Pre-operative information

Before coming to hospital

Except in emergency situations, patients will generally meet with their anaesthetist prior to their procedure. This is particularly important where the patient has multiple or complicated medical problems, takes medications or has had complications with previous anaesthesia.

Patients who have a letter from a previous anaesthetist should tell all future anaesthetists and provide them with a copy of the letter.

During consultation, the anaesthetist may discuss matters including the conduct of the anaesthesia or sedation, pain management, potential complications and risks, and provide an opportunity for the patient to ask questions. As part of the preoperative assessment, the anaesthetist will assess a patient’s medical history, review appropriate records, read letters from specialists, which patients should bring to their appointment, may order relevant investigations and tests or refer to other appropriate specialists where necessary to assist in preparing the patient for anaesthesia, and check that the patient has understood, and given consent (preferably signed) for the procedure. He or she may explain the type of anaesthesia that is most appropriate and may discuss pain management options.

Patients will, where relevant, receive instructions regarding the medications to be taken prior to and on the day of surgery. This is especially important in patients prescribed medicines such as aspirin (Astrix, Cartia), clopidogrel (Plavix, Iscover), and warfarin, which thin the blood and increase the risk of bleeding and bruising. Regarding stopping and re-starting these medications patients should obtain instructions from their anaesthetist or by contacting the preadmission department at the hospital.

Other medicines that may need to be modified prior to surgery include those used to control blood sugar in diabetic patients.

Occasionally patients may be prescribed medications (such as anti-reflux medicine) to be taken the night prior and on the morning of surgery.

The anaesthetist may discuss relevant risks and complications associated with the type of anaesthesia that has been selected.

Can I eat and drink before my anaesthetic?

Patients who are having an anaesthetic may not be allowed to eat or drink within a specified time of their procedure. This is called fasting. Patients will be advised of fasting times for solid food and liquids and it is important to follow the instructions provided by the anaesthetist. Generally, the protocols below will apply, however it is essential to follow the instructions of your anaesthetist, which may vary depending on the patient and the procedure.

• For adults having an elective (planned) procedure, limited solid food may be taken up to six hours prior to anaesthesia and clear fluids may be taken up to two hours prior to anaesthesia.
• For children over six months of age having an elective (planned) procedure, breast milk or formula and limited solid food may be given up to six hours and clear fluids (no more than 3ml/kg/hr) up to one hour prior to anaesthesia.
• For infants under six months of age having an elective (planned) procedure, formula may be given up to four hours, breast milk up to three hours and clear fluids (no more than 3ml/kg/hr) up to one hour prior to anaesthesia.

Medications ordered by the anaesthetist can be taken (with a little water if required) less than two hours prior to anaesthetic being given.

Patients who suffer from obstructive sleep apnoea and who use a CPAP machine at night must bring the CPAP machine with them to hospital.

Patients who expect to be discharged from hospital within 24 hours of their procedure should arrange for someone to escort them home. It is a requirement that such patients are accompanied home by a responsible adult, who should remain with them for 24 hours. Patients must arrange this prior to coming to hospital.

Day of operation

Patients should ensure that they arrive in hospital at their allocated time so that the admission process can be completed before their scheduled surgery time. The hospital admissions unit or day-surgery unit will notify patients when they must arrive.

Preparation for surgery commonly includes recording blood pressure, pulse rate, temperature and weight, and ensuring that the patient has followed the anaesthetist’s instructions about fasting (when you last ate and drank). These precautions help to ensure that any immediate risks, such as the presence of an infection, a fast heart rate or very high blood pressure, are minimised.

If patients have recently developed an acute illness, they should notify the nursing staff on arrival so that the anaesthetist can review their condition. The anaesthetist will determine whether it is appropriate to proceed with surgery.

The hospital will provide the necessary operating theatre clothing. Patients will meet with a specialist anaesthetist and will have an opportunity to speak with their surgeon, who will confirm the nature and site of the operation. Patients should use this opportunity to ask questions.

Any special procedures, such as nerve blocks, epidurals or spinals, may be performed in the anaesthesia bay or room prior to entering the operating theatre. The anaesthetist will obtain your consent before performing these procedures if this was not done preoperatively. Explaining the procedure is part of the process of obtaining your consent.