Anaesthesia

General Anaesthetic / Narcosis

This is general information about narcosis written by our patients at Art Clinic. The information does not claim to be fully comprehensive. If, after reading this, you feel you have further questions surrounding narcosis then you are welcome to ask during your consultation at the clinic. Anaesthesia, like general anaesthesia (anaesthetic/narcosis), regional anaesthesia (numbness to specific nerv-paths in one area) or local anaesthesia (numbness to the skin which is to be operated on) are used alone or in combination in conjunction with surgical procedures, so that the patient will not feel pain or any other discomfort during surgery. Anesthesiology as a medical speciality includes, in Sweden, knowledge about narcosis, intensive care and pain relief and is performed by both anaesthetists and anaesthetist nurses.

Preoperative assessment/ assessment prior to narcosis.

- Prior to the procedure the patient fills out a health declaration. Questions to answer include Existence, nonexistence of illness that is relevant to the narcosis and operation. It is important to be informed about heart and lung functions. This can be roughly estimated from the patients’ capability of physical activity, such as cycling, walking up stairs etc.
- Smoking habits.
- Any existing allergies or hypersensitivity.
- Current medication. Certain medications must be stopped before narcosis but there are others that are to be continued as usual up until surgery or in certain cases, a higher dosage.
- Earlier experiences of narcosis and potential consequences. Art Clinic has permanent anaesthetist and anaesthetist nurses who will perform a medical assessment of your health declaration. . One can in some cases need to provide supplementary information with laboratory examinations and EKG. Also one may need further information from other hospitals or care centres, to have access to this information the clinic will need the patients’ written consent. From this information the anaesthetist will assess if there are any risks and then tailor your narcosis for your surgery or sometimes dissuade from surgery.

Narcosis preparations

For how long should I fast?
It is important to fast prior to narcosis since there is a risk of the content of the stomach entering the windpipe and lungs if one was to vomit in connection with the anaesthetic. The risk of vomiting can be greater in those individuals that have stomach issues.
The stomach empties faster from liquid rather than solid foods. The stomach also empties slower from liquids that contain milk products then with water or tea. The following are the fasting time to be followed:
- a minimum of 2 hours fast after consuming water, coffee, te and juice.
- a minimum of 6 hours fast after consuming other drinks, including milk, yoghurt, soured milk (fil)
- a minimum of 6 hours fast after consuming solid, part-solid food. Patients that have stomach problems, such as heartburn, may need to drink a liquid prior to the narcosis in order to neutralise the gastric juice.

What do I do with the medication I regularly take?
Patients that are continuously treated with gastric juice neutralising medication, such as Omeprazol, Losec or Nexium shall continue with this treatment even on the day of surgery. Patients with lung diseases like asthma, COPD etc are often treated with medication like Bricanyl, Ventoline, Pulmicort. These are given for continuous use and when needed. It is important to continue with this medication and bring the instant active medication to the clinic.
Medication for high blood pressure exists in various ways. Patients that are treated with, so called beta-blockers, for instance Seloken should continue with their treatment, including on the day of surgery.
Patients treated with anticoagulant substances such as Waran, Persantin, Magnecyl etc, should suspend this treatment. Before suspending and changing the treatment contact your regular physician. If treated with Waran (apekumarol), it will need to be substituted for a different treatment which the patient will be informed about. Changes to anticoagulant treatments, always take place by through discussion between the plastic surgeon, anaesthetist and possibly the patients regular physician.
Treatments with certain pain relief medication are to be suspended one day before surgery since this medication causes increased bleeding during surgery; Magnecyl is to be suspended 14 days before surgery. The only exception from this rule is treatments with a low dosage of Magnecyl, 75-160 mg. It is possible to continue with this dosage, but is needed to be discussed from case to case.

Narcosis preparation at Art Clinic on the day of surgery

One is given a vein cannula in the crook of the arm or on the back of the hand. The cannula is a thin plastic tube which is inserted into the blood vessel and through the vein catheter one can administer fluids, such as salt or sugar water. Via this vein catheter one later administers the anaesthetic.
Before being anaesthetised one should visit the toilet to urinate, so that the bladder is as empty as possible during surgery.

Pre medication

Prior to surgery the patient is given a few tablets which are swallowed with some water. This is medication intended to prevent any pain and nausea after surgery. Patients with stomach problems will also be given liquid to drink, which neutralises the acidic gastric juice.

Narcosis

The purpose of general anaesthetic is for the patient not to feel pain or discomfort during the operation and in some cases for the patient not to move during surgery. This is achieved by supplying medication into the patients’ blood stream (intravenous anaesthetic) or by the patient inhaling the medication (Inhalation anaesthetic), most often it is a combination of both.
Complications due to narcosis and anaesthetic are very rare. The risks of narcosis are mainly dependant on the health problems the patients has. If one is young and healthy then the risks are extremely small. There are very few patients that have such grave health issues that one dissuades from narcosis. Through the health declaration we receive a good understanding of the patients health and from this we can evaluate any possible risks that narcosis may bring.
Falling asleep happens quickly once the anaesthetic is applied. Simultaneously as the anaesthetic is given one is provided oxygen through a mask, that the anaesthetist or anaesthetist nurse holds in front of the face.
During the entire procedure the patients is asleep by narcosis and oxygen being continuously supplied to the lungs. This occurs by the patient breathing through a face mask, but if the procedure is lengthy a larynx mask is placed in the mouth, just behind the epiglottis, from which one breathes the narcosis gases. This happens when the patient is asleep and does not notice. One can however notice that something has been in ones mouth once awake. During certain procedures one needs to, instead of a larynx mask, place a plastic tube in the windpipe. This is also performed when the patient is asleep.
After this the patient can feel a sensation and some discomfort of having something in ones throat, but this should disappear within a day.
Since one hasn’t eaten or drunk liquid for many hours one needs to supply fluid to the patient. This is done via the cannula placed in a blood vessel on the back of the hand or in the crook of the arm. The fluid is mainly saltwater but other fluids can be supplied. The surgeon is careful about stopping all bleeding which means one can perform many surgical procedures without a large blood loss. The blood loss which occurs is compensated by supplying fluid to the blood.
During narcosis one does not feel the urine that is collecting in the bladder. One doesn’t urinate but it collects. If the surgery is only a couple of hours long then one can urinate after surgery. If the operation is longer one may need a urine catheter in the bladder, to avoid too much fluid collecting. This catheter is placed in the bladder via the urethra while asleep and is removed in the recovery ward once one is awake and can pee by oneself again.
The patient is monitored during the entire narcosis and one checks the patients level of consciousness, breathing and heart function (control and measuring of EKG, blood pressure, pulse, oxygenation, breathing frequency and carbon dioxide in the exhaled breathe. One also checks regular oxygen supply to the patient and how much narcosis gases the patients receives.
At the end of the operation one terminates the supply of anesthetic resulting in the patient awakening. One also removes the larynx mask or the windpipe tube. During narcosis patients have various dreams, but they do not talk.

Post operative /after narcosis

Even though one awakes quickly from modern anaesthetics and feels awake, the anaesthetic does not leave the body fully until after several hours, in some cases after 12-24 hours. Therefore one must not be alone during this time and should have someone with you during home transportation. One should not be alone during the first night since one may need help if any issues arise. However, most patients gradually wake up within a few hours without any issues. It does occur that patients feel nauseas and can even vomit. This is due to the surgery and the anaesthetics and some patients are more sensitive than others. It is important that the patient before surgery mentions any previous narcosis experiences which have involved nausea and vomiting, or if they are susceptible to motion sickness.
When necessary medication which counteract nausea is supplied. Pain in the area of surgery can occur and pain relief medication is then given.
Before going home one must be able to drink and eat without feeling sick, one is also asked to visit the toilet.

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