General anaesthetic Informed consent: patient information This information sheet answers frequently asked questions about having a general anaesthetic. It has been developed to be used in discussion with your doctor or healthcare professional. 1. What is a general anaesthetic? 4. What are the risks of having an Source of images: Shutterstock images: of Source A general anaesthetic (sometimes referred to as anaesthetic? a “GA”) is a mixture of medicines to keep you Modern anaesthesia is generally very safe. unconscious and pain free during an operation Every anaesthetic has a risk of side effects or procedure. Medicines are injected into a vein and complications. Whilst these are usually © The State of Queensland (Queensland Health) 2017 Health) (Queensland Queensland of State The © To request permission email: [email protected] email: permission request To and/or breathed in as gases into the lungs. To temporary, some may cause long-term give the gases, the anaesthetist will use a face problems. mask and/or a breathing tube which will be Common side effects and complications placed through your mouth or nose and into Except as permitted under the Copyright Act 1968, no part of this work may be may work this no part of 1968, Act the Copyright under permitted as Except include: reproduced communicated or adapted without permission from Queensland Health Queensland from permission without or adapted communicated reproduced your throat. The tube is removed as you wake up • nausea and/or vomiting after surgery. • headache • pain and/or bruising at injection sites • sore or dry throat and lips • minor damage to lips • blurred/double vision • dizziness and feeling faint • mild allergic reaction such as itching or a rash • problems passing urine • shivering • damage to teeth and dental work Image 1: Patient with general anaesthetic being given with a face mask • confusion and memory loss, usually in older 2. What is a pre-medication? people. It usually recovers but may take weeks or months A pre-medication (pre-med) is a medicine that • emotional distress/behavioural disturbances is given to patients before some anaesthetics to • chest infection help reduce or relieve anxiety. • bleeding is more common if you have been 3. What does my anaesthetist do? taking blood thinning and antiplatelet medicine. Your anaesthetist is a doctor with specialist training who will: Uncommon side effects and complications • assess your health and then discuss with include: you the type of anaesthetic suitable for your • allergic reactions surgery or procedure • asthma • discuss the risks of suitable anaesthetic • muscle aches and pains options • temporary slow or difficulty breathing when • agree to a plan with you for your anaesthetic woken up and pain control • temporary nerve damage (paralysis or • be responsible for giving your anaesthetic and numbness) caring for you during your surgery and straight • being awake or aware after your surgery or procedure • damage to the voice box and vocal chords, • manage blood transfusions if required. which may cause a temporary hoarse voice • damage to the eyes (small pieces of tape are You may be seen and cared for by a specialist usually used to keep the eyelids closed and/or anaesthetist, a GP with training in anaesthetics eye ointment is used (particularly in rural areas) or a doctor/ • prolonged paralysis requiring breathing SWPI9464 SWPI9464 healthcare professional/student undergoing support further training. All trainees are supervised • worsening of an existing medical condition according to relevant professional guidelines. ÌSWPIÇ~`4Î ÌSWPIÇ~`4Î Department of Health General anaesthetic patient information v1.00 09/2017 Page 1 of 4 4. What are the risks of having an 6. What are the risks of not having anaesthetic? (continued) general anaesthesia? • sleep problems There may be consequences if you choose not to • blood clot in the leg (DVT) causing pain and have the proposed anaesthetic. Please discuss swelling. In rare cases part of the clot may these with your doctor/healthcare professional. break off and go to the lungs. 7. What are my responsibilities before Rare risks and complications include: having a general anaesthetic? • severe allergy or shock • very high temperature requiring You are at less risk of problems from an emergency treatment anaesthetic if you do the following: • stroke or heart attack In preparation for your procedure: • leaking of stomach contents/vomit into the • Increase your fitness before your procedure lungs causing pneumonia to improve your blood circulation and lung • prolonged paralysis requiring health. Ask your GP about exercising safely. breathing support • If you are overweight, losing some weight • severe and permanent nerve damage will reduce many of the risks of having an • blood clot in the lungs anaesthetic. Ask your GP about losing • brain damage weight safely. • damage to the eyes including loss of vision • Stop smoking as early as possible before your • deafness (usually short term) surgery to give your lungs and heart a chance • epileptic seizures to improve. Smoking cuts down the oxygen in • equipment failure causing significant harm your blood and increases breathing problems • death (very rare). during and after an operation. Phone 13 QUIT 5. What are my specific risks? (13 78 48). • Drink less alcohol, as alcohol may alter the There may also be risks specific to your effect of the anaesthetic medicines. individual condition and circumstances. Your • Do not drink any alcohol 24 hours doctor/healthcare professional will discuss before surgery. these with you. Ensure they are written on the • Stop taking recreational drugs (this includes consent form before you sign it. recreational smoking such as marijuana) The risk to you will depend on: before your surgery as these may affect • how simple or complex your surgery is the anaesthetic. • whether your surgery takes a short or a • If you take anticoagulant or antiplatelet (blood long time thinning) medicines, such as warfarin, aspirin, • whether your surgery is an emergency. clopidogrel (Plavix, Iscover, Coplavix), prasugrel (Effient), dipyridamole (Persantin or Asasantin), Your risks are also increased if you: ticagrelor (Brilinta), ticlopidine (Tilodene), • are elderly apixaban (Eliquis), dabigatran (Pradaxa), • smoke rivaroxaban (Xarelto) or complementary/ • are overweight herbal/alternative medicines, such as fish oil • have the following: or turmeric: – a bad cold or flu, asthma or other – ask your surgeon and/or anaesthetist if you chest disease should stop taking it before surgery as it may – diabetes affect your blood clotting – heart disease – do NOT stop blood thinning medicines – kidney disease without medical advice – high blood pressure – if you are asked to stop taking blood thinning – other serious medical conditions. medicine before your procedure, ask your doctor when you can restart the blood thinning medicine. SWPI9464 SWPI9464 Department of Health General anaesthetic patient information v1.00 09/2017 Page 2 of 4 ÌSWPIÇ~`4Î ÌSWPIÇ~`4Î 7. What are my responsibilities before 8. What does my anaesthetic recovery having a general anaesthetic? (continued) involve? (continued) On the day of your procedure: Tell nursing staff if you have any side effects • Nothing to eat or drink (‘nil by mouth’): you from the anaesthetic, such as headache, will be told when to have your last meal and nausea, or vomiting. They will be able to give drink. Do NOT eat (including lollies), drink, you some medication to help. or chew gum after this time otherwise your The anaesthetist will arrange pain relief, any operation may be delayed or cancelled. This is other medications and extra fluids by a drip, to make sure your stomach is empty so that if if needed. you vomit, there will be nothing to go into Some ways of giving pain relief are: your lungs. • tablets or pills: • If you are a smoker or drink alcohol: do not – used for all types of pain smoke or drink alcohol. – you need to be able to eat and drink and • If you are taking medicines: most medicines not feel sick for these to work should be continued before an operation, but – these take at least half an hour to work there are some important exceptions: • injections: – your doctor will provide specific instructions – will usually be given into a vein and pain about your medicines relief is within a few minutes – take to the hospital all your prescribed – can also be given into a muscle or under the medicines, those medicines you buy over skin and will take 20 minutes to work the counter, herbal remedies and • suppositories: supplements to show your anaesthetist what – are small pellets that are placed into your you are taking. back passage (rectum) for pain relief • If you feel unwell: telephone the ward/hospital • patient-controlled analgesia (PCA): for advice. – you control your own pain relief by pressing • Tell your doctor and the anaesthetist if a button for your drip to give you a dose of you have: strong pain relief medicines – health problems (e.g. diabetes, high blood – it is programmed in such a way to prevent pressure, infectious diseases, serious accidental overdose illnesses), including if regular treatment or a • local/regional anaesthesia: stay in hospital is needed – the surgeon often injects local anaesthetic – a drug addiction into the wound while you are having the – had previous problems and/or known family general anaesthetic giving you around 4–6 problems with anaesthesia hours of pain relief after the surgery. – false teeth, caps, loose teeth or other – request a copy and/or refer to the relevant dental problems patient information sheet – been taking prescribed and/or over the www.health.qld.gov.au/consent counter medicines, herbal remedies and supplements; this may include and are not 9. Following a general anaesthetic limited to blood thinning medicines, the A general anaesthetic will affect your judgment contraceptive pill, antidepressants and/or for about 24 hours or sometimes longer. For your diabetic medicines (e.g.