Does the idea of ‘going under the knife’ make you feel nervous? It is normal to feel anxious before surgery. No matter how minor the surgery is, most people feel uncomfortable about “going under the knife.” With that said, we have put together a full breakdown of everything you need to know so that you can feel fully informed and relaxed about having surgery under anaesthesia.
Firstly, remember that you are in very safe hands. Anaesthetists are highly trained specialist doctors. They will be by your side throughout your operation, watching you closely and keeping you safe.
What’s involved in a pre-surgery?
Every patient – and every operation – is different, which means your response to anaesthesia will be too. To ensure you are optimally fit for the surgery, there are a few things your anaesthetist will need to know about you before your operation:
- Your general health and fitness
- Any existing health conditions ( e.g. asthma, heart problems, or medications)
- Any allergies or reactions to medicines
- Any recent coughs, colds or fevers.
- Any experience with surgery or anaesthesia
- Your preferences
How do I better prepare myself before surgery?
A little bit of preparation before your anaesthesia can make a huge difference. Let your surgeon know if you wish to have a pre-anaesthetic consultation before the day of surgery so that they can make an appointment with an anaesthetist who can answer all of your questions.
Specific instructions prior to surgery:
- Stop eating and drinking at least 8 hours before surgery, since having undigested food in your system can cause serious complications.
- If you are a smoker, give smoking a break-even quitting for a short period is helpful. The better you look after your body before your operation, the quicker it will recover.
- You will also need to arrange for a family member or friend to pick you up after your surgery since it won’t be safe for you to drive for at least 24 hours.
Before you go into the operating theatre, your anaesthetist will have another conversation with you to check that you’re comfortable and discuss any last-minute questions. Together with the surgeon, we will decide on the safest and most appropriate type of anaesthesia for each clinical situation.
What are the types of anaesthesia?
1. Local anaesthesia (LA)
LA involves injecting local anaesthetic into the tissues near the surgical site. Local anaesthesia may be used alone or in combination with sedation or General Anaesthesia (GA). Small, simple procedures (e.g. cosmetic procedures like eye lift) are often performed using a local anaesthetic, which numbs the area to be operated on.
2. Regional anaesthesia (RA)
RA involves injecting local anaesthetic around major nerve bundles supplying body areas. It may be used on its own or with General Anaesthesia. RA is sometimes performed using a nerve-locating device such as an ultrasound, to accurately locate the nerves. Once LA is injected, patients may experience numbness, tingling and “heaviness” around the injected area. The duration of the anaesthesia can last from several hours to several days.
3. Monitored Anaesthetic Care (MAC) with Sedation
Sometimes sedation is used in addition to LA. This may be referred to as “twilight sedation” or “conscious sedation”. It helps you to relax while remaining conscious and may decrease your memory of the procedure. Deep levels of sedation, where patients lose consciousness and respond only to painful touch, can lead to the patient having difficulty breathing and their heart function being affected. Though these incidents are uncommon, the anaesthetist is trained to manage these situations.
4. General anaesthesia (GA)
GA involves putting a patient into a medication-induced state of carefully controlled unconsciousness. It stops you from being aware, feeling pain and forming memories during your procedure. During a GA, a breathing device may be put into your throat or windpipe to help you breathe when you are asleep and is removed as you wake up after your operation is over. The anaesthetist will keep you safe by constantly monitoring the patient to manage the airway, blood circulation and general responses.
Note: If you are planned for a surgery that requires anaesthesia, do note that all forms of anaesthesia have some risk.
What are the risks of general anaesthesia and sedation?
Common
Risk ratio (1:10 to 1:100)
- Temporary headache, dizziness
- Blurred vision
- Nausea/vomiting
- Sore throat and hoarse voice
- Shivering
- Short term memory loss or confusion
- Muscle aches and/or backache
- Pain or bruising at the site of injections or drips
- Skin redness or rash from
- tapes/medication
Uncommon
Risk ratio (1:1000 to 1:10000)
- Awareness during anaesthesia
- Damage to teeth, dental prosthetics, lips or tongue
- Damage to vocal cords and voice box
- Damage to nerves over pressure areas
- Injuries to the eye
- Difficulty in passing urine
- Breathing difficulties requiring
- Ventilator support
- Existing medical condition getting worse
Rare
Risk ratio (1:10000 to 1:100000)
- Severe allergic reactions
- Malignant hyperthermia (very high temperature)
- Stroke, Brain damage, seizures
- Heart attack
- Chest infection
- Blindness
- Blood clot in the leg/lungs
- Death
- Equipment failure
Anaesthesia for Mastectomy in FeM’s Day Surgery Center
Enhanced Recovery After Surgery (ERAS) principles has been widely shown to improve post-operative recovery in the following ways – shorter length of stay, decreased postoperative pain and need for analgesia, more rapid return of bowel function, decreased complication and readmission rates, and increased patient satisfaction.
In FeM Surgery, the surgical and anaesthetic teams have extended these principles to our breast cancer patients undergoing simple mastectomy. Our aim is to optimize patient outcomes, reduce surgical stress and increase patient satisfaction without increasing postoperative complications.
Our ERAS mastectomy model addresses several perioperative core principles:
- Focused pre-operative education to reduce anxiety and to assess medical suitability for day surgery.
- Multi-modal analgesia and opioid-sparing techniques are used to avoid negative side effects such as nausea and somnolence.
- Optimal prevention of post-operative nausea and vomiting (PONV)
- With the combination of good analgesia, PONV prophylaxis and excellent surgical skills, the patient will be able to have adequate oral intake and early ambulation in the Post Anaesthetic Care Unit.
- Post operatively, FeM Surgery’s patients benefit from a 24-hr priority line that can triage potential postoperative complications, should they arise, while recovering in the comfort of their own home.
In the highly specialized FeM’s Day surgery centre, mastectomy is medically safe and has proven to lead to a positive experience for both the patient and their family.
