The Phases of General Anaesthesia
Saturday, May 24th, 2008“Dr X gave me the anaesthetic”
General anaesthesia has many similarities with taking a flight by jet. You turn up at the alloted time after minimum preparation, you are checked in, go through security screening, get on the plane, fall asleep, get off again the other end and not think too much about it — most of the time! It is only when we have a rough flight, or the baggage gets lost, that we become aware of all of the people, procedures and events that ensures a satisfactory outcome whenever possible. General anaesthesia is the same.
This posting will outline phases we pass through before, during and after general anaesthesia. Subsequent posts will expand these to help you to understand why we ask all of those personal questions, why it really does matter, and how we can all work together to ensure a successful outcome.
Notification: The Anaesthetist is given basic details such as name, contact details and a very brief summary of any known medical problems. This information can derive from diverse sources such as hospital administration, the surgeon, theatre bookings or even telepathy. Telepathy? .Yes some days it does help to be telepathic. We have all had days where we get to the end of the operating list only to find an extra patient added that we knew nothing about. The upshot is that if you know you have a problem with general anaesthesia start mentioning it to anyone and everyone you are in contact with so that your anaesthetist gets to know about it.
Preoperative assessment: This is usually where you get to meet your anaesthetist, or someone deputising for them - another anaesthetist, an anaesthetist in training or a suitably trained nurse. Occasionally preoperative assessment is performed via questionnaire or telephone but there are many things that we look for where we have to do exactly that - look!
Preoperative fast: This is where we starve you and stop you drinking. Its all for your own safety and will be explained in the more detailed post. But it matters!
Premedication: Some people need drugs to prepare them for surgery. This may be to remove anxiety, control blood pressure, prevent nausea, control diabetes, relieve asthma. All sorts of little tricks we have to make the anaesthesia itself smoother and safer.
Induction: Finally you get to go off to sleep!
Maintenance: We keep you asleep.
Emergence: Start breathing. Start coordinating. Start talking!
First stage recovery: Wake up, see the world is still there and plan what comes next.
Second stage recovery: Sleep it off. Get street fit!
The first 24hrs: Clear those drugs, take the pain killers, have a rest.
Convalescence: Rest, reflect and provide feedback. And if you are a private patient - please remember to pay the account. Anaesthetists have school fees to pay for the kids too!
Have you noticed something in the number of words for each section? Time spent on detailed preoperative assessment and planning results in very simple, planned, safe, boring general anaesthesia. General anaesthesia should be boring. Boring is good, exciting is bad.
Think about it next time you fly - have a boring flight!