Anaesthetic and pre-operative information

This leaflet provides information to help you prepare for your anaesthetic at Cambridge University Hospitals (CUH). On the following websites, you will be able to watch a video of a patient’s perioperative (perioperative describes the time before and after surgery) journey at CUH, as well as access useful patient information from the Royal College of Anaesthetists.

• Pre-assessment service page
• Fit4Surgery
• Preparing for surgery: Fitter Better Sooner (opens in a new tab)
• Royal College of Anaesthetists - Patient information resources (opens in a new tab) (includes translation in 20 languages)

Social arrangements

If you are having day case surgery, you must make arrangements for someone to stay with you for the first 24-hour period after your procedure. Please alert the pre-assessment team if you live alone, or are unable to arrange for someone to stay, as this will require an overnight admission into hospital. This could mean rescheduling your admission to a more suitable date.

Before your admission to hospital, you may receive an automated text message or telephone call, reminding you of your admission.

Feeling unwell before an operation

If you are feeling unwell at any point close to your admission, have an infection, or have recently been to your GP, please contact our Pre-Assessment Department on 01223 250888. When you call, the pre-operative nurse will ask you a few questions to check that you are still able to proceed with surgery. Failure to inform us may result in your operation being cancelled on the day of surgery.

What to bring and what not to bring with you

When you come into hospital, please bring your current prescription and all current medications, in their boxes if possible. Use the green bag provided at one of your pre-assessment appointments.

Please note - simple painkillers (such as paracetamol or ibuprofen) and laxatives (such as senna or lactulose) may be required after surgery. We suggest you discuss this with your local pharmacist. We recommend a seven day supply of this medication to keep at home in order to help your recovery.

Not eating before your treatment

Stop eating and drinking (this includes chewing gum) five hours before your admission. You can continue to drink water until one hour before your admission.

For example – An admission at 07:00 would require you to stop eating at 02:00 and then consume clear fluids (for example, water, black tea or black coffee) only until 06:00.

If advised by the pre-operative assessment nurse, please take the complex carbohydrate drinks ('Nutricia Pre-op') as directed;

• 4 drinks - throughout the evening before admission
• 2 drinks - on the morning of admission (to finish one hour before admission as per instructions for clear fluids)

Your anaesthetist will give instructions to the nursing team looking after you on the admission ward. Depending on the timing of your operation, you may be allowed to drink clear fluids until later in the day.

Taking medicines before your treatment

Certain medicines may need to be stopped before surgery (for example, blood thinning medication). You should have been given instructions at your pre-assessment appointment regarding any medication you need to stop prior to your admission.

It is important that you continue all your other medicines (tablets, liquids, inhalers, patches, creams, etc.) as normal. On the morning of your admission, you can take your tablets with up to 200ml of water as long as this is done by 07:00.

If you are at all unclear about the advice you were given about your medication, please call the Pre-Assessment Department on 01223 250888.

Please remember to bring all your medication with you to hospital, including any medicines that you have been asked to stop before surgery. This includes any herbal remedies or alternative medicines.

Any medicine that you stop before surgery will be reviewed by the doctor before you are sent home and re-started after your treatment, if it is necessary and safe to do so. Before discharge, please make sure that you are clear about which medicines, including herbal remedies or alternative medicines, you should be taking after surgery. On discharge from the ward, you will be given a list of the medicines you should be taking at home. A copy will be sent to your GP.

Washing before surgery

Please shower or bath thoroughly in soap and water on the morning of admission. Dry yourself with a clean towel, and put on clean underwear and clothes. This will reduce the risk of you developing a surgical infection.

Remove all jewellery and body piercings. If you are unable to remove them, please inform staff and they will put protective tape over them. Do not apply make-up. Remove false nails, hair extensions and nail varnish.

You will meet your surgeon and anaesthetist before your operation. If you have not done so already, you will be asked to sign a consent form for your treatment. If you have any questions for your clinical team, please feel free to ask at any point during your stay.

The list order of patients having an operation can change on the day. This can happen for many reasons, but is often due to changes in a patient’s clinical condition. A patient may go earlier or later than expected; please be reassured that this is for the safe and efficient running of the theatre list.

Your anaesthetic

This section gives information to help you prepare for your anaesthetic. You can also visit the patient information section on The Royal College of Anaesthetists website (opens in a new tab), as well as request further information from your anaesthetist when you see them before your operation.

Anaesthetists

Anaesthetists are doctors with specialist training who:

• Discuss types of anaesthesia with you and choose the best option for your procedure.
• Discuss the risks of anaesthesia with you.
• Agree a plan with you for your anaesthetic and pain control.
• Are responsible for giving you your anaesthetic and for your wellbeing and safety throughout your surgery. They will stay with you throughout the operation and as you wake up.
• Manage any blood transfusions you may need.
• Plan your care, if needed, in the Intensive Care Unit.
• Make your experience as pleasant and pain free as possible.

Before your anaesthetics

You will be asked some questions about your health before your operation. This may be in the form of a pre-assessment clinic, a questionnaire, a discussion with doctors on the ward or your anaesthetist. It is important to tell your anaesthetist about:

• All the medicines, herbal remedies or supplements you are taking, both prescribed and those that you have purchased over the counter.
• Any allergies you may have.
• Important medical conditions for which you have seen other specialists at other hospitals.
• Any current use of cigarettes, alcohol or recreational drugs.

On the day of your operation

The hospital will give you clear instructions about fasting. These will be found on your admission letter and it is important to follow them. If there is food or liquid in your stomach during your anaesthetic, it could come up to the back of your throat and damage your lungs. If you are taking medicines, you should continue to take them as usual, unless your anaesthetist or surgeon has asked you not to. If you take drugs to stop you getting blood clots (anticoagulants such as aspirin, warfarin, clopidogrel), drugs for diabetes or herbal remedies, you will need specific instructions at your pre-op appointment. If you feel unwell when you are due to come into hospital, please call the number on your admissions letter.

Your anaesthetist will meet you before your operation and will:

• Ask you about your health
• Discuss with you which types of anaesthetic can be used
• Discuss with you the benefits, risks and your preferences
• Decide with you which anaesthetic would be best for you
• Make the decision for you, if you would prefer that

Nothing will happen to you until you understand and agree with what has been planned for you. You have the right to refuse if you do not want any of the treatments suggested. The choice of anaesthetic depends on:

• Your operation
• Your answers to the questions you have been asked
• Your physical condition
• Your preferences and the reasons for them
• Your anaesthetist’s recommendations for you and the reasons for them
• The equipment, staff and other resources at the hospital

If you are having a local or regional anaesthetic you may:

• Be fully alert
• Be relaxed and sleepy (sedated)
• Have a general anaesthetic as well

When you are called for your operation:

• A member of staff will go with you to the operating theatre.
• You can wear your glasses (contact lenses need to be removed), hearing aids and dentures until you are in the anaesthetic room. If you are having a local or regional anaesthetic, you may be able to keep them on during the operation.
• Jewellery, including decorative piercings, should ideally be removed. If you cannot remove your jewellery, it can be covered with tape to prevent damage to it or to your skin.
• Theatre staff will check your identification bracelet, your name and date of birth, and will ask you about other details in your medical records as a final check that your details are correct.

Local anaesthetics

A local anaesthetic numbs a small part of the body. This involves a small injection as the anaesthetic is put in. You stay conscious and, once the anaesthetic starts working, free from pain. Common examples of surgery under local anaesthetic are removal of teeth, removal of skin lesions and operations on the eye.

Sedation

Sedation involves using small amounts of anaesthetic drugs to produce a ‘sleep-like’ state. Sedation makes you feel relaxed, but not unconscious. It may be used in addition to a regional anaesthetic (or a local anaesthetic).

Regional anaesthetics (includes spinals, epidurals and nerve blocks)

This is when local anaesthetic is injected near the nerves which supply a large or deep area of the body. The area of the body affected becomes numb.

Your anaesthetist will ask you to keep still while the injections are given.

You may notice a warm, tingling feeling as the anaesthetic begins to take effect.

Your operation will only go ahead when you and your anaesthetist are sure that the anaesthetic is working.

If you are not having sedation, you will remain alert and aware of your surroundings. A screen shields the operating site, so you will not see the operation.

Your anaesthetist will remain near you and you can speak to them whenever you want to.

General anaesthetics

General anaesthesia is a state of controlled unconsciousness during which you feel nothing, and after which you will have no memory of what happened (except going to sleep and waking up at the end of the procedure).

Once you are unconscious, an anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised. As soon as the operation is finished, the drugs will be stopped or reversed so that you regain consciousness. After the operation, you will be taken to the recovery room. Recovery staff will be with you at all times. When they are satisfied that you have recovered safely from your anaesthetic, you will be taken back to the ward.

What will I feel like afterwards?

How you feel will depend on the type of anaesthetic and operation you have had, how much pain relieving medicine you need and your general health.

Understanding risk

In modern anaesthesia, serious problems are uncommon. Risk cannot be removed completely, but modern equipment, training and drugs have made it a much safer procedure in recent years. To understand a risk, it is useful to know how likely it is to happen, how serious it could be and how it can be treated.

The risk to you as an individual will depend on:

• Whether you have any other illnesses
• Personal factors, such as smoking or being overweight
• The type of surgery, with greater risks if the surgery is complicated, long or carried out in an emergency

Side effects and complications

Listed below are a number of side effects that may be experienced. Please ask your anaesthetist if you require more information. They will discuss with you which of these may be particularly relevant to your situation.

Very common and common side effects

Regional anaesthesia

• Feeling sick and vomiting after surgery
• Dizziness, blurred vision
• Headache
• Itching
• Aches, pains and backache
• Pain during injection of drugs
• Bruising and soreness

General anaesthesia

• Feeling sick and vomiting after surgery
• Dizziness, blurred vision
• Headache
• Itching
• Aches, pains and backache
• Pain during injection of drugs
• Bruising and soreness
• Sore throat
• Confusion or memory loss

Uncommon side effects and complications

Regional anaesthesia

• Bladder problems
• Slow breathing (depressed respiration)
• An existing medical condition getting worse

General anaesthesia

• Bladder problems
• Slow breathing (depressed respiration)
• An existing medical condition getting worse
• Muscle pains
• Chest infection
• Damage to teeth, lips or tongue
• Awareness (becoming conscious during your operation)

Rare or very rare complications

Regional anaesthesia

• Serious allergy to drugs
• Nerve damage
• Equipment failure
• Death

General anaesthesia

• Serious allergy to drugs
• Nerve damage
• Equipment failure
• Death
• Damage to the eyes

Deaths caused by anaesthesia are very rare, and are usually caused by a combination of complications occurring together.

Questions you might like to ask your anesthetist

• Who will give me my anaesthetic?
• Do I have to have a general anaesthetic?
• What type of anaesthetic do you recommend?
• Have you often used this type of anaesthetic?
• What are the risks of this type of anaesthetic?
• Do I have any special risks?
• How will I feel afterwards?

If you have any other questions for your anaesthetist, you can write them down here, and then ask your anaesthetist when you meet them on the day of surgery.

Recovering from your operation/procedure

Useful contact information

• Ward A2
  Telephone: 01223 216294 or 01223 216358
• Ward A3
  Telephone: 01223 216305
• Ward A4
  Telephone: 01223 217216
• Ward A5
• Telephone: 01223 216314
• Ward C8
  Telephone: 01223 217279
• Ward D3
  Telephone: 01223 217494
• Ward D4 IDA
  Telephone: 01223 348144 or 01223 256523
• Overnight intensive recovery - J3
  Telephone: 01223 217402
• Ward D8
  Telephone: 01223 217282
• Ward F5
  Telephone: 01223 216811
• Ward F6
  Telephone: 01223 217323
• Ward G5
  Telephone: 01223 217711
• Ward L2
  Telephone: 01223 348589
• Ward L4
  Telephone: 01223 348544
• Ward L5
  Telephone: 01223 274280
• Ward M4
  Telephone: 01223 274284
• Ward M5
  Telephone: 01223 348527, 01223 348525 or 01223 256336
• Daphne ward
  Telephone: 01223 257206
• Cambridge eye unit
  Telephone: 01223 257168
• Ely day surgery unit
  Telephone: 01223 257168

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.