A consultant Anaesthetist is a specialist doctor who has achieved a very high level of training specifically in the administration of anaesthetic drugs and the care of patients during all forms of surgery. Your anaesthetist has spent a  minimum of six years training in the speciality of anaesthesia after having first studied medicine and done at least two years in a hospital as a Resident House Officer.

Your anaesthetist will ask you a series of questions prior to your operation regarding your general health which are of importance in the overall management of your care during and after your anaesthetic and surgery.

These questions will include: your previous operations (and any problems that you may have experienced); any medical conditions such as hypertension (high blood pressure), asthma,diabetes etc.; medications that you are currently taking; allergies; your smoking history and whether any anaesthetic problems have occurred with any of your own family members.Your anaesthetist will also like to be aware of your dental health and whether you have any crowns, dentures, loose teeth or plates.

The visit by your anaesthetist (Pre-operative Consultation) may be:

• Prior to commencement of your Surgeon's list on the morning, or afternoon, of your operation.
• In theatre reception before your operation (this occurs if the surgeon requests that you come into hospital whilst his/her list is in progress) Your anaesthetist will be anaesthetising another patient tat this time and will therefore be unable to leave the theatre until the operation is complete.
• If you require pre-operative investigations he/she may visit you on the day you come into hospital if your surgeon has brought you into hospital early to have these tests done.
• In the anaesthetist's rooms (AXXON) before the scheduled surgery.

Throughout the operation, the anaesthetist will be carefully monitoring your vital bodily functions. During your procedure your anaesthetist ensures that you are closely "looked after"  replacing lost fluid, administering pain relief, maintaining your body temperature, and monitoring your heart beat, blood pressure, brain and kidney function whilst your surgeon performs the surgical operation.Your anaesthetist does not leave your side and is constantly busy throuhgout this time looking after your well being.

Following surgery your anaesthetist will escort you to the post anaesthetic recovery room and will instruct the recovery room nursing staff regarding your post-operative care. Your anaesthetist will stay with you until they are happy with your initial recovery so that they can then return to the operating room. Your care will then be taken over by specially trained nursing staff who will continue to monitor your post anaesthetic recovery and immediately contact the anaesthetist or surgeon if they have any concerns. 

The drugs used to ensure that you are unconscious/asleep during the operation will be stopped once your surgery is complete. Your body will then start to slowly destroy and excrete/remove these drugs from your system enabling you to awaken post-operatively. Some of the anaesthetic drugs given throughout the operation can also be neutralised/reversed by other specific "antagonists".

The speed at which you awaken/recover post-operatively varies from patient to patient and also depends upon the type of surgery performed,the anaesthetic requirements for that procedure and the nature of the pain relief used during surgery and in the recovery room. Some of the factors that influence your recovery following anaesthesia include the type of drugs administered, the length of your operation, any pain relief medication administered and your pre operative state of health.

General Anaesthesia
When you have a general anaesthetic you are temporarily unconscious. This state of temporary unconsciousness is controlled by your anaesthetist, who administers the appropriate drugs and gases to ensure that you are pain free and remain in this unconscious state. These drugs are administered via your bloodstream (through a vein) or breathed as gas/vapour into your lungs.

Local/Regional Anaesthesia
Local or regional anaesthetics are designed to numb part of your body so you cannot feel pain whilst the procedure/operation is being performed. During an epidural, spinal or regional local anaesthetic block, the anaesthetist may allow you to be awake whilst undergoing your operation.

• Local anaesthetics may be injected or applied to the area just around the operative site.
• Regional local anaesthesia is where a local anaesthetic is placed close to the large nerves, which supply sensation to the area of surgery (this injection may be placed near your collar bone for an operation in your hand,your back for an operation on your leg,prostate or even having a baby by Caesarean Section).

Local anaesthetics may also be combined with a general anaesthetic or sedation.

• Sedation is when you are given drugs that will make you sleepy but you will not be unconscious, you will be able to hear conversations and respond to questions.
• Epidural injections of local anaesthetic are used to assist with pain relief during labor for childbirth, and can also be run continuously after an operation to assist with pain relief. Epidurals are where local anaesthetic is injected into your back and spreads out around the nerves as they leave the spinal chord. The needles used to administer this local anaesthetic are very carefully placed and you may be asked to lie a particular way assist the anaesthetist in finding the exact position.

Once the local anaesthetic has been injected, the area will become numb. You will still be aware that the operation is being performed but you will feel no pain. The local anaesthetic will gradually wear off after the operation until sensation (if not a consequence of surgery) is restored.Your anaesthetist will remain with you during this time to ensure that you remain comfortable and that your blood pressure, fluids and other requirements are looked after.

PAIN RELIEF

There are many types of pain medication that can be administered for postoperative pain relief. It is important to inform your Anaesthetist if you are taking regular pain medication prior to your operation so that he/she can adjust the amount of medication required in the post operative phase.

Your anaesthetist will tailor your pain relief to accommodate your needs.

Pain relief can be provided orally or by injection or even by infusion of local anaesthetics...the use of each of these options can be discussed with your anaesthetist prior to your operation. 

 
Continuous Epidural Analgesia:-
A continuous epidural infusion involves the following:
A fine catheter is inserted into the epidural space that delivers a local anaesthetic and (opioid) pain medication. This combination of drugs is designed to temporarily numb the nerves that carry pain signals to the brain and also decrease your perception of pain.
 
This can assist you in the first few days after the operation by enabling you to move and cough with less discomfort.

Effects of epidural analgesia:
Whilst the epidural is insitu the local anaesthetic & opioid may cause:

• Light headiness
• Nausea
• Numbness or tingling
• Difficulty passing urine
• Heavy feeling in your legs
• Drowsiness
• Itching

If these effects are too unpleasant, or the epidural is not working, please inform the nursing staff immediately so they can notify your anaesthetist.

The nursing staff caring for you will monitor your blood pressure, temperature, pulse & oxygen level. They will also ask you questions that indicate how effective your pain control is . 
 
The nursing staff  will also assist you to roll on your side so they can visually inspect the epidural catheter site. Your blood pressure and pulse will be monitored continuously.

Each hospital has its own policy on epidural management for nursing staff designed to ensure your safety.

Patient Controlled Analgesia (PCA)-
Another form of pain relief is a Patient Controlled Analgesic Pump (PCA). Patient controlled analgesia is exactly as it sounds, pain relief controlled by you, the patient. The desired drug (chosen by your anaesthetist) is drawn up into a bag or syringe pump that is connected to your intravenous access line directly into your vein. The pump has a handset attached to it that is placed around your wrist or within easy reach. Pushing the button can activate the handset and pain relief will be instantly administered to you .

The medication is administered intravenously and therefore will take only a few minutes to take effect. This system has a safety lockout mode that is designed to stop you from accidentally administering too much medication that could compromise your health.

It is important to inform relatives and friends that they must NOT press the button for you, as this could lead to you receiving too much medication and may cause unpleasant side effects.

If you know that you are just about to endure physiotherapy or other activities that cause discomfort, you can press the button to make sure you have adequate pain control prior to the event.

The Patient Controlled Analgesia Pump is fully transportable and has a battery system that enables you to mobilise post operatively.