Bay Anaesthetists

Fasting before Anaesthesia

Adults:
Do not eat within 6 hours of your Anaesthetic
Clear fluids until 2 hrs pre- surgery

Children:
No food within 6 hrs of surgery
No formula feed within 6 hrs of surgery
No breast milk within 4 hrs of surgery
Clear fluids ( water,apple juice) up to 2 hrs before surgery

Medication

  • Bring your current medication to hospital
  • List of medication, current and past 3 months, including homeopathic and natural products
  • List of allergies
Drugs on the day of surgery –  to give or not to give?

Many drugs should be given on the day of surgery even when the patient is nil by mouth.

A few exceptions are listed below. Drugs may be taken with a small amount of water at any time during the NBM period.

GIVE

  • All “cardiac” or blood pressure drugs
  • EXCEPT ACE inhibitors, AT2 antagonists and diuretics (see below)
  • All epilepsy or Parkinsons drugs
  • All asthma drugs or inhalers
  • All tablets which reduce gastric acid (omeprazole, lansoprazole, ranitidine)
  • All thyroid drugs
  • All major and minor tranquilisers , which are taken regularly at home . Also anti-depresents and nicotine patches.
  • All steroids taken regularly, including inhalers
  • All immunosuppressants and cancer drugs (eg. Azathioprine, tamoxifen)
  • All analgesics can be given before surgery – EXCEPT NSAID’S (see below)

OMIT

 ACE inhibitors (Ramipril, enalapril, perindopril, captopril)

  • Angiotensin 2 antagonists (candesartan, losartan)
  • Both these drugs may drop the blood pressure during an anaesthetic
  • Anaesthetists may request that these drugs are given before surgery but this will be requested on an individual basis. Please with-hold unless requested. 
  • All diuretics (frusemide, bumetanide, bendroflumethiazide, amiloride, spironolactone). The anaesthetist may request that these are given – this will be on an individual basis.
  • Diabetic treatment (alternative diabetic treatment must be arranged with Dr.)
  • Asprin, clopidogrel, dipyridamole, wardarin. You must be familiar with the individual requirements of your surgical team. These drugs must NOT be stopped in patients who have a coronary stent without prior discussion with an anaesthetist or cardiologist
  • Drugs which are not essential in the short term. Eg. Vitamins, iron, laxatives, osteoporosis treatment, liquid antacid medicines (eg gaviscon) HRT, anti – histamines, herbal remedies or homeopathic medicines.
  • Lithium should be omitted 24 hours before surgery.
  • Non steroidal anti inflammatory drugs (eg. Diclofenac (voltarol), indomethacin, ibuprofen), unless prescribed by an anaesthetist as a pre-med.

MAOI’S

  • Stop 2 weeks before surgery
  • Never reversible 
  • MAOI’S reversible after 24 – 48 hours
  • Tricydic antidepressants
    • Omit pre – op dose
    • SSRI’S – Omit pre – op dose

Musculoskeletal

  • Methotrexate
    • Stop  1 -2 weeks pre – op

CNS 

  • Stop 2 weeks before surgery
  • Never reversible

Contact surgeon regarding use of blood thinners (Plavix, Aspirin, warfarin etc) pre- operatively

Diabetes Mellitus:

Pre-operatively please follow the Diabetes medication instructions:

If in doubt, please contact your Anaesthetist.

Diabetes information table

Complications

No one can guarantee an incident free anaesthetic. Complications may be related to underlying patient conditions, the surgery, the anaesthetic, procedures done for pain relief or monitoring.

The following list includes some of anaesthetic related complications:

Feeling sick
Sore throat
Shivering
Damage to teeth, lips and tongue
Damage to the eye during general anaesthesia
Post- operative chest infection
Becoming confused after an operation
Accidental awareness during general anaesthesia
Read More

Your Child's General Anaesthetic

Anaesthesia and neurotoxicity
Caudal block
Your Child’s General anaesthetic- Information for parents
General Anaesthetic Paediatric Leaflet

Complications of Anaesthesia

Complications and unpleasant effects following an anaesthetic are fairly common and can occur even after previous uneventful procedures.  These complications may range from trivial to brain damage and death. The following list covers some of the complications that may occur under anaesthesia or after an operation.

Common Complications (1-10%) Mininmal Treatment Usually Required

Rare Complications (<1:1000) May Require FurtherTreatment

Very Rare Complications (1:10 000 - 200 000) Often Serious with Longterm Sequelae

Brain Damage or Death (<1:250 000)

  • Nausea and vomiting
  • Sore throat
  • Shivering or feeling cold
  • Headache
  • Dizziness
  • Itching
  • Pain during drug injection
  • Swelling/Bruising at drip site
  • Confusion/Memory loss (especially in the elderly)
  • Injuries to teeth, crowns, tongue, lips, mouth
  • Hoarseness, vocal cord damage
  • Muscle pains
  • Difficulty urinating
  • Difficulty breathing
  • Visual disturbances
  • Worsening of underlying medical condition
  • Side effects of post op Medications
  • Eye injuries
  • Nerve injuries causing paralysis
  • Lung infection
  • Awareness
  • Bleeding
  • Stroke
  • Allergic reactions
  • Unexpected drug reactions
  • Inherited reactions to drugs (Malignant hyperthermia, scoline apnoea, porphyria)
  • Due to any other complication getting more severe
  • Heart attacks
  • Emboli (Clots)
  • Lack of oxygen

Complications of procedures which may be performed during your anaesthetic

Procedure

Complication

  • Intravenous line
  • Central line for specialised monitoring / therapy
  • Arterial line for specialised monitoring
  • Airway management
  • Nerve block, spinal or epidural injection
  • Pain, swelling, repeated insertions, inflammation, infection
  • Pain, swelling, bleeding, inflammation, infection, repeated insertions, puncture of lung, artery or nerve.
  • Pain, swelling, bleeding, inflammation, infection, repeated insertions, loss of blood flow to the hand leading to death of fingers
  • Damage to lips, teeth, tongue, palate, throat, vocal cords, hoarseness, inhalation of stomach contents (aspiration), pneumonia, obstruction of breathing, failure to manage the airway which may require an emergency operative procedure.
  • Nerve damage, paralysis, backache, headache, nausea, vomiting, dizziness, shortness of breath, pain, bleeding, inadequate pain control.