Q & A

1. What is an anaesthesiologist?

An anaesthesiologist is a qualified medical doctor. After having qualified, he can further qualify himself as a specialist in any field of his choice. Anaesthesiologists are doctors who qualified in anaesthesia, intensive care and pain management. The standard of training in South Africa is very high.

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2. What is an anaesthesiologist's 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:
  1. Pre-Op: Before surgery
  2. Intra-Op: During surgery
  3. Post-Op: During your recovery after the operation; in recovery room, back in the ward, or in the high-care/intensive care ward.

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3. 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:
  1. 1. Respiratory(lung) disease
    1. Asthma: If you have severe asthma this may be life-threatening without proper preoperative preparation.
      • You should be taking your medications regularly
      • You should not undergo anaesthesia and surgery if you are presently having an asthmatic attack, even if mild.
      • 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.
    2. Chronic lung conditions such as emphysema or bronchiectasis:
      • 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?
      • 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.
  2. Cardiac disease
    1. Hypertension(high blood pressure)
      • 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.
      • Blood pressure medications may have severe effects when combined with anaesthetic drugs. Do not stop taking your medications because you are 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.
    2. Angina, previous heart attack or cardiac surgery, cardiac rhythm disturbances, venous thrombosis and lung embolism; previous cardiac failure:
      • Does your cardiologist know of your impending surgery? Is he satisfied with your cardiac status?
      • 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.
    3. 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.
  3. 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.

  4. Genetic diseases:
    Porphyria, Malignant Hyperthermia tendency and Sickle Cell anaemia are diseases which require special precautions and therefore prior notice .In Malignant Hyperthermia you must be booked first on the theatre list and the anaesthetist must know the day before about your MH status. MH patients can contact the MH centre for diagnostic work-up, family counseling, general information and medic-alerts. You can contact dr JC Brand (specialist anaesthetist and MH expert) at mh-info@lantic.net. Please contact us early if you have concerns.

  5. 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.

  6. 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:
  • No food within 6 hours of surgery
  • No formula feed within 6 hours of surgery
  • No breast milk within 4 hours of surgery
  • 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.

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4. What does the hospital admission entail

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. It would be in your interest to confirm the specific option or plan of your specific medical aid beforehand as it does not normally appear on the medical aid card.

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5. What is "informed consent" ?

This means that you are informed about options regarding treatment, general and more serious risks involved in the treatment, as well as pro's and cons and the result of being treated or not. You should also be given the opportunity to ask questions. Written consent is usually required, except in extreme emergencies

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6. What is important for your anaesthesiologist to know?

It is important to answer all questions honestly and truthfully. These questions are related to your health and any medical condition that may pose a risk. You will be asked questions about your next of kin's medical history, medication, smoking habits, drug habits, previous anaesthetics etc.

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7. Why is a pre-operative examination necessary?

The effect of anaesthetic drugs is influenced by numerous factors. Age of patient, weight, pregnancy, race, alcohol consumption, tobacco, medication, drugs, kidney- and liver diseases are but a few examples. In some instances certain anaesthetic drugs should not be administered at all.

Some medical conditions increase the risk of anaesthesia, e.g. heart diseases. Although seldomly experienced, Malignant Hyperthermia is one example where anaesthesia can be fatal if not administered correctly. Anaesthesia and surgery can affect all the systems of the body, therefore it is vitally important that the anaesthesiologist should be informed of all medical conditions you may have. This will enable him to use the most effective method.

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8. What is a pre-operative visit?

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.

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9. May I have a pre-medication?

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.

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10. Should I inform my anaesthesiologist if I am taking any herbal medication?

Some of these products are very potent and can be dangerous, especially if the anaesthesiologist is unaware that you are taking them. Some herbal medication prolongs the effect of anaesthetics while others may tend to cause bleeding or induce palpitations and high blood pressure.

The use of herbal medication should ideally be stopped 2 weeks pre-operatively. If this is not possible, the product should be taken to hospital in its original packing so that the anaesthesiologist can familiarize himself with the contents of the product.

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11. Do I have to inform the anaesthesiologist about smoking and alcohol consumption?

Tabacco and alcohol sometimes affect the body more than medication. Due to their effect on organs such as the heart, lungs, liver and blood, they have an influence on the way anaesthetics work. This is especially important with regard to "street drugs" e.g. marijuana, cocaine, amphetamine, heroin etc. Patients are sometimes embarrassed to reveal this information, but it is worth while to remember that all information is strictly confidential. It is important for the anaesthesiologist to be well informed.

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12. Do I have to stop smoking before my operation?

Tabacco has an influence on your heart, lungs, blood and other aspects of the body. You should stop smoking 6 weeks prior to your operation. If not possible, stop the moment you are scheduled for the operation.

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13. Why am I not allowed to eat or drink before my operation?

Aspiration is the inhaling of food particles into the lungs and can be extremely dangerous. The body has an effective mechanism to prevent this, but when you are unconscious, this mechanism is also "unconscious". It is therefore important for the stomach to be empty when you are receiving anaesthetics. In cases of emergencies where the patient has been eating and/or drinking less than 6 hours previously, the anaesthesiologist will take special precautionary measures to minimize the risk of aspiration. This rule of no eating and drinking 6 hours prior to anaesthesia, should also be applied when regional anaesthesia is administered because the possibility that general anaesthesia might become necessary can not be ruled out. It is also not advisable to chew gum or suck sweets, as these enhance the acid secretion in the stomach.

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14. What about 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.

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15. My child and anaesthetics: How can I help?

The anaesthesiologist and surgeon will do their utmost to keep your child happy during his stay at hospital. You as the parent can also help.

It is important to prepare the child as soon as it has been decided that an operation is necessary. Children deal with surgery and anaesthetics better if they are well prepared. The keyword is honesty. Explain to him that he will be in a strange evironment, but that there will be friendly people to look after him.

Children should know that they are going to get an operation and that they might feel a bit uncomfortable afterwards. Prepare them for the fact that you will not be with them constantly, but that you will be close by.


Talk to them light heartedly about the hospital, the long passages, the hospital beds and the possibility of other children in the ward.

A calm parent leads to a calm child.

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16. How long before the operation must I keep my child nil per mouth?

As a general rule children should not eat any solid food or milk 6 hours prior to the operation. Clear liquids may be given up to 3 hours before the procedure.

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17. How am I transferred 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.

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18. What happens in 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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19. How am I monitored during my 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.

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20. Will I need a blood transfusion?

There are many factors determining the need of a blood transfusion. The most important is the type of operation you will be undergoing and the condition of your own blood prior to the operation. During some procedures the loss of blood is unavoidable, regardless the skills of the surgeon. Most blood transfusions are given directly after or just before an operation. All fluids given in the operating theatre are administered by the anaesthesiologist. Blood is only given when the risk of not giving blood exceeds the risk of giving it. Anaesthesiologists are specialists in the field of making these decisions.

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21. What are the most common side-effects of anaesthesia?

Sore throat: This is due to the breathing tube in your throat during anaesthesia. At least 95% of all patients have some or other tube in the throat during anaesthesia. This causes friction during breathing, hence the sore throat. Please note - nothing went wrong with the anaesthesia.

Pain: This is due to the surgical procedure. Most anaesthesiologists administer pain medication during the procedure. He will also prescribe medication post-operative. Please ask - it is unnecessary to suffer pain.

Nausea and vomiting: There are various reasons for this e.g. the type of operation, your pre-operative condition, the use of pain killers as well as the use of anaesthetics. Some anaesthesiologists will administer "anti-nausea" medication during the procedure, but medication will also be prescribed post-operatively.

Drowsiness after the procedure: Some patients are very sensitive to anaesthetics. Everybody reacts differently - some people need more than others. Longer procedures also influence the post-operative recovery.

Less serious side-effects may include:

Dry mouth or temporary breathing problems.

Itchiness, bruising or pain at the spot of injection.

Rash due to plasters or medication.

Sore neck, sore or dry eyes.

Pain in arms or legs due to the positioning during the operation.

You may also feel cold and shaky.

These side-effects usually do not last long and do not need any treatment.

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22. What are the complications of anaesthesia?

The less serious complications have already been discussed.

More serious complications are not necessarily due to the anaesthesia, but a combination of various factors. These include: serious allergic reactions, heart attacks, massive blood loss, thrombosis, pulmonary embolism, stroke, serious asthma attacks and other cardio-pulmonary problems.

These complications are very rare and your anaesthesiologist is well qualified to deal with any such complication.

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23. What happens if I am allergic to anaesthetics?

Some people may think that they "are allergic to anaesthetics" because of previous unpleasant experiences such as nausea and vomiting. These are side-effects and not allergies. True allergies include swelling of the mouth, throat or eyes, breathing problems, hives and wheals, and sometimes a drop in blood pressure.

It is possible for a patient to show allergic reactions to some drugs, although it seldom happens. If it does happen, it is seldom permanent, because anaesthesiologists are specialists who will notice these reactions immediately and act fast to prevent any permanent damage. Allergy to latex is an increasing phenomenon, but seldom serious. If you suspect such an allergy you should inform your surgeon and anaesthesiologist in order to avoid rubber products being used.

If any allergies occur, you will be tested after the operation so that those products can be avoided in future. You may have to wear a "medic-alert" bracelet. Allergic reactions to one type of anaesthetic does not mean that you will not be able to receive anaesthetics in future.

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24. What happens to me in recovery room?

This is the safe place where you will be monitored while the anaethetic wares off and you regain consciousness. Although a trained person as part of the nursing staff team will be allocated to watch over you, the anaesthetist will stay involved till it is safe for you to be transferred to the ward. This is the place where acute post-operative pain and nausea and vomiting are dealt with in order to send you relatively comfortable to the ward. A formal handing over process takes place before the ward’s nursing staff take over your care.

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25. Will I have pain?

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.

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26. Which methods are available to control 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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27. What exactly is 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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28. 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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29. What is patient controlled analgesia?

"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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30. Where does regional anaesthesia fit in?

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).

See more information about the different types of regional anaesthesia like spinals, epidurals, upper limb blocks and lower limb blocks under Information leaflets.

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31. What about my account?

From 2004 there is no recommended or fixed tariff for medical services. To comply with the law of the country, there is no medical aid rate or "contracted in" fee, neither is there a " contracted out" or SA Medical Association rate.

This means that doctors would be allowed to charge whatever professional fee they can justify. Every medical scheme, on the other hand, will determine the level of benefits they are prepared to pay.

There is a so called "National Reference Price list" compiled by associates of the Department of Health. This is a reference list only and no doctor or medical aid is under obligation to comply with this. We have been advised by the SA Medical Association that accounts rendered according to this list, do not compensate doctors adequately.

This means that patients are responsible for paying their own accounts or at least expect an extra payment over and above the amount that the medical aid may agree to pay.

Rates and perceptions are changing rapidly and this is an attempt to keep you informed.

What has not changed is our commitment to render a quality health care service.

Please discuss your concerns with us.

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32. When can I resume my normal activities?

Normally this depends on the type of surgery you had and you will be guided by your surgeon. Anaesthetics are usually out of the system within a few hours, but it is not advisable to drive a motor car or to sign any legal documents for at least 24 hours after anaesthetics.

If you have any questions other than these, consult your surgeon or anaesthesiologist.