FAQs

Have any questions about your upcoming surgery?

Below we have answered the most common questions our patients have about their surgeries. You will find links to official resources as well as answers to other general questions.

Helpful links
Safety of Anaesthesia

Anaesthesia in Australia is very safe.

In a recent review of anaesthesia related mortality “Safety of Anaesthesia in Australia”, Australian and New Zealand College of Anaesthetists 2006., the chance of dying under anaesthesia is thought to be less than one in 53, 000. Most people probably have a greater chance of being involved in a serious motor vehicle accident driving around Melbourne.

Morbidity

All anaesthesia and procedures are associated with some risk of unwanted side effects.

Fortunately the most common adverse outcomes include unpleasant but temporary side effects such as sore throat from the breathing mask or breathing tube placed while you are asleep, some nausea or vomiting, bruising from cannulation sites, aches and pains from positioning or effects of drugs used and a prolonged post operative observation time to ensure you are tolerating oral fluids and not too dizzy or unwell when you leave the hospital.

Less common but more serious problems include adverse drug reactions, teeth damage during airway management, being awake under the anaesthetic, breathing difficulties, low blood pressure, paralysis, nerve or eye damage, infection, and severe headache.

There is always the possibility of a severe allergic drug reaction or major heart, lung, neurological, liver, kidney or bleeding problem that could be life threatening. This may require intensive treatment. Fortunately, this is very rare. If something serious like this does arise, your anaesthetist will be there to look after you while you are asleep.

The anaesthesic technique you will require depends on the procedure planned and your medical evaluation. Different anaesthetic techniques will vary in their side effect profile and you can discuss your particular needs and risks at the preanaesthesia consultation with your anaesthetist. Please feel free to note down any questions you have and these can be answered during this discussion.

The most recent “Safety in Anaesthesia” report from the Australian and New Zealand college of Anaesthetists can be viewed at

http://www.anzca.edu.au

What is Anaesthesia

Anaesthesia is the absence of pain sensation in either any or all parts of the body. In a general anaesthetic, consciousness is lost and you go to “sleep”. In a local or regional anaesthetic, only a part of your body loses sensation or goes “numb” e.g. arm or legs.

The drugs used in anaesthesia can affect other body functions, so you will be reassured to know your anaesthetist will be present throughout your entire operation to take care of you.

Who are Anaesthetists?

The anaesthetist is the doctor who will administer your anaesthetic. After completing a medical course and basic hospital training, an anaesthetist spends at least 5 years years undergoing specialist training, gaining knowledge and skills in the speciality of anaesthesia.

Your anaesthetist is a specialist just like other specialists you may have seen, such as your surgeon or physician, and works as part of a team looking after you. While the surgeon is operating on one part of the body, the anaesthetist is looking after the rest of you.

Fasting

Fasting prior to elective surgery is necessary to ensure your anaesthetic is as safe as possible.

The current guidelines for the Australian and New Zealand College of Anaesthetists1 are

4.5.2.1 For healthy adults having an elective procedure, limited solid food may be taken up to six hours prior to anaesthesia and clear fluids totalling not more than 200 mls per hour may be taken up to two hours prior to anaesthesia.

4.5.2.2 For healthy children over 6 weeks of age having an elective procedure, limited solid food and formula milk may be given up to six hours, breast milk may be given up to four hours and clear fluids up to two hours prior to anaesthesia.

4.5.2.3 For healthy infants under 6 weeks of age having an elective procedure, formula or breast milk may be given up to four hours and clear fluids up to two hours prior to anaesthesia.

4.5.2.4 Only medications with a little water if required as ordered by the anaesthetist should be taken less than two hours prior to anaesthesia.

Should you not adhere to the specified fasting period:
  • The risk of vomiting and inhaling either food or fluid whilst you are unconscious can lead to severe complications
  • Your operation may be postponed and rescheduled at a later time to ensure your safety so that risks are minimised

If you have any questions or concerns, please contact your anaesthetist.

1. http://www.anzca.edu.au

What happens before the operation?

It is convenient for most patients to be seen in the hospital on the day of operation for the pre-anaesthetic consultation. However, you are asked to contact the Albert Street Anaesthetic Group if you have any problems related to previous anaesthetics or any other concerns. A pre-anaesthetic in-rooms or telephone consultation can then be arranged prior to admission to hospital if required.

What happens during the operation?

When you are taken to the operating theatre, your anaesthetist will insert an intravenous drip often in the back of the hand, you will be positioned and the monitoring attached. Anaesthesia is usually started with medicines given via the drip.

Your anaesthetist will be responsible during your operation for constantly watching over your breathing, pulse and blood pressure, and supporting and controlling these as necessary. By careful administration of the anaesthetic drugs, the anaesthetist will safely control your waking up and recovery.

Patient Positioning for Anaesthesia

For your procedure you will be positioned on an operating table. The goal of positioning is to facilitate the performance of the surgical procedure by the surgeon while maintaining a physiologically safe position for you. The tables can be quite narrow with various adjustable and moveable arm boards and extensions. These allow access to all parts of your body and allow the rapid change in position that is sometimes required.

During an anaesthetic you cannot look after yourself so care is taken to keep you in a safe and comfortable position. This involves applying gel pads to the limbs and other pressure points, minimising any deviation from your body’s neutral position to avoid stretching of nerves, muscles, ligaments and joints and securing your body in place for the duration of the procedure. Sometimes it is necessary to alter the position to facilitate a special part of the operation or to correct a physiological change such as alteration of blood pressure or breathing under the anaesthetic. The operating tables whilst initially may not seem the most comfortable bed you have ever laid upon, are specially designed to allow these necessary changes in position.

Some special operations need specific positions which have their own considerations. In the face down or prone position a special head cushion is used so that there is no pressure applied to the eyes. In the lithotomy or ‘legs up’ position, care is taken to avoid pressure on the lower back. In the sitting position a special blood pressure measuring device may be inserted into the artery to measure your blood pressure beat to beat to ensure good blood supply to your brain during the anaesthetic. In the lateral position special padding is applied to pressure points and lateral supports are used to stabilize your position on the table.

In many cases once you have been adequately positioned, a warming blanket is applied to keep you warm during the anaesthetic. The eyes are carefully taped or ‘lacrilube’ applied to avoid drying of the conjunctiva. Your position is constantly checked throughout the procedure.

Monitoring During Anaesthesia

A large part of anaesthesia is devoted to watching you carefully while you are asleep or sedated. This is essential for your safety and comfort and can be thought about as occurring on three levels.

Level One:

This includes routine monitoring of the oxygen levels in your body reflected by a peg placed on your finger measuring your oxygen saturation levels. A blood pressure cuff is commonly applied to your upper arm which inflates tightly the first time and then less so after this, to measure your blood pressure during the anaesthetic. Special sticky dots may be applied to your chest and arms to measure your heart rhythm and rate. While you are breathing under the anaesthetic, some of the gases you exhale are analysed to measure the carbon dioxide levels and anaesthetic gas levels. This gives your anaesthetist vital information about your heart and lung function and how deeply anaesthetised you may be.

Level Two:

Sometimes because of the duration or complexity of the anaesthesia you receive to facilitate your surgery you need additional monitoring. This includes an intra-arterial catheter which measures your blood pressure beat to beat. When this is removed postoperatively it usually leaves a substantial bruise because it was placed in a high pressure artery. Blood specimens can be taken from this catheter during the anaesthetic to check your respiratory and metabolic and haematological functions. Important decisions about your care are made on the basis of these test results such as ventilation changes and blood transfusions. Continuous temperature monitoring assists in keeping you warm during the anaesthetic. Special dots are placed over peripheral nerves to measure your depth of muscle paralysis.

Sometimes sticky dots will be placed on your forehead to measure the electrical activity of the brain while you are asleep and this assists in determining your anaesthetic requirements.

For major surgery a urinary catheter is usually inserted into the bladder which allows accurate assessment of urine production reflecting kidney function. Sometimes a special drip or catheter is inserted into one of the central veins such as the large internal jugular vein in the neck. This allows continuous measurement of pressures close to the heart and provides access to administer critical drug infusions if you need them. All invasive line insertions carry with them a degree of risk such as bleeding, infection, blood clots or damage to nearby structures. Fortunately major complications are rare but this is why this invasive monitoring is only performed when necessary.

Level Three:

Some operations require specialised monitoring with catheters that pass through the heart into the pulmonary artery or special ultrasound probes passed into the oesophagus to visualise the heart. Specialised neurological monitoring is used in some spinal and neurosurgery. This highly specialised monitoring is not used routinely.

In summary, all procedures have some risk. In order to administer your anaesthetic and keep you safe during your procedure it is important to monitor certain parameters. The insertion of catheters and monitors can in itself be associated with complications. These are necessary in some cases and the potential benefits are believed to outweigh any risk.

Regional Anaesthesia

Sometimes a regional anaesthetic such as spinal, epidural or caudal anaesthetic may be considered. This provides good pain relief during and immediately after your surgery. You will usually require intravenous sedation or a general anaesthetic in addition to the regional anaesthetic.

What are the risks with regional anaesthesia?

Bleeding, infection or serious neurological problems occur very rarely with regional anaesthesia. Precautions are taken to minimize these risks such as ceasing blood thinning medications prior to surgery and using an aseptic technique when performing these blocks.

Sometimes people may experience temporary numbness, abnormal sensations or even pain following a regional anaesthetic but this does not occur commonly and rarely requires any intervention. There is a particular type of headache which may occur following a regional anaesthetic which does require treatment but fortunately also does not occur commonly.

With all anaesthetics there is always the possibility of blood pressure problems, heart or breathing problems or allergic drug reactions. In some cases this is why special monitoring such as intra-arterial blood pressure monitoring is also considered. The important thing to remember is that the chances of something serious arising are small and if it were to occur, YOUR ANAESTHETIST IS THERE TO LOOK AFTER YOU!

What does a regional anaesthetic involve?

These major blocks are almost universally performed while you are awake (except in children). Your cooperation during the block actually makes it safer. After securing an intravenous drip, intravenous fluid and some light sedation is administered. You are also given oxygen and some monitoring is applied. You are then positioned for the block, usually sitting up or lying on your side. Some antiseptic is applied to the back which may feel cold. The area is draped and kept clean to prevent infection. Local anaesthetic is used which may sting a little as it is given. This numbs the area so the actual block is not painful. You may feel some sensations during the block. This is normal and you should let your anaesthetist know if you are uncomfortable at any stage. Once the block is inserted you are brought into the operating room where the general anaesthetic is administered.

Anaesthesia and Blood Transfusion

Surgery is often associated with blood loss. Depending on what type of surgery you are having and your clinical condition you may need to receive some blood products in the peri operative period. Because every blood transfusion is associated with some risk of complications, blood products will only be used if it is felt that the benefits outweigh the risks. A blood management plan will have been employed even before you arrive for your surgery. This may include blood conservation techniques to minimise blood loss, reinfusion of your own blood if appropriate, autologous predonation and preoperative testing including blood and coagulation levels and checking for blood group and antibodies.

If you have any concerns about receiving blood products you should discuss these with your anaesthetist prior to your surgery. Sometimes blood products need to be given while you are anaesthetised.

If you would like to know more about the nature of blood transfusion, potential complications of blood transfusion or would like to become a blood donor, visit the Australian Red Cross Blood Service website on www.transfusion.com.au. This is an excellent site with much useful information. If you would like to discuss any of these issues further prior to surgery, feel free to do so.

What happens after the operation?

After the operation is over you will be taken to a special area, called the Recovery Room or Post Anaesthetic Care Unit (PACU), close to the operating theatre and staffed by nurses specially trained to look after anaesthetised patients who are recovering from their surgery.

Your anaesthetist is still responsible for your general condition whilst you are in the recovery area. If you have pain after you wake up, you can be reassured your anaesthetist will arrange for post-op medications to make you more comfortable.

Your anaesthetist will also oversee your pain management plan for the immediate post operative period and help arrange other care as required

Anaesthetic Fees

There is a fee for the specialist anaesthetic service provided to you. This fee will vary depending on the complexity and duration of the anaesthetic and is determined by each individual anaesthetist. Your anaesthetic fee is separate from any other fee you may incur for any surgery or procedure you have eg. hospital, surgical, pathology, radiology etc.

Anaesthetic fees are calculated using the Relative Value Guide (RVG) for anaesthesia as endorsed by the Australian Society of Anaesthetists (ASA) and Australian Medical Association (AMA). This is the basis for Medicare and health fund reimbursement for anaesthesia

The relative value of an anaesthetic has three main components

  1. A basic unit value;
  2. A time unit value
  3. Modifying units.

These components when added together give the total relative value for the service in units.

Medicare and health insurance funds provide a rebate for part of this fee. Your out-of-pocket or gap contribution, however, cannot be claimed for. Depending on the operation and your level of insurance the out of pocket will vary. Some insurance companies eg HBA, HCF, MBF and NIB unfortunately, do not have a known gap product for anaesthetic services and therefore the out of pocket costs are greater

Generally speaking the larger and more complex the operation, the more anaesthetic components will be involved, and therefore, the larger the anaesthetic fee will be.

If you have not been provided with an estimate of your anaesthetic fee, please contact your anaesthetist at the Albert Street Anaesthetic Group (ASAG).

Accounts for Anaesthetic Services

As discussed in “Anaesthetic Fees”, there is an individual and separate fee for the specialist anaesthetic service. Because of varying factors, the type of account you receive also varies.

  • “No-gap”, TAC & WorkCover accountsFor accounts where no co-payment is required you will not receive an account from us. The account will be sent directly to the relevant bodies, who will pay the anaesthetist and these relevant bodies will advise you once the account has been paid.
  • Account for co-paymentYour “out of pocket” or “gap” payment – you need to pay this fee. This cannot be claimed. The rest of your account is sent directly to your health insurer.
  • Account for total fee (for those self insured or insured with NIB (and its associates) and HCF (for some specialists) neither of which permit a co-payment) When this account is paid, an itemised receipt will be issued and reimbursements can be claimed from Medicare and your health insurer.
  • Itemised ReceiptYou have paid your “out of pocket expense” or anaesthetic fee prior to your anaesthetic. An itemised receipt is then issued and reimbursements can be claimed from Medicare and your health insurer.
Further Information about Medical Fees

There will be a gap between the fee for your anaesthetic and the rebates from Medicare and your insurer. It would be more accurate to call it an insurance shortfall and it is the direct result of federal government policy.

Your Medicare rebate has not been indexed adequately by the federal government and has been steadily eaten away by inflation over many years.

Over the same period the costs of running a quality medical practice have increased at a rate greater than inflation, for example, the premium for medical indemnity insurance has increased by a factor far greater than inflation.

Each anaesthetist in this practice sets their own fees. As a general guideline, for most procedures, your anaesthetic fee will be in excess of the Medicare rebate but less than the fee that the Australian Medical Association recommend as being fair and reasonable. You will usually receive a written estimate of your anaesthetic fee. Uninsured patients are normally requested to pay their account in advance. If you have any concerns about the anaesthetic fee or account please contact the Albert St Anaesthetic Group.

If you still have a question that isn’t answered here, please get in touch