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Anaesthetic FAQs

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.

The following information about anaesthesia has been prepared by specialist anaesthetists Dr Paul Williams and Dr Andrea Santoro. It is intended as a general guide and does not replace a direct and individualised discussion with your treating anaesthetist, which will occur prior to your surgery.


What is Anaesthesia?

General anaesthesia (from the Greek “without sensation”) is a reversible state of controlled, temporary loss of sensation or awareness which cannot be interrupted by stimulation.


What is an Anaesthetist?

An anaesthetist is a specialist doctor trained in all aspects of anaesthesia who, after obtaining their medical degree, has spent at least two years working in the hospital system before completing a further five years of training in anaesthesia. Clinical anaesthesia is built on knowledge of physiology (how the body works) and pharmacology (how medications work in the body). Anaesthetists have an extensive knowledge of medicine and surgery and an understanding of the basic sciences. They know how the body responds to anaesthesia and surgery, and how a patient’s health affects these responses.


What Are the Risks Involved?

Australia has rigorous training, continual professional development, and continuing medical education requirements for anaesthetists, which contribute to a high standard of anaesthetic safety. A tailored discussion of risk associated with anaesthesia for your surgery will occur with your anaesthetist prior to the procedure. This is an opportunity to ask any additional questions you may have.


What if I Am Allergic to the Anaesthetic?

Allergy under anaesthesia is rare, occurring in approximately 1 in 5,000 to 1 in 10,000 anaesthetics. Most people who experience a severe allergic reaction or anaphylaxis under anaesthesia respond well to appropriate emergency treatment from the anaesthetic team.


Practical Considerations Before and During Surgery

False eyelashes
May be damaged or removed by anaesthesia gels and tapes. Do not have these placed close to the date of surgery.

Nail polish
Nail polish may interfere with anaesthesia monitoring. Ideally remove nail polish prior to surgery. At least one nail (finger or toe) should be polish free. For acrylic nails, at least one nail on each side should be free.

Makeup
Do not wear makeup or apply moisturiser to your face on the day of surgery — it interferes with anaesthesia monitoring and application of tapes.

Beards
Beards may interfere with anaesthesia. If your beard is not important to you, shaving prior to surgery is suggested but not essential.

Jewellery
Jewellery can cause pressure sores and may conduct electricity from surgical instruments. Do not wear jewellery to surgery. If you are unable to remove jewellery, inform the admitting nurse so appropriate precautions can be made.

Exercise
Regular cardiovascular exercise in the weeks prior to elective surgery has been shown to assist recovery. Even four to six weeks of regular exercise prior to surgery can reduce risk. Exercise may be restricted for two to four weeks following surgery depending on the procedure.

Smoking
Smoking should ideally be stopped six to eight weeks prior to elective surgery — with increasing benefit with up to six months cessation. Smoking cessation removes the irritant effects of smoking, decreases associated risks, and improves healing capacity. Even stopping for more than 12–24 hours prior to surgery removes nicotine from the bloodstream and allows more oxygen into the bloodstream during anaesthesia and recovery.

Alcohol
Avoid alcohol in the 24 hours before and after surgery — it can interact with sedatives and analgesics. Do not consume alcohol while taking strong pain medicines such as oxycodone, codeine, tramadol, or tapentadol.

Recreational drugs
Do not take recreational drugs prior to or after anaesthesia. If you use recreational drugs, inform your anaesthetist as this may affect the amount of anaesthesia required or your tolerance to pain medicine. Abstinence for one week prior to anaesthesia is recommended.

Fasting
The hospital will contact you the day before surgery to confirm arrival time and fasting instructions. Generally, stop eating and drinking at least six hours prior to the estimated surgical start time. Water is permitted up to two hours before. Fasting prevents the rare but serious complication of aspiration (stomach contents entering the lungs), as anaesthesia is not the same as normal sleep.

Regular medicines
Bring all regular medicines to hospital. Continue all your medicines unless instructed by your surgeon or anaesthetist to stop. Once fasting, take normal tablets with a small sip of water. Diabetic tablets are not taken on the day of surgery. Newer diabetic tablets (SGLT-2 inhibitors / Gliflozines) need to be stopped three days prior. Patients on insulin should have a management plan directed by their endocrinologist, surgeon, or anaesthetist. Blood thinners require specific guidance — notify your surgeon and anaesthetist.


Common Questions About Anaesthesia

Can I take a sleeping pill the night before surgery if I am nervous?

Pre-medication with sedatives is not normally required with modern anaesthesia. If you feel you require a sedative or normally take these medications, inform your anaesthetist — sedatives may interact with anaesthetic medicines.

What if I am sick on the day of surgery?

A mild cold usually has little impact on anaesthesia for a healthy person. If you are suffering from a significant illness — fever over 38°C and/or a lower chest infection — elective surgery may be postponed to minimise risks. Your safety is the most important consideration when this decision is made.

Will I dream while under anaesthetic?

Anaesthesia is commonly experienced as “lost time” — it is not the same as normal sleep. Some people report dreaming, most commonly during lighter periods of anaesthesia such as induction or emergence.

Is there a chance I could remember things during surgery?

Awareness during anaesthesia is rare, occurring in approximately 1 in 1,000 patients overall (including high-risk patients). The rate in healthy elective surgery patients is much lower. Implicit awareness (a vague sense of something without specific memories) is more common than explicit awareness (remembering specific events). Your anaesthetist takes steps to minimise this risk.

How long will it take to wake up?

Once anaesthetic agents are ceased, waking typically takes 10–30 minutes, depending on age, type and duration of anaesthesia, and overall health. It takes up to 24 hours for anaesthesia to be fully cleared from the body.

Will I feel nauseous when I wake up?

Nausea and vomiting after anaesthesia occurs in approximately 1 in 3 anaesthetics. Risk is influenced by the type of surgery, age, gender (higher in females and children), type of anaesthesia, and previous experience. Your anaesthetist assesses this risk and administers appropriate preventive medications as part of the anaesthetic plan.

Will I have a sore throat?

A breathing tube is commonly placed during general anaesthesia. This can cause some throat irritation. Rates of sore throat range from 1 to 3 people in 10. It generally settles over one to two days.

Can I drive home?

You must not drive, operate machinery, sign documents, or make important decisions for at least 24 hours following anaesthesia. You must be discharged into the care of a responsible adult who can care for you on the first post-operative night.

What are the chances of death under anaesthesia?

Death as a direct cause of anaesthesia is very rare — estimated at 1 in 50,000 to 1 in 80,000 anaesthetics in Australia. To contextualise this, the rate of road-related deaths in Australia is approximately 1 in 10,000 to 1 in 15,000 per year.

What if someone in my family has had Malignant Hyperthermia?

Malignant hyperthermia (MH) is a rare life-threatening reaction triggered by specific anaesthetic medicines in genetically susceptible individuals. If someone in your family has had MH or been diagnosed as susceptible, you must inform your surgeon and anaesthetist when booking surgery so a “trigger-free” anaesthetic plan can be arranged in advance. When triggering agents are avoided, MH is not triggered and anaesthesia can proceed safely.

My child is having surgery — what if they are unwell?

Children with minor coughs and colds can often proceed safely. Children with significant lower chest infections or high fevers may be at increased risk. If your child is unwell, inform the surgeon, anaesthetist, and/or hospital the day prior to surgery. Your anaesthetist will determine whether it is safe to proceed. The decision to postpone is made in the interest of your child’s safety and is not taken lightly.

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Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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Anaesthetic FAQ content prepared by Dr Paul Williams and Dr Andrea Santoro, specialist anaesthetists.
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