Pre-anesthesia check-up is a pre-condition for safe anaesthesia. Prior to administration of any type of anaesthesia, the patient has to be checked up by an anesthesiologist. In pre-anesthesia check-up the following are done:

• Patient history and physical examination
• Investigations in laboratory, imaging and others, as necessary
• Set questionnaire to be answered by patient
• Explaining to patient and then obtaining informed consent

The main types of anaesthesia are local, regional, and general.

• Local anaesthesia numbs the part of your body where you will have the surgery. It is for simple procedures such as sewing up a cut or removing a skin growth.

• Regional anaesthesia can be used for more extensive procedures than local anaesthesia. Two major types of regional anaesthesia are neuroaxial (spinal and epidural) and peripheral nerve block.
  • Spinal anaesthesia is given with the anaesthetic through a needle in your spine. The drug takes effect quickly and blocks pain in the lower body. It may be used for many operations below the navel, such as rectal, bladder, and prostate operations, as well as operations on the legs.
  • Epidural anaesthesia may be used for many of the same procedures for which spinal anaesthesia is used. It is also given with a needle in the back. The dose is adjusted so that the nerves that transmit pain are blocked, but you keep the ability to move. In some cases a thin tube, or catheter, may be placed at the site of injection to treat pain for several days after surgery.
  • Peripheral nerve blocks are used to provide anaesthesia and analgesia for surgical procedures of superior and inferior extremity (arm, forearm, hand and leg).

• General anaesthesia relaxes your muscles, puts you to sleep, and prevents you from feeling pain. It will also prevent you from remembering the operation. The anaesthetic may be given intravenously (IV) or as a gas inhaled through a breathing mask or tube plus intravenous medicines.

Preparation for anaesthesia varies depending on the kind of procedure you are having. Follow the instructions your Consultant gives you. Make sure your consultant knows what medicines you take and about any allergies or health problems you have. An anaesthesiologist may talk with you.

He or she may recommend the type of anaesthetic that may work best for you and the procedure you are having. Anesthesiologists often ask for further investigations and/or consultation(s) from other specialists depending on the type of surgery and associated medical conditions.

• Local anaesthesia is usually given by injecting a specific part of your body with a medicine that numbs the nerves. It can sometimes be given as nose drops or spray.
• You may be given a sedative with a local or regional anaesthetic to relax you and reduce anxiety. The sedative may cause you to fall asleep. Spinal anaesthetic is injected through a small needle into the fluid-filled space surrounding your spinal cord. Epidural anaesthetic is injected just outside the sac that contains your spinal fluid.

• If you are having general anaesthesia, drugs may be given through a mask covering your nose and mouth. Sometimes, insertion of a breathing tube through your throat may become necessary for several surgical procedures after anaesthesia is induced. To do this, a special kind of drug called “muscle relaxant” is used in addition to anaesthetic agents. The tube helps you to get adequate oxygen and other gaseous anaesthetic agents down to your lungs for maintaining safe anaesthesia. The tube will be removed before you wake up after the surgery.

During the whole procedure, your heart rate, blood pressure, oxygenation and state of breathing are continuously monitored so that any abnormal deviation can be remedied immediately. However, during recovery from anaesthesia, a very temporary disorientation and dry mouth may be present until the effect of the drugs wears off.

Each procedure or type of surgery requires different follow-up. Check with your Consultant about what you need to do.

Anaesthesia helps to relieve pain and to create numbness or a state of unconsciousness during surgery.

Risks from local and regional anaesthesia:

• You may feel some minor discomfort because the anaesthetic may not numb the area enough.
• You may have an allergic reaction to the anaesthetic, causing fever, nausea, vomiting, swelling, hives, or trouble breathing.
• Although very rare (according to global record), you may have long-term damage to the nerve
• You may experience difficulty in breathing because sometimes local anaesthetic agents affect some nerves of breathing

All these conditions have internationally accepted management plan.

Risks from general anaesthesia:

• After the anaesthesia, you may have nausea and vomiting, sore throat, dry mouth, and muscle pain.
• You may feel tightness in the chest, especially if you have a heart or chest condition preoperatively
• You may have irregular heartbeat, along with confusion, on rare occasions
• You may have pain in the area of surgical procedure

These are temporary problems; Post Anaesthetic Care Unit staffs are aware of these conditions and are trained to manage them accordingly with the help of relevant physicians. Discuss with your Consultant any concerns you may have regarding anaesthesia.