Anaesthesia is a medical speciality in its own right practised by anaesthetists who acquire their expertise over 11 years of training.
The anaesthetist has a variety of responsibilities:
- Ensuring that the patient’s state of health is compatible with the operation scheduled
- Administering and monitoring the anaesthetic throughout the operation and until the patient wakes up after a general anaesthetic or until they begin to recover motor activity after a regional anaesthetic
- Post-operative pain management
During the operation, the anaesthetist may be assisted by an anaesthetic nurse.
The pre-operative assessment varies according to the operation scheduled, as well as patient age and history.
For numerous operations, no biological tests are necessary before administering an anaesthetic.
However, with major surgery, especially if the patient is old or fragile, more comprehensive tests may be requested, the nature of which will be determined by the anaesthetist.
Anaesthesia during the operation
The aim of an anaesthetic is to stop you feeling pain so the surgery can be performed.
There are 2 possible types of anaesthesia:
- General anaesthesia: The anaesthetic is administered intravenously and the patient loses consciousness. The purpose is to induce analgesia (absence of pain), amnesia (the patient is unconscious and will not remember the anaesthetic), and muscle relaxation to ensure the operation goes smoothly.
- Regional anaesthesia: Only part of the body, which comprises the surgical site, is numbed. This type of anaesthetic can be achieved with an injection between the lumbar vertebrae (spinal block which numbs the lower limbs) or selective ultrasound-guided nerve blocks.
During a regional anaesthetic, the patient remains conscious but, if they do not wish to hear what is happening around them, they can be sedated with a powerful sedative. In this case, the patient is asleep but breathing unaided, contrary to a general anaesthetic. After the operation, the anaesthetic wears off over a few hours and mobility of the surgical site returns.
A regional anaesthetic is often ideal for orthopaedic surgery and can be proposed for most operations.
The post-anaesthesia care unit (PACU) or “recovery room”
After the operation, the patient is taken to the post-anaesthesia care unit or recovery room where the length of stay will vary.
During their time in the recovery room, the patient’s vital signs (blood pressure, heart rate, oxygen saturation) are monitored continuously to ensure good recovery from the anaesthetic and the operation.
The healthcare staff in the recovery room monitor the intensity of the post-operative pain and analgesics are administered if necessary. They also ensure recovery of motor function of the limb operated on as well as the absence of severe bleeding around the scar or drains.
When recovery room lead anaesthetist deems possible, the patient is taken back to their room.
Post-operative pain management
Some operations cause more pain than others and post-operative pain must be managed individually according to the nature of the surgery.
The aim is to achieve early mobilisation of the patient and quicker functional recovery:
- Cryotherapy: This involves putting an ice pack on the surgical site. Cold is a powerful anti-inflammatory and is often very effective in the first days following the operation. Seemingly inoffensive, there are rules to be followed. The ice pack must not be placed in direct contact with the skin to prevent skin burns.
- Analgesics: These medicines can be injected or taken orally. Of varying strength, some of these drugs, such as morphine, are opium derivatives. The stronger the medication, the more likely there will be side effects (sickness, dizziness, constipation).
- Anti-inflammatories: These drugs aim to decrease post-operative inflammation and often provide very effective pain relief. However, they must only be used for a limited time due to the risk of gastrointestinal and renal side effects.
- Local injections: During some operations, the surgeon may inject a long-acting anaesthetic (12 to 18 hours). These injections help decrease the pain experienced as the anaesthetic wears off and can be supplemented with anaesthetic blocks for more extensive pain relief around the surgical site.
- Nerve blocks: Nerve blocks help maintain the numbness of the surgical site for longer periods of between 12 and 18 hours after the operation. Ultrasound-guided nerve blocks can be very selective and only concern sensory nerves while motor function around the surgical site is recovered very quickly. For more painful operations, the effect of these nerve blocks can be extended by placing, under ultrasound guidance, a small flexible catheter in contact with the nerves concerned to inject more anaesthetic to prolong the analgesic effect over time.
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