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Sunday October 6, 2013 MYT 12:00:00 AM
Sunday October 6, 2013 MYT 1:02:27 PM
by dr lee yan wei AND datin dr v. sivasakthi
A spinal anaesthesia involves injecting local anaesthetics into a space in your back that will numb the lower half of your body for two to three hours.
In this second article to commemorate National Anaesthesia Day, we take a look at what goes on in the operating theatre.
OPERATIONS can be done using regional or general anaesthesia, as discussed in the previous article on preoperative assessment (Not just ‘sleep’ doctors, Star2, Oct 2).
Monitoring devices will aid in monitoring heart rate, blood pressure and oxygen content, and any changes will be addressed immediately.
Your anaesthesiologist is the lifeline of surgery. They stay with you throughout your surgery, watching over you and ensuring your safety.
The type of regional anaesthesia given will depend on the site of surgery. The most common ones are spinal and epidural, which are done for surgeries involving the lower half of the body.
Spinal anaesthesia involves injecting local anaesthetics into a space behind your back, which contains fluid that bathes the nerves supplying the lower half of your body. This will numb the lower half of your body for two to three hours. It is normal for the lower half of your body to feel numb and your legs weak with spinal anaesthesia.
Only when both you and your anaesthesiologist are satisfied with the effectiveness of the spinal anaesthetics will the surgery proceed.
The benefits of spinal anaesthesia include: less risk of chest infections after surgery; less effect on the heart and lungs; excellent pain relief immediately after surgery; less need for strong pain-relieving drugs; less sickness and vomiting; earlier return to drinking and eating after surgery; and less confusion after the operation in older people.
As with all anaesthetic techniques (as well as surgeries), there is a possibility of unwanted side effects or complications. To help quantify the risks, the following scale is usually used: If something is ‘very common’, this means that about one in 10 will experience it; ‘common’ means about one in 100; ‘uncommon’ means about one in 1,000; ‘rare’ means about one in 10,000; and ‘very rare’ means about one in 100,000.
Very common and common side effects include:
Low blood pressure – As the spinal takes effect, this may lower blood pressure and make you feel faint or nauseous. This is usually alleviated by giving you fluids in the drip or medication to bring up your blood pressure.
Itching – This may occur if a group of medication called opioids are given together with local anaesthetics. This can be treated as long as you let the medical staff know about it.
Difficulty passing urine – You may find it difficult to empty your bladder when the spinal anaesthetic is in full effect. Your bladder function will return to normal once the spinal anaesthesia wears off. Until then, you may require a catheter to be placed in the bladder temporarily while waiting for the anaesthetic to wear off or as part of the surgical procedure.
Pain during injection – You must immediately inform your anaesthesiologist if you feel pain or pins and needles during the injection as this may indicate nerve irritation or damage, and requires repositioning of the needle.
Headache – Severe headache may occur after spinal anaesthesia and this can usually be treated with pain relief medications.
Rare complications include:
Nerve damage – temporary loss of sensation, pins and needles, or weakness of the legs, may occur for days or several weeks, but almost always recover fully with time. Permanent nerve damage is extremely rare.
An epidural anaesthesia is quite similar to a spinal anaesthesia. The difference is that a small plastic tube (catheter) is inserted into the epidural space (a space in the spine), which is near the nerves in the back.
This means that the anaesthesiologist is able to add on medications as the anaesthetic wears off, without repeated injections. The epidural is used for longer surgeries, as well as for postoperative pain relief.
The risks and complications for epidural anaesthesia is similar to that of spinal anaesthesia.
You will be given a few breaths of oxygen before the anaesthesiologist injects a medication through the intravenous cannula in your arm and you will quickly become unconscious.
At the end of the surgery, your anaesthesiologist will stop giving you the anaesthetic medication and you will wake up gradually. If muscle relaxants have been given, another medication that reverses it will be administered.
Once the anaesthesiologist is satisfied that you have recovered properly, you will be transferred to the recovery room.
Common side effects and complications of general anaesthetics include:
Feeling nauseous and vomiting – this can last from several hours to several days. It can be treated with anti-vomiting medications.
Sore throat – This usually lasts a few hours and will subside once you start eating and drinking.
Headache – Most headaches will get better with time or treatment with analgesic agents.
Aches, pains and backache – this could be due to the surgery itself or being in a similar position for hours during the surgery. This also usually resolves with time and treatment with analgesic agents.
Confusion and memory loss – this is more common in the elderly. It is usually temporary, but some can be permanent.
Uncommon side effects and complications include:
Damage to teeth, lips, gums or tongue – minor cuts over the lips and tongue may occur during insertion of a tube into your windpipe to help you breathe. Damage to the teeth is uncommon.
Breathing difficulties – this may be related to any preexisting medical conditions that may be compounded by anaesthetic drugs
Rare and very rare complications include:
Serious allergy to medications – Allergic reactions are usually noticed quickly and treated aggressively.
If you or your family members have any allergy problems, you should inform your anaesthesiologist.
Awareness – Being aware during a general anaesthetic is extremely rare.
These days, there are monitoring devices to guide the anaesthesiologist to ensure that adequate medication is given to keep patients in deep sleep throughout the operation.
Deaths – This is extremely rare. The incidence is about five deaths for every one million anaesthetics given.
If you have any doubts or queries about anaesthesia, discuss this with your anaesthesiologist prior to surgery.
National Anaesthesia Day
Interested to learn more about anaesthesia? We invite you to unveil an anaesthesiologist’s mask during this National Anaesthesia Day celebration on Oct 12.
This year, “Your LIFE... We CARE!!!” has been chosen as the main theme for the celebrations, and refers to our commitment to ensure that your life is in safe hands under our care.
Listed below is a snapshot of our activities:
Taman Tasik Titiwangsa (Oct 12)
1. Walk Treasure Hunt – Registration forms can be downloaded from www.msa.net.my.
2. Learn to save a life with a hands-on cardiopulmonary resuscitation (CPR) session.
3. Video shows and exhibitions.
4. Free medical check-up.
5. Blood donation drive and organ donation pledge.
Hospital Kuala Lumpur
1. Exhibitions at the main foyer (Oct 21-25).
2. Health talks on Oct 25 at the Main Auditorium.
See you there!
*Datin Dr V. Sivasakthi is head of Anaesthesiology and Intensive Care Services, Malaysia, as well as head of the Department of Anaesthesiology and Intensive Care, Hospital Kuala Lumpur. Dr Lee Yan Wei is from the Department of Anaesthesiology & Intensive Care, Hospital Kuala Lumpur. October 16th was observed as World Anaesthesia Day in 1996, 150 years after the specialty was founded, and it is now celebrated annually worldwide. The Malaysian Society of Anaesthesiologists and the Department of Anaesthesiology & Intensive Care, Hospital Kuala Lumpur, is launching National Anaesthesia Day to increase awareness about the role of anaesthesiologists and how they contribute towards patient care.
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Health, anaesthesia, operating theatre
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