10 things to consider before surgery

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1. Meet your anaesthesiologist and raise any concerns

   Find out from your surgeon who your anaesthesiologist will be. Make contact before the surgery to ask any questions you may have about your anaesthesia. Anaesthesiologists are highly qualified, specialist doctors who play a critical role before, during and after surgery by providing the anaesthetic and constantly observing and monitoring the status of each patient.

   Many anaesthetic practices offer a pre-anaesthetic consultation service. Should you suffer from any significant illness that could affect the outcome of your surgery, please request your surgeon to refer you for a consultation with the anaesthesiologist. At this consultation you will be assessed in terms of anaesthetic risk and may be sent for special investigations, such as chest X-rays, an ECG or blood tests. This will prevent your operation from being cancelled or delayed on the day of surgery.

   If you are in any doubt about the chosen anaesthetic or prescribed surgical procedure advised, get a second opinion from a specialist in the field. This is your right as an individual, and you should not feel guilty about "second-guessing" your doctor. Bear in mind though, that the second opinion may very well confirm the first.

2. Anaesthesia options

   The anaesthesiologist's creed is to always put the patient's safety first. As a patient, you should never be afraid to ask your anaesthesiologist about the different anaesthetic options available to you. Local anaesthesia numbs a specific location on the body, regional anaesthesia affects a larger area, while general anaesthesia affects the entire body and you are unaware of proceedings.

   The manner in which anaesthesia is administered also differs: some forms are inhaled while others are administered intravenously. People react better to some options than others. It is important to notify your surgeon if you or anyone in your family has had an adverse reaction to anaesthesia.

3. Pre-existing medical conditions

   Advise your doctor and anaesthesiologist about any health issues, as these may affect your surgery and post-operative treatment. Those of highest concern include heart- or lung-related disease, diabetes, high blood pressure, dental fittings, arthritis or drug allergies.

   Be open and honest about any recreational drug use, as this can have a significant impact on surgery and your anaesthesiologist needs to be prepared for possible complications as a result.

   Drinking alcohol may also have unpredictable effects on anaesthesia, and could cause excessive bleeding or liver damage. Be honest about how much you drink and how often you drink. Cutting out alcohol at least a week before surgery is the best option, but if you are a heavy drinker, discuss this beforehand with your doctor and your anaesthesiologist.

   Smoking raises your risk of picking up infections and possible surgical complications. Quitting two weeks before surgery may also promote more rapid healing (consider using nicotine patches). Anti-smoking support groups are available to advise you.

   There is no such thing as too much information. Even a single event of breathing difficulty in the past will alert your anaesthesiologist to potential risks.

4. Current medication

   Be sure to inform your anaesthesiologists of all the medications you are taking, including the dosing and timing. This would include over the counter medications and supplements.

   Certain supplements may increase the risk during surgery. Ginkgo biloba, ginseng, garlic, Echinacea, fish oils and vitamins may raise the chance of heart problems or bleeding. Others may exaggerate the effects of anaesthesia or cause an adverse reaction with other medicines, causing unexpected side effects. Confer with your doctor about any supplements that you have been taking. Generally, you are advised to stop taking these one to two weeks prior to surgery.

5. Confirm surgical instructions

   To avoid surgical error, your doctor or a nurse may indicate with an "X" the spot on your body where the surgery is to take place. Other methods may include the wearing of coloured plastic armbands that inform both surgeon and anaesthesiologist of your operation details, patient allergies and other relevant information. You are entitled to check this yourself for added peace of mind.

   The anaesthesiologist is responsible for maintaining sterility in the surgical environment, but it will not do any harm to make sure that your doctors and nurses wash or sanitise their hands before they treat you.

   Although it should be common practice, a reminder could help prevent infections such as Methicillin-Resistant Staphylococcus Aureus (MRSA), bacteria that causes a number of treatment-resistant infections.

6. Pain management

   Post-operative pain or a burning sensation is to be expected after a surgical procedure. You might also experience aching muscles and a dry throat. Post-operative pain management is the responsibility of your anaesthesiologist.

   Keep him or her informed of any such symptoms and ask for painkillers to continue using at home after discharge. Apart from pain medication, relaxation tapes, hot or cold therapy or gentle massage may also help to promote the healing process.

7. No eating or drinking

   Do not eat anything for at least six hours before your anaesthetic. Under certain circumstances, you may drink small volumes of water up to two hours before your anaesthetic. However, this should be discussed with and approved by your anaesthesiologist well in advance.

   Should you have mistakenly eaten less than six hours before surgery, you must advise your anaesthesiologist who may have to postpone your operation in the interests of your safety. If you have a child or infant that has to undergo an anaesthetic, you need to discuss this with your anaesthesiologist well in advance.

8. Potential complications after surgery

   Every surgery carries a risk, particularly in the recovery period. For example, certain surgeries increase the likelihood of deep vein thrombosis (DVT), a blood clot that travels to the lungs and obstructs blood flow, resulting in a pulmonary embolism. Although such an eventuality is potentially life threatening, prompt intervention often saves lives. Increased risk of DVT is likely in older patients, those who are overweight, smokers, cancer sufferers, those who have previously experienced the condition and those consuming certain medications.

   The anaesthesiologist is aware of these risks and selects your anaesthetic options accordingly. Open, honest answers to the questions he or she asks will help to manage your risks most effectively.

9. Nausea and vomiting

   Post-operative nausea and vomiting is the most frequent side effect of anaesthesia and ranked by patients as the least desirable. Less than a third of patients experience nausea and vomiting, which may result in dehydration and feeling unwell. Those at high risk of this side effect can be treated pre-operatively to reduce the symptoms.

10. Follow doctor's orders

    In the lead-up to your operation, take extra care of yourself and follow your doctor's advice. Surgery puts the body under significant stress, so the stronger you are physically and mentally, the better you will be able to cope. Make sure you get sufficient sleep, eat a healthy diet and follow your doctor's directions on starting or stopping medications before your operation.

The South African Society of Anaesthesiologists (SASA) has as its mission: "Leading the science and practice of safe anaesthesia at the highest standard and ensuring the sustainability of anaesthesiology services."

SASA members continuously hone their skills by taking part in refresher courses and attending an annual congress at which international experts in the field share their insights in the interests of maintaining high standards within the profession.