General anaesthetic | Twilight sedation | Regional anaesthetic | Pain management | Outpatient procedures | Risks and side effects | Frequently asked questions
The Pyramid Clinic takes great pride in the excellent patient care provided by our anaesthetics team. Our experienced anaesthesiologists take time to prepare patients for their upcoming surgery with sensitivity to their needs. This begins with the preoperative consultation, continues with the anaesthesia management during the procedure, whether under general or regional anaesthetic, and extends to care in the Recovery Room and pain management after the operation. Anaesthesia care is always available for our patients, including for outpatient procedures.
An anaesthesiologist is also on hand during minor or outpatient surgery, such as eye procedures, to monitor cardiovascular functions and provide sedation.
PREOPERATIVE CONSULTATION AND INVESTIGATIONS
One reason for the safety of anaesthesia is the proper assessment of risk. This includes not only the risk of the planned procedure, but also consideration of any pre-existing conditions that the patient may have. This is why certain investigations are carried out prior to hospital admission. These include the anaesthesia questionnaire, in which patients provide their medical details (previous illnesses, allergies, current medications, previous surgeries, etc.), and any preliminary investigations by the family doctor or specialist.
Any questions can then be discussed in the preoperative consultation with the anaesthesiologist.
Since the introduction of ether anaesthesia in the century before last, tremendous progress has been made in this area, not only in terms of patient safety but also in terms of comfort. Today, for example, we rarely use anaesthetic gases and maintain anaesthesia exclusively with intravenous substances, which means that nausea very rarely occurs after anaesthesia. Monitoring of the depth of anaesthesia is now routine, which allows for customised anaesthetic management and additional safety.
Our clinic has the responsibility and task of choosing the best method of anaesthesia and maintaining the very highest safety standards. In this video, Dr Christoph Helmuth Schubert addresses the prejudices against general anaesthesia and explains the disadvantages of twilight sedation.
“Many people are afraid of general anaesthesia. This is because, in the past, general anaesthetics were used that were riskier and less well tolerated. A lot has happened in the last few years and general anaesthesia is absolutely safe. Safer than road traffic!” - Dr Schubert
(Video in German)
Spinal anaesthesia, also known as lumbar anaesthesia, is suitable for procedures below the belly button. This involves an injection into the spine to numb the nerves that supply the abdomen and legs. These nerves run through the lower part of the spinal canal and can be easily accessed there. The spinal cord itself is also located in this canal, but it stops well above the injection site, so the risk of injury is extremely low. With a regional anaesthetic, it is possible to be awake during the procedure, which is sometimes desirable from the patient’s point of view or for medical reasons.
Block anaesthesia/Peripheral regional anaesthesia
This is a form of anaesthesia to anaesthetise a specific area of the shoulder, arm, or leg. A local anaesthetic is used to block single or multiple nerves, eliminating the sensation of pain. Often a thin catheter is placed, through which an analgesic block can be continued for a few days after surgery for pain management.
For certain surgical procedures, multiple forms of anaesthesia can be combined.
There are surgical procedures for which only local anaesthesia is needed. Pain relief is managed by the surgeon by injecting a local anaesthetic directly into the wound area. In most cases, however, monitoring of cardiovascular functions and administration of sedatives by the anaesthesiologist are required.
A note on twilight sedation, see video: As a rule, we do not perform deep sedation for major procedures, such as breast surgery, as this impairs the patient’s breathing and circulation.
In addition to the usual pain management following surgical procedures, we also offer nerve blocks, which can be given as a single injection or with the insertion of a pain catheter, as required. This can be used to make a targeted surgical area (usually the shoulder, hand, knee or foot) numb and pain-free, even for several days after the procedure. These techniques are usually combined with a general anaesthetic.
Generally, the same techniques are used for outpatient procedures as for inpatient procedures. However, since these are usually minor operations, local anaesthetics combined with mild sedation are used more frequently. These are typically procedures for eye surgeries, such as cataract surgery. If it becomes apparent after an outpatient procedure that longer monitoring will be necessary, this will always be carried out at the Pyramid Clinic, including overnight if required.
The risk of anaesthesia today is extremely low, because the latest medications and techniques with few side effects are used and the patient is continually monitored. We will inform you about the specific risks of a particular form of anaesthesia during the anaesthesia consultation.
During surgery with anaesthesia, temporary mild side effects may be experienced, but these are easily treated or resolve on their own after a short time. In addition to hoarseness or difficulty swallowing, dizziness, nausea, vomiting and chills may also occur after a general anaesthetic. After spinal anaesthesia with the extremely thin needle that we use, complaints of temporary headaches have not occurred for many years. Immediately after surgery with spinal anaesthesia there may initially be difficulty passing urine. Transient nerve irritation may occur with regional anaesthesia; permanent or severe nerve damage associated with peripheral block techniques is considered extremely rare.
How dangerous is anaesthesia?
In recent decades, the risks associated with anaesthesia have decreased dramatically. Currently, the chance of an anaesthesia incident resulting in a fatality is less than 1 in 200,000. In comparison, the risk of a fatal traffic accident is around 10 times higher.
Is it true that memory deteriorates during general anaesthesia?
It is known that short-term memory, i.e. the memory for things that have just been noticed, can be impaired after anaesthesia. However, this phenomenon resolves completely within a few hours to days during the normal course of anaesthesia. Evidence of longer-lasting impairment or interference with long-term memory has not been scientifically demonstrated.
Why can’t I eat or drink before anaesthesia?
During anaesthesia, not only is consciousness switched off, but also coughing and swallowing reflexes. To prevent the contents of the stomach from being regurgitated during induction of anaesthesia and then entering the lungs, the stomach should be as empty as possible. For emergency procedures, the surgeon cannot always wait for the patient to have an empty stomach, so in these cases anaesthesia must be performed at increased risk.
Is it possible for me to wake up during the anaesthesia?
Awareness during anaesthesia is a known but very rare event. However, there is no need to fear waking up or even feeling pain, as the depth of the anaesthesia can now be monitored.
After the last anaesthetic I was terribly nauseous. Is there any way to avoid this?
Anaesthesia management without anaesthetic gases, as is performed in our clinic, reduces the frequency of postoperative nausea and vomiting considerably. However, it can still occur in particularly sensitive people who are also otherwise more prone to nausea.
In these cases, medications are available that combat nausea effectively in the vast majority of cases.
Why should I postpone my surgery if I have a cold?
A cold weakens the body’s defences and increases the risk of infection after surgery. Particularly in the case of fever, a bacterial infection may also be present, which further increases the risk. Therefore, if the procedure does not need to be performed urgently, it should be postponed.
Is a general anaesthetic or regional anaesthetic better?
In terms of safety and efficacy, both methods are equivalent. If there are no medical reasons why a technique should not be used – for example, spinal anaesthesia may be more difficult after back surgery – the patient can generally choose which form of anaesthesia they would like.