Know Your Anaesthesia
Before You Go Into Surgery

When you go into surgery as a patient, you will encounter the use of anaesthesia. All forms of surgery need anaesthetics in one form or another.

Here are 3 types of anaesthesia used in the operating theatre during surgery.

Local Anaesthesia

Best suited for small minor procedures where the area to be operated upon is not too big. The advantage of this type of anaesthesia is that it needs very little preparation and is the safest of all the anaesthetic options.

The local anaesthetic drug will be injected in a ring around the area that is going to be operated upon. During the injection, you may experience a mild stinging sensation but this lasts only a while as the area will soon go numb.

During the operation, you should feel little or no pain though you will be wide awake and may experience some tugging or pushing.

As local anaesthetic is limited by the area it is injected into, at times the deeper tissues of that particular area may not receive enough anaesthetic solution during initial injection and you may feel pain in the midst of the surgical procedure. If that happens, you may be injected with more local anaesthetic.

 

Regional Anaesthesia

Commonly employed as spinal or epidural anaesthesia, it involves an injection to the spinal cord in the lower back. As a result, the lower half of your body is numb but the upper half above the umbilicus isn’t.

When done properly, regional anaesthesia is very effective especially for operations on the legs, the area around the groins and anus (example, open inguinal hernia repair, piles). It can also be used for Caeserean sections.

It differs from General Anaesthesia (see below) in that you are awake and breathing on your own during the procedure. Therefore, if you have a bad lung problem, it would be better for you to have a spinal anaesthetic.

In all other respects, spinal anaesthesia carries the same risk as General Anaesthesia. Spinal anaesthesia requires exactly the same preparation as General Anaesthesia.

It is not suitable at all for major abdominal surgery (laparotomy), laparoscopic work or for anything above the umbilicus as the area covered is insufficient.

We also try to avoid spinal anaesthesia if you have a bleeding tendency and if you are on blood thinning medication (antiplatelet drugs like Aspirin, Clodiprogel, Ticlodipine, Xarelto or Warfarin).

Sometimes, you can get a headache after spinal anaesthetic, a “spinal headache”. This is due to the effect of the drug in the spinal cord and pressure changes in the spine. You may also have temporary difficulty passing urine afterwards, especially if you already have a bit of a prostate problem to start with.

 

General Anaesthesia (GA)

This is the most complete of the available anaesthetics. You will be completely asleep during the procedure. All procedures big and small are possible with General Anaesthesia.

General Anaesthesia is necessary for most major surgery and also for very young children who may not be able to lie still for surgery under local or regional anaesthesia.

General Anaesthesia usually begins with a Pre Med, typically an injection given in the ward. When you arrive in the Operating Theatre (OT),  the Anaesthetist will need to insert an intravenous drip (injection on the wrist). He may also need to insert other lines and tubes, depending on the type of operation.

He then induces the General Anaesthesia by giving a sequence of drugs by injection into the vein. You will have a mask placed over your face to supply oxygen and some anaesthetic gases.

All the while, he will have to monitor your vital signs closely. When you are asleep, he will secure the airway, either with a laryngeal mask or an endotracheal tube inserted into the windpipe.

This tube will be taped to your face to provide a constant supply of oxygen and anaesthetic gases for the duration of the operation.

At the end of the operation, the endotracheal tube will be removed and the anaesthetist will give you medication to reverse the general anaesthetic. You will be observed in the Recovery Room where your vital signs will be carefully monitored. When you have recovered from the anaesthetic, you will be transferred back to the ward.

Occasionally, if the operation is a big or long operation, you may be sent to the Intensive Care Unit for close observation after the operation. This is to make sure everything goes well after the operation. We aim to get you out of the Intensive Care Unit as soon as it is safe to do so.

Modern-GA-unit
Here's what a modern General Anaesthetic Unit looks like.