surgery? Is he satisfied with
your cardiac status?
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Anti-anginal drugs and anti-coagulant drugs need careful planning to avoid
problems. Please contact us or your regular medical attendant at least a week
before admission.
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Drugs: Check with us beforehand which medicines you should take up to the time
of surgery. Antihypertensives should be taken on the day of surgery,
particularly b-blockers(Ziak, Concor, Inderal etc), as should anti-anginal
drugs and cardiac failure medications. Anticoagulants (Warfarin) on the other
hand should generally be stopped at least five days before surgery. It is very
important to clear this with your doctor.
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Neurological disease, epilepsy and muscle diseases:
All of these may have profound implications for the anaesthetic; you should
check with us well before your surgery whether an assessment is needed. A
report from your specialist about your condition will be very helpful. Do not
stop your anti-epileptics; anaesthesia and surgery may interfere with your
anticonvulsant regimen, leading to seizures and loss of your driver status, and
should be planned for ahead of time.
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Genetic diseases:
Porphyria, Malignant Hyperthermia tendency and Sickle Cell anaemia are diseases
which require special precautions and therefore prior notice . Please contact
us early if you have concerns.
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Psychological or psychiatric treatment:
If you are on treatment for depression or schizophrenia we need to be informed
two weeks early as certain drugs may be dangerous when combined with
anaesthetics.
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Metabolic disease:
If you suffer from Diabetes it is very important that you are assessed by the
anaesthesiologist prior to your admission if you are having anything other than
minor day-case surgery. Some diabetic drugs may need to be changed before
surgery.
New medical conditions:
Intercurrent illnesses such as colds, flu, bronchitis and pneumonia may
markedly increase your risk of complications under anaesthesia, and you should
not undergo elective surgery while you have an active infection. Please be sure
to attend your regular physician or check with us if you are unsure.
Smoking:
Smokers are at increased risk of complications following anaesthesia and
surgery. These result from both the short-term effects (airway irritability,
decreased ability to clear sputum from the chest) and the long-term effects
(lung tissue destruction, emphysema and heart disease). You can reduce the risk
of complications by stopping smoking. Even twenty-four hours of not smoking
will reduce your risk of hypoxic (low blood oxygen) events; however you need to
stop 6 to 8 weeks before surgery for the benefits to be substantial. Also you
do not want to be suffering symptoms of enforced withdrawal at the same time as
you are recovering from major surgery.
Starvation guidelines:
You will be warned by your surgeon not to eat or drink before your surgery.
This is important! It is extremely dangerous to disregard this or to conceal
from your anaesthesiologist that you have eaten. Why is this? Anaesthesia
relaxes the functional valve system preventing regurgitation of stomach
contents into the throat; if there is food residue in your stomach this may
enter your lungs leading to major damage and even death. The following
guidelines should only be disregarded in the case of emergency surgery:
Adults:
Do not eat within 6 hours of your anaesthetic.It is preferable not to eat on
the day of your surgery even when this is scheduled for the afternoon unless
you have been given specific permission to do so. Note: This does not mean that
you cannot take your medications. If you are taking anti-hypertensives,
anti-anginal drugs or anti-epileptics these should be taken with a small amount
of water (25 ml) 2 hours before your surgery.
If your surgery is scheduled later you may drink water or clear fluids (apple
juice, black tea or coffee, coke etc) up to two hours before the anaesthetic.
Children:
Children become distressed when hungry or thirsty and should not be starved
unnecessarily. The following are safe but should not be reduced:
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No food within 6 hours of surgery
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No formula feed within 6 hours of surgery
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No breast milk within 4 hours of surgery
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Clear fluids (water, apple juice, cordials without fruit cells) may be given up
to two hours before surgery.
Please remember that the order of the surgical slate may be changed, so that
the times above should be taken as starting from the beginning of the slate,
usually 07h30 in the morning or 13h00 in the afternoon.
Fees:
Your Medical Aid may reimburse you the full amount of the doctors fee or only a
part thereof, depending on which Medical Aid and which Plan you have. You
should be sure before entering the hospital whether your Medical Aid will cover
the doctors fees or whether you will have to make up any difference.
Proper preparation for your surgery may make all the difference. It is much
preferable to contact us at the numbers given on this website if you are in any
doubt. We wish you a safe and speedy recovery from your surgery.
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ANAESTHETIC FEE STRUCTURE
The fees that anaesthesiologists charge are a summation of the preoperative
consultation and a time based anaesthetic procedure fee. The consultation is
needed to assess any patient risk factors and to enable planning of the
anaesthetic management. The consultation fee makes up a significant percentage
of our total anaesthetic fee and while this often seems inappropriate for
patients the reasons are:
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Over the last decade there has been an unparallel increase in consultations
over procedure codes by the Medical Funders. Whilst the South African Society
of Anaesthesiologists would have preferred a combined fee for the anaesthetic
procedure and consultation this would have significantly disadvantaged us. For
example the increase in procedures for 2005 is 5.2% whilst that for
consultations is 17%.
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The fee for consultation has been calculated on a time base but this is
erroneous for anaesthesiologists as we are forced to assess patients often on
the day of surgery (as most Medical Funders have blocked admission the night
prior to major surgery) and in a limited time period prior to the commencement
of the operating list. While the anaesthesiologist may only spend 5-10 minutes
with you this time is used effectively to assess your recorded medical history,
to perform an examination to exclude any anaesthetic risk factors and to plan
the nature of the anaesthetic.
If your procedure is either unbooked prior to the start of the list or an
emergency then this type of case attracts an additional 'emergency fee'
irrespective of the time of day. If the attending anaesthesiologist needs to
make a special trip to the venue were your procedure is booked this will
attract an additional 'emergency travel' fee. These fees are included to
remunerate anaesthesiologists for the disruption to their planned workday and
to encourage timeous attendance at any emergency.
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