Usually the anaesthetist will visit the patient on the day of surgery or the night before. In some cases you will have been referred sometime before that to see your anaesthetist in our rooms. It is our job to assess your suitability for an anaesthetic. We will ask questions on the following:
- general health
- previous medical history
- previous anaesthetics received
- smoking habits
- previous heart problems.
A physical examination of your heart and lungs will be carried out. Your neck will be checked for shape and your mouth for loose teeth or caps. These are checked because if a breathing tube is to be inserted, it can sometimes be difficult to insert depending on the shape of the neck and mouth and also to prevent damage to teeth in the process.
The anaesthetist may prescribe a pre-med, which is a medication taken prior to surgery, designed to aid in relaxation and help keep the patient calm.
During the operation the anaesthetist’s main roles are as follows:
- to prevent pain – achieved by administration of pain relief agents appropriate for you and for the extent and duration of the operation
- to monitor oxygenation – this means ensuring that all vital organs are being adequately supplied with oxygen. This is assessed by skin colour, heart rate and your level of consciousness
- to monitor ventilation – assessed by the respiratory rate, volume of each breath and the inhaled and exhaled carbon dioxide concentrations. The anaesthetic gas and oxygen are delivered together either via a mask or breathing tube. If a mask is used the patient usually breathes on their own. If a tube is used the patient may breathe on their own or be mechanically ventilated using an artificial ventilator
- to monitor circulation – during the operation, intravenous fluids and/or blood products are administered if necessary. Circulation is assessed by blood pressure, urine output and skin temperature.
When your operation is over, you will be taken to a special recovery area where your condition will be monitored as you wake up from the anaesthetic. We will then be consulted by the recovery room nurses about your condition. Once back on the ward we are on call for any issues you might have with pain relief and management of any medical issues as result of the surgery and anaesthetic.
PROCEDURES AND TREATMENTS
You are put into a state of unconsciousness either by the injection of an anaesthetic medication into a vein or by breathing in a mixture of gases. You will be unaware of what is happening around you and you feel no pain from the surgery. You will be constantly monitored and the anaesthetic adjusted as necessary throughout the operation. A muscle relaxant may also be administered, which relaxes muscle and allows easier surgical access to the operation area.
WHAT DO WE DO DURING SURGERY?Although most people think they are “asleep” during an operation, you are actually in a state of controlled unconsciousness. Your anaesthetist is there to monitor and control your level of unconsciousness to ensure you are unaware and free of pain during your operation. During this time your anaesthetist takes over care and control of all your major bodily functions such as blood pressure, breathing and fluid requirements. Unlike some other countries where it may be an anaesthetic tech or nurse who remains with you, in New Zealand your anaesthetist remains at your side for the duration of your procedure until you are in the recovery ward, where your care will be supervised by a recovery nurse. Anaesthetists are also highly trained in pain management, preoperative medical preparation and critical care services. They are experts in resuscitation and managing acutely ill patients. They are frequently the ones called to assist other doctors during cardiac arrests and trauma.
Dr Michal Kluger
MBChB, MD, DA, DipDHM, FRCA, FANZCA, FFPMANZCA
Specialist Anaesthesiology, Perioperative Medicine and Pain ManagementPain management is undertaken following referral from General Practitioners or Specialists directly to our rooms. Unfortunately we do not take direct patient referrals. A multidisciplinary approach is taken to all pain management referrals, and we have a direct link to various psychological and activity based healthcare providers. A first referral takes approximately 60 minutes during which time a management plan is formulated in conjunction with the patient. After this follow-up reviews are conducted, dependent on clinical need. On occasion, further referral may be made to tertiary centres such as the Auckland Regional Pain Service at Greenlane. For some pain conditions interventions such as trigger point injections, nerve blocks or epidural steroids may be undertaken at Southern Cross North Harbour Hospital in Wairau Rd. Dr Kluger conducts private clinics at Anaesthesia Associates, Wairau Rd as well as undertaking public sessions at North Shore Hospital, Auckland. Dr Kluger is a member of the New Zealand Pain Society, International Association for the Study of Pain and the Australian and New Zealand College of Anaesthetists.
FEES:Initial visit – $430 Follow-up visits – $200
Regional anaesthesia (sometimes called nerve blocks) is a the use of local anaesthetics to numb a specific area of the body. This is much like when your dentist injects local anaesthetic to numb your teeth however anaesthetists are skilled at blocking many other nerves. In many cases it is sufficient for you to have the anaesthetic without any other intervention required. This might include surgery on the lower half of your body which can be anaesthetised using a spinal or epidural anaesthetic or operations on your hand and arm. However many people would prefer some sedation and this is also provided by your anaesthetist. In some cases a regional anaesthetic is given along with a general anaesthetic to decrease the amount of general anaesthesia that is required.
This type of local anaesthesia is achieved by injecting an anaesthetic that blocks nerve impulse transmission. It can involve one or more nerves that are associated with the area to be operated on. A nerve block is often done for hand surgery.
An epidural block involves injection of local anaesthetic and pain medication into the epidural space, blocking the transmission of nerve impulses in the spinal cord. It usually involves insertion of a small tube (that stays in place in the back) that can allow regular small does of pain medication to be administered, depending on the amount of pain you are feeling. An epidural takes around 10-20 minutes to take effect and takes about the same amount of time to set up and be administered.
Sensation is decreased or lost (dependent on the amount administered) below the level of the block (usually around the mid stomach region). This should take effect on both sides of the body, but sometimes can be varied.
An epidural block may be used as the only anaesthetic given for an operation that is carried out below the level of the diaphragm, but a sedative can also be administered with it.
An epidural is commonly used for pain relief during labour and also for caesarian section.
This involves an injection of a local anaesthetic and pain relief. A spinal block is a one-off injection, unlike an epidural which is used for regular/continuous administration. The injection is given directly into the cerebrospinal fluid and takes effect very quickly. Patients have a risk of headache that may be related to a leakage of cerebrospinal fluid from the hole made by the injection.
A local anaesthetic drug is injected at the site of the surgery to cause numbness. You will be awake but feel no pain. An obvious example of local anaesthesia is numbing an area of skin before having a cut stitched.
Following local anaesthesia, you are awake but the part of your body being operated on is numb. Local anaesthesia is administered via an injection; it takes effect quickly and lasts a long time. During the surgery you will be aware of touch and pressure, but not pain. If this type of local is being used, it is common practice to be looked after only by the nursing staff and the surgeon, an anaesthetist does not need to be present. The surgeon will generally administer the local anaesthesia.
This type of anaesthesia can also be given with a sedative through an IV line, which means you will just be drowsy and semi-alert. This type of procedure is called local anaesthetic with sedation injection.
The anaesthetist administers drugs to make you relaxed and drowsy. This is sometimes called ‘twilight sleep’ or ‘intravenous sedation’ and may be used for some eye surgery, some plastic surgery and for some gastroenterological procedures. Recall of events is possible with ‘sedation’. Most patients prefer to have little or no recall of events. Please discuss your preference with your anaesthetist.
WHO ARE ANAESTHETISTS?
Anaesthetists, like your surgeon, are medical specialists who have completed many years at medical school, internship. They have then specialised in anaesthesia for a minimum of another 5 years. Having passed two exams set by the Australian and New Zealand College of Anaesthetists they are able to practice as specialist anaesthetists.
The anaesthetic training program in New Zealand is recognised as one of the most comprehensive, rigorous and respected programs in the world. Many New Zealand anaesthetists spend more than the required five years of training, either sub-specialising or obtaining other medical degrees or diplomas.