Anaesthesia and PAC

What is Anaesthesia?

The word “anaesthesia” means “loss of sensation”.  Anaesthesia can range from the loss of sensation in a small body part like a finger after injecting a local anaesthetic, to the lower half of the body after an injection given in the back, to sedation after some drugs injected into the body to the complete unconsciousness that is a part of general anaesthesia. Anaesthetic drugs stop the brain from responding to sensory messages travelling from the nerves in the body.

Local anaesthetic (LA) drugs make parts of the body “numb” by blocking the path of nerves that transmit signals from the body part to the brain. By adjusting the concentration of the LA, you can receive only analgesia (no pain) or surgical anaesthesia (no pain & no movement).  As the drugs’ effects wear off, sensation and movement return.

Anaesthetic drugs also affect the functions of the heart, circulation and the lungs.  So, it is necessary that anaesthesia is given by an anaesthesiologist in the safe environment of the Operation Theatre (OT) or a critical care area where all necessary equipment and drugs are available.

Who is an Anaesthesiologist/ Anaesthetist?

An anaesthesiologist (or anaesthetist) is a doctor who has undergone extensive training to provide surgical patients with anaesthesia. Physician anaesthesiologists are the most highly skilled medical experts in anaesthesia care, pain management, perioperative medicine and critical care, with the education and training that can mean the difference between life and death. They are responsible for:

1. Assessing whether you are fit enough for the anaesthetic for your surgery
2. Explaining appropriate anaesthetic options for you and making an anaesthetic plan.
3. Explaining and making an appropriate pain control (analgesia) plan for you
4. Obtaining your permission for anaesthesia (written informed consent).
5. Taking care of you in the operation theatre, providing anaesthesia and monitoring you very closely during surgery.
6. Taking care of you in the post anaesthesia care unit or in the intensive care unit or ward.
7. Taking care of your other medical issues e.g. blood sugar levels if you are a diabetic, during and after your surgery.

What are the types of Anaesthetic Techniques?

Depending on the effect on the body and the portion of the body effected, anaesthesia can be categorized into the following types:

1. General Anaesthesia- the patient is fully unconscious and does not have awareness of the environment or any recall of the procedure.
2. Local Anaesthesia: a small part of the body is anesthetized. There is no pain.
3. Regional Anaesthesia
   1. Spinal Anaesthesia- the waist and legs become immobile and have no sensation.
   2. Epidural anaesthesia and analgesia- a part of the body has less sensation and decreased movement.
   3. Nerve blocks /Plexus Blocks / Plane or Fascial Blocks- Local anesthetics are injected near nerves to block pain sensation and sometimes movement.
4. Sedation- to allow the patient to comfortably undergo the planned procedure with or without recall of the same.
5. Monitored Anaesthesia Care (MAC)
6. Combinations of the above techniques

Why has my surgeon told me to get a “PAC” done before my surgery?

Your surgeon will refer you to the anaesthesiologist before they operate to prepare you for your surgery and the anaesthesia required. This anaesthetic evaluation is called a Preoperative* Anaesthesia Check-up (PAC).

When you visit the anaesthesiologist, please bring with you:

• A current prescription or your medicines in their full packaging.
• Any information you have about tests and treatments at other hospitals.
• Information about any problems you or your family may have had with anaesthetics
• Any recent blood pressure, blood sugar measurements.

Before you meet the anaesthesiologist, you will be requested to answer a Preanaesthesia Questionnaire that has questions pertaining to your medical history and some other information that is relevant to the performance of your anaesthetic. Please answer it to the best of your knowledge.

The Type of Anaesthesia you will receive depends upon

• The nature of the surgery,
• Your physical condition including your pre-existing diseases like hypertension, diabetes, hypothyroidism
• The anaesthesiologist’s best judgment to best suit requirements of the operation/procedure and your current physical condition and
• Your preferences- as much as is feasible

The anaesthesiologist will perform a detailed assessment to find out these factors and will decide whether you can undergo the anaesthesia necessary for your surgery.

This assessment will include, among others,

• Questions about your activity & any physical and mental health problems.
• Questions on allergies and reactions (please bring details)
• Taking your weight and height.
• Making an accurate list of the medicines you take.
• Questions about smoking, alcohol intake or taking recreational drugs
• Examining your heart and lungs
• Examining other systems as necessary.
• Examining your airway and your back- to help with the anaesthetic technique
• Asking for blood tests as needed
• Asking for special investigations like an ECG (a heart tracing)
• Asking, if needed, for another specialist’s advice for e.g., a cardiologist’s consultation, if you have a serious heart condition
• Advising you on what you can do to prepare for your surgery and how your physical condition can be optimized for it.
• Advising you about the medications that you already take and pain relief.
• Explaining the options available for your anaesthetic and discussing them with you.
• Explaining the risks associated with anaesthesia and specific risks that you might face as a result of your physical condition.
• Giving you information about blood transfusions if they think you might need one.
• Taking your consent for the anaesthesia after you are admitted
• Answering your queries about the anaesthesia and analgesia you will receive.

The aim of such a detailed assessment is that you undergo your surgery under the most optimized circumstances so that the entire surgical journey is safe, smooth and uneventful.

In some patients, attaining this most optimum condition can involve treating their pre-existing conditions like getting their sugar levels under control if they are diabetic and their blood pressure controlled if they are hypertensive. To do so, your anesthesiologist may involve concerned specialists in your care.

Once the anesthesiologist is satisfied that you are in the most optimum physical condition possible, they will give the go ahead for anaesthesia for the planned surgery.