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General anaesthetic

If you have a private operation planned, it may involve an anaesthetic procedure, in this instance a general anaesthetic. You may wish to know what this involves.
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when administering a general anaesthetic, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.



What is a general anaesthetic?

A general anaesthetic, or GA for short, is the use of drugs that cause you to become unconscious. It is often the most suitable way of keeping you safe and comfortable for an operation. You are unaware of what is happening during your operation. The general anaesthetic may be given in two ways. Medications can be given through a drip, usually in your arm or hand. Alternatively you can breath gases through a mask. Either way, the anaesthetic is continued until the operation is complete. Once the operation is finished the anaesthetic is ended and you regain consciousness. You are taken to a recovery area until you are safe to go back to the general ward.


The aims

The aim of the general anaesthetic is to keep you safe and comfortable for your operation. You are also given pain relief so that you feel no pain.


The benefits

The main benefit of any general anaesthetic is that it allows you to have your operation in comfort. The general anaesthetic also enables the surgeon to perform your operation with greater ease and safety.


Are there any alternatives?

There are several alternatives to a general anaesthetic. They avoid the need for a general anaesthetic and include:


  • Epidural - It may be possible to perform an epidural where the lower part of your body goes numb and is pain free. This involves placing a catheter next to the nerves in the spine. Drugs are then injected, stopping the nerves working temporarily. The doctors can use the epidural as pain relief after the operation by leaving the catheter in place. More drugs can be given to keep you pain free.
  • Spinal - Alternatively a single injection, like an epidural, but without putting the catheter in, can be used. This single injection is called a spinal. More drugs cannot be given after the operation and the spinal wears off in a few hours.  
  • Regional anaesthetic - Another method is to make individual nerves go numb temporarily. This could be your whole arm or leg. This makes a small region of the body numb, hence the name regional anaesthetic. 
  • Local anaesthetic - Sometimes, if the surgery is minor, local anaesthetic injections can be used to numb the operation area only.
  • Hypnosis - More recently, patients have used hypnosis to help them during an operation. Few people can tolerate operations with hypnosis alone, but it may assist with the relief of anxiety, when used with other nerve blocking methods.



Whether any of these alternatives are suitable, depends on the part of the body to be operated on. The length of the procedure is also important. There may be a medical reason where these procedures are not possible. For instance, if you have a condition where your blood does not clot, such as haemophilia, then you cannot have an epidural. All of these injection methods can be used with sedation to help relieve anxiety.


If you are to have one of these procedures there is another information leaflet that will tell you more about it.


Who should have it done?


Reasons for having a general anaesthetic for surgery include:


  • Where the operation is long and complicated. This includes heart surgery or other operations on the chest.
  • When other ways of having a conscious anaesthetic, such as an epidural, are not enough on their own to keep you comfortable and pain free. This includes major bowel surgery.
  • When the shape of your body makes placing needles near your spinal nerves difficult, which is necessary for an epidural or a spinal. Severe arthritis of the spine may make these procedures impossible.
  • When the operation involves an area of the body around the head and neck, such as having your tonsils removed.



Who should not have it done?


If you are unwilling to have a general anaesthetic you should discuss this with your anaesthetist. If an epidural, or other method where you can stay conscious, is possible a general anaesthetic may be avoided. Patients with the medical conditions listed, should not have a general anaesthetic:


  • Chest infection - The most common reason for not having a general anaesthetic is a throat or chest infection. During the general anaesthetic a breathing tube is inserted through the throat. Infection can be passed from the throat to the lungs. This will make you ill and delay your recovery. If there is already infection in the lungs, it can be made much worse by a general anaesthetic. This is a serious problem. The right thing to do is postpone the operation until the infection has gone. You may require antibiotics. Tell your anaesthetist if you have a sore throat or a cough producing phlegm.
  • Allergic reactions - Previous allergy to general anaesthetic drugs. You may be allergic to any of the drugs used during a general anaesthetic. There is also a relatively rare, but serious condition called malignant hyperpyrexia. This condition runs in families. Anaesthetic gases and other drugs used during a general anaesthetic can cause a severe rise in temperature in patients who suffer from this condition.
  • Anatomical problems - Where you have had problems with your trachea in the past. It may be narrowed, or have had previous surgery. It is not impossible to have a general anaesthetic, but other methods may be simpler and safer. Again an epidural may be suitable.



All patients can have a general anaesthetic if absolutely necessary. There are many situations, too numerous to mention in this leaflet, where it is preferable to avoid a general anaesthetic. The risks and benefits should be discussed with your anaesthetic doctor.


Author: Dr Sean White FRCA. Consultant in pain and anaesthesia

© Dumas Ltd 2006

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