Non-fiction

This is a list of my articles, book reviews, news stories etc. Some have been published by others, and nearly all are available in my self-published ebooks. - C. A. Broadribb.


Anaesthesia for Operations

Copyright © C. A. Broadribb 2018

Index:

Introduction.
Types of Anaesthetic.
Anaesthetists.
Choice of Anaesthetic.
Informed Consent.
Risks.
Hospital Procedures.
Emergencies.
After an Operation.
Medical Records.
Complaints.
Local Anaesthetic.
Regional Anaesthetic.
Spinal Block.
Epidural.
Combined Spinal Epidural.
General Anaesthetic.
Sedative.
Sedation.
Further Reading.
My Experiences:
Experience 1: The dramatic effects of a sedative.
Experience 2: Cancelling an operation.
Experience 3: Choosing an anaesthetic.
Experience 4: Misinformed consent.


Introduction:

It’s difficult to find information about anaesthesia online because most websites either have a simplistic description of a few sentences or provide dense technical information from research papers that most people won’t understand. There are also some differences in the terminology used by different sites. This is a summary of information that I’ve obtained from various sources (websites, books, anaesthetists, and my own experience).  It’s only about anaesthesia for adults.

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Types of Anaesthetic:

Anaesthetic keeps you free from pain during an operation.  Staff also monitor and maintain your essential bodily functions such as breathing, temperature, blood pressure etc. 

There are three main types of anaesthetic.

  1. Local anaesthetic:  numbs a small area of your body.

  2. Regional anaesthetic:  numbs a large area of your body.
    It’s also called ‘local anaesthetic’ or a ‘block’ or a phrase including the word ‘block’.
    Spinal blocks and epidurals are special types of regional anaesthetic.

  3. General anaesthetic:  a deep level of unconsciousness.

    Sometimes it can be called ‘light general anaesthetic’.

Local or regional anaesthetic can be used with general anaesthetic.

A sedative is a drug often given with local, regional or general anaesthetic to cause relaxation, drowsiness, or a light level of unconsciousness.  It also causes memory loss.

Sedation is a drug-induced light level of unconsciousness sometimes used with local or regional anaesthetic.  It’s also called ‘procedural sedation’, ‘conscious sedation’, ‘twilight anaesthesia’, ‘twilight sleep’, ‘deep sedation’, or ‘monitored anaesthesia care’ (MAC).

People often use the word ‘sleep’ as a euphemism or simplification for unconsciousness, both for the deep level of general anaesthetic and the light level caused by sedatives\sedation.

Anaesthetists use standard terminology when talking to other medical staff or filling in medical records, but sometimes use ambiguous or misleading language or make up their own terminology (e.g. ‘soft anaesthetic’ or ‘part general’) when talking to patients.  You can ask the anaesthetist whether he or she means local, regional, or general anaesthetic and whether he or she intends to use a sedative\sedation too.

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Anaesthetists:

Anaesthetists study a medical degree, as other doctors do, then complete additional study and training in anaesthesia over a number of years.  They need to be highly qualified because they use powerful, dangerous drugs and medical equipment and are literally responsible for keeping you alive during an operation. 

They need to have certain qualities to do that type of work.  They're highly intelligent and also need to be mentally tough to handle the stress of the job.  They’re expected to develop some sort of rapport with you so they may have (or affect) a friendly and cheerful manner.  Like other medical staff, they often deliberately act in a casual and relaxed manner while around you, presumably because having an operation is already a stressful situation and they’re trying to avoid stressing you further. 

Anaesthetists can make mistakes, fail to explain things properly, mislead you or lie to you, regardless of how highly qualified or experienced they are or how nice they appear to be.  They can also mislead or lie to other medical staff or medical authorities.

Like all medical practitioners in Australia, they’re listed in the Australian Health Practitioner Regulation Agency (AHPRA) database, accessible through the AHPRA website.  They’re legally required to update their details within 30 days of any changes, but don’t always do so.

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Choice of Anaesthetic:

Whether it’s possible to have a choice of anaesthetic for an operation depends on the type of surgery you’re having, the hospital’s policy, and the anaesthetist’s and surgeon’s skills and attitudes.

Some types of operations can only be performed under general anaesthetic but others can be performed under local or regional anaesthetic instead. Unfortunately, there’s a small possibility that local or regional anaesthetic won’t be completely effective.

Some hospitals have a policy of offering you a choice of anaesthetic whenever possible, some have a policy of using general anaesthetic for all surgery, and some don’t have a set policy either way.

Not all anaesthetists regularly use all of the different types of anaesthetic or are highly skilled in all of them. They may prefer to use a particular type, or to only work on certain types of operations.

Some anaesthetists are happy to let you help choose the type of anaesthetic if possible, but others, particularly older ones, have the attitude that they should make all the decisions and that you should have no say in it. This is unfortunate because the older, more experienced anaesthetists are likely to be more proficient in using local or regional anaesthetic and be able to use it for a wider range of operations.

Sometimes patients don’t know much about local or regional anaesthetic and an anaesthetist would need to spend some time explaining matters in order to offer them as an option. In a busy hospital, under pressure, he or she may not want to do this and may find it easier to just use general anaesthetic.

Surgeons can’t make the decision about what type of anaesthetic you have, but they can discuss it with the anaesthetist and yourself, and they can refuse to perform the surgery under particular types of anaesthetic. Some surgeons prefer to operate on patients under general anaesthetic, and some are too rough in handling patients to operate on them while they're conscious. Anaesthetists and surgeons often develop close working relationships and understand each other’s skills and attitudes.

Although the Australian Charter of Healthcare Rights includes a communication principle of ‘I have a right to be informed about services, treatment, options and costs in a clear and open way’, and a participation principle of ‘I have a right to be included in decisions and choices about my care’, hospitals and staff don’t seem to regard it as applying to anaesthesia, and set their own policies instead. The charter doesn’t stipulate anything about anaesthetic specifically.

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Informed Consent:

Informed consent is an important principle of medical care and in the context of anaesthesia means that the anaesthetist or other staff should explain what type of anaesthetic will be used, give you honest and accurate information about it and answer your questions about it, so that you can decide whether you want to proceed or not, without being pressured or coerced into it. Medical practitioners should tell you about likely significant risks but aren’t required to tell you about every possible risk.

You normally have the legal and ethical right to refuse medical treatment, including the right to refuse to have particular types of anaesthetic or to cancel the operation altogether if you’re not happy about the options. You can do that even if you’ve signed a consent form, and even if you’re in the anaesthetic room or operating theatre and the anaesthetist is about to administer the anaesthetic. Staff should respect your rights, however, sometimes they can act with disdain or anger, either in public or private hospitals.

The Australian and New Zealand College of Anaesthetists has guidelines on informed consent, however, anaesthetists don’t always follow them. An anaesthetist is more likely to explain things properly and be honest at an anaesthetic consultation held in advance of an operation than at a brief discussion just before the operation starts. In the latter case, he or she may not explain things properly or may be tempted to give inaccurate or misleading information or to gloss over the risks in order to persuade you to go ahead with the operation. Staff present might not speak up about it. If the anaesthetist uses general anaesthetic then other staff who enter the operating theatre later may just assume that the situation was informed consent.

There are medical and legal scenarios where it’s acceptable for an anaesthetist to give anaesthetic without informed consent. For example, if a patient’s badly injured or unconscious when brought in to the hospital, or if a medical emergency occurs during an operation and the anaesthetist needs to act immediately to save the patient’s life. Also, some patients aren’t able to give informed consent because of serious intellectual disabilities or mental illnesses.

If you’re capable of giving informed consent then it’s a serious issue for an anaesthetist to give you anaesthetic without it. If you agree to anaesthetic based on misinformation, it’s misinformed consent, and can be medical negligence. If you’re given anaesthetic without any consent at all, it can be assault.

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Risks:

Australia is one of the safest countries in the world to have anaesthetic, but unfortunately, all types of it carry a small risk of unpleasant side effects, minor or major injuries, or even death.  However, the risk of dying specifically because of anaesthetic is much lower than the risk of dying because of an operation itself.  Anaesthetic isn’t usually even a contributing factor. 

The risk of injury or death from anaesthetic varies depending on your health status. You’re at less risk if you’re young and healthy and at higher risk if you’re elderly, ill, seriously injured, or have a chronic medical condition.  Other factors that increase the risk are being overweight, being unfit, smoking, drinking alcohol or using recreational drugs.  Being given anaesthesia for a long period of time (such as for a major operation that lasts many hours) also increases the risk of something going wrong. 

It’s also possible for an anaesthetist or other staff member to make a mistake (such as giving you the wrong dose of a drug, or inserting a breathing tube incorrectly) or for medical equipment such as an anaesthetic machine to malfunction or fail.

According to the Australian Society of Anaesthetists website, a large study showed that only 10% of patients had problems from anaesthetic, and that the most common problems were relatively minor, such as nausea, vomiting, or a sore throat.

Another issue is that the anaesthetic might not be completely effective. There is a small possibility that local or regional anaesthetic won’t completely numb the area to be operated on, or will wear off partway through the operation. There’s a slight risk that general anaesthetic won’t keep you completely unconscious throughout the operation. The anaesthetist may need to give you more anaesthetic, a different type of anaesthetic, or additional drugs.

Although websites about anaesthesia claim that an anaesthetist or other medical practitioner will discuss everything with you before the operation, telling you how likely the anaesthetic is to be effective and warning you of likely risks, this doesn’t always happen, especially in busy hospitals.  Staff might not say anything about risks, only briefly mention a few of them, or only mention afterwards that there had been a particular risk.  Even if you bring up something that you’re concerned about, an anaesthetist or medical practitioner might not discuss it. 

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Hospital Procedures:

A doctor will give you basic information about what the proposed operation will involve and ask you to sign a consent form for it. He or she might not tell you the whole truth about it: how poorly you’ll feel afterwards, how long it will take you to recover, or the possibility of suffering side-effects from the surgery such as nerve damage or ligament or muscle damage. If you’re having elective surgery (surgery planned in advance) then you can look up additional information online about it.

Hospital staff will perform a variety of tests to evaluate your health. They will take blood samples for testing and may ask you to do breathing tests, have an ECG to measure your heart function, take X-rays etc. They may look into your mouth to check how easy it will be for an anaesthetist to insert a breathing tube if general anaesthetic is needed. They will ask you about medical problems, medications or supplements that you’re taking, previous operations and anaesthetic that you’ve had etc. They will make a basic evaluation of your overall health and fitness level.

If you’re badly ill or injured and need urgent surgery, these procedures will be done soon after you arrive at the hospital, however, if you have elective surgery then staff will ask you to come in on particular dates to do these things. That will be days or weeks before the actual operation.

It’s possible to make an appointment for an anaesthetic consultation to talk to an anaesthetist. If you’re going to a private hospital, it will be with the same person who will treat you during the operation, however, if you’re going to a public hospital, it will probably be with someone different. An anaesthetic consultation is a good time to find out what types of anaesthetic are possible and the risks and benefits, without the anaesthetist being under time pressure. However, if you’re at a public hospital, the anaesthetist assigned for the operation may have different skills and attitudes from the one you talk to at the consultation.

Hospitals in Australia don’t usually have separate anaesthetic consent forms. The consent form for the surgery will be taken to include consent to anaesthetic too, even though you will probably be asked to sign it before you even talk to an anaesthetist. It won’t have a separate section on it specifically for anaesthesia, so there won’t be any written record of what types of anaesthetic you’re willing to have and what types you would like to refuse (if any).

Staff will ask you to avoid eating or drinking anything for many hours before an operation, because food and drink could interfere with the anaesthetic or cause other problems e.g. you could vomit up food and choke on it. 

When it’s time for the surgery, staff will ask you to change into a hospital gown and lie on a bed, then wheel you to the anaesthetic room, where the anaesthetist assigned for the operation will talk to you. The discussion might be brief and unsatisfactory if he or she is under time pressure. Although there will be many staff members present during the operation, they won’t all be present for the discussion about the anaesthetic. There might only be one nurse present, who won’t necessarily speak up if the anaesthetist says something inaccurate or misleading.

The anaesthetist will either give you the anaesthetic in the anaesthetic room or move you into the operating theatre first.  It can be daunting to have it done in the operating theatre because of all of the lighting equipment and unfamiliar medical equipment around you.

Staff will perform a variety of tasks to prepare you for the operation.  They may insert a catheter into the back of your hand to give you intravenous (IV) fluids; attach equipment to monitor your vital signs such as heart rate, blood pressure, blood oxygen level etc; ask you to breathe air through a face mask; shave hair off the area to be operated on; wipe you with antiseptic fluid; put a warming blanket over you; place gel heel pads on your ankles etc.  If you’re going to be conscious during the operation, then a screen or blankets will be used to block your view of the surgery so that you can’t see any of it. The anaesthetist may tell you what’s happening and why, to reduce stress.

Sometimes medical staff will want to insert a urinary catheter for a spinal block, epidural, or general anaesthetic.  Some hospitals have a policy of always using one for general anaesthetic - the staff might put it in after you’re unconscious, without your knowledge or agreement.

Staff may confirm with you what type of operation you’re having and that you signed the consent form for it, however, they might not confirm what type of anaesthetic you’ve agreed to. 

Numerous staff will be present during the operation, e.g. an assistant anaesthetist, surgeon and assistant surgeon, and various nurses.  They will have their names recorded on your medical record.  If you’re in a teaching hospital, other staff may come in to watch and learn, but won’t be noted down on the medical record.

While the operation is in progress an anaesthetic machine is used to monitor your vital signs and also to give you drugs though the IV line.  If you have general anaesthetic, it may also be used to give you a gas through a tube in your throat.  It includes a ventilator which breathes for you if you can’t breathe on your own under general anaesthetic (which, often, you can’t).

After the operation is over, the anaesthetist and other staff will move you to the recovery room, which is also called a PACU (Post Anaesthetic Care Unit) and nurses will look after you while the anaesthetic wears off.  You may need to stay there for a number of hours.  Then you may be able to go home, or you might be asked to stay in hospital for a time if you need further monitoring or treatment.

If something went wrong during the operation or if it took a long time, you may be taken to the Intensive Care Unit (ICU) instead of to the recovery room, so that the staff can better monitor and treat you.


Emergencies:

If there’s an emergency and you need immediate treatment for a serious injury, illness or medical problem then staff will follow different procedures, taking whatever action is necessary to save your life, and trying to keep you as safe as possible while doing so.  It might not be possible for them to explain what’s happening, what type of anaesthetic you will have, or what type of surgery you will have, or to ask for your consent.  You might be unconscious or too badly injured to be able to understand anything, or there might not be time to explain anything.

Staff will take all possible action to help you unless you had previously signed a ‘Do Not Resuscitate’ or ‘Not For Resuscitation’ order to refuse particular types of life-saving treatment such as CPR.  Terminally ill patients sometimes do this, because treatment wouldn’t help them much – at best, it would only return them to the same severely ill state that they were in before.

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After an Operation:

You’ll feel very bad physically after an operation, regardless of what condition you were in before you went through it.  You can be hot, tired, feel ill, be in a lot of pain, have difficulty concentrating etc.  Staff will give you painkillers and other medicine to take at home, but they will only help up to a point, and you’ll still feel very poorly at first.  You’ll gradually feel better over the following days. 

One website reported that patients often feel emotionally low while recovering from an operation, but that this could be more to do with having time for reflection while taking a break from their usual activities than being a side effect of the operation or anaesthetic.

Your body will gradually heal itself as much as it can. It takes at least six weeks to recover from an operation, and sometimes much longer. You may be asked to have a number of medical check-ups or undergo treatment such as physiotherapy. If you suffered nerve damage from an injury, the operation, or the anaesthetic then it will either be permanent or partially or completely heal over a period of many months.

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Medical Records:

Regardless of whether you go to a public or private hospital, you have the legal right to look at your own medical records. You can make an appointment to go in to the hospital to see them or order a copy of them (which may incur a small fee).

The records may include forms filled out before the operation, test results, nurses’ notes, anaesthetist’s and surgeon’s notes, and anaesthetic machine printouts. The latter will show various readings. These are some possible readings and abbreviations that may be used: heart rate (HR), blood pressure monitoring (Art NIBP for Arterial Non-Invasive Blood Pressure, and CV for Central Venous pressure), blood oxygen levels (SPO2 using a device called a Pleth - Plethysmograph), temperature (T1, T2), blood supply problems (ST for Systemic Event), oxygen given (O2%), nitrous oxide anaesthetic gas given (N2O%), other anaesthetic gas given (e.g. Sev % for Sevoflurane) and carbon dioxide exhaled (CO2).

There are some issues with studying medical records. They can be difficult to understand as they use unfamiliar abbreviations and medical terminology. Anaesthetic machine graphs can be hard to decipher and staff members’ handwriting can be messy and hard to read. Patients often expect that all conversations, procedures and events will be documented, but this isn’t always the case. There’s also an issue of staff members occasionally misunderstanding matters or being deliberately dishonest and recording inaccurate information (which is a serious matter).

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Complaints:

If you’re unhappy with the information the anaesthetist provided (or didn’t provide), the way that he or she acted, the effectiveness of the anaesthetic or other aspects of your care, you can take action.

Options include:

  • * Asking the hospital for a copy of your medical records to learn more about what happened.
  • * Contacting the anaesthetist (e.g. via the hospital) to discuss the matter.
  • * Providing feedback or suggestions to the hospital or local health district organisation.
  • * Making a complaint to the hospital or local health district organisation.
  • * Making a complaint to an official agency.  The Australian Health Practitioner Regulation Agency (AHPRA) website has a list of organisations in different states and territories, or it may be appropriate to make a complaint to the AHPRA itself.
  • * Talking to a lawyer about suing the anaesthetist or hospital for medical negligence or assault, if applicable. However, lawsuits are very expensive.
  • * Writing about your experiences to warn other potential patients.

Note that taking one action may have an effect on whether you can take another.  If you make a complaint, the anaesthetist might not want to talk to you directly.  If your complaint is to an official agency, the hospital or local health district organisation may regard it as a legal issue and refuse to discuss the matter further.  If you sue the anaesthetist or hospital, everyone may refuse to talk to you, and an official agency may not be able to accept a complaint from you because of their policies. 

If you make a complaint, it’s important to say what you would like to happen, e.g. an explanation or apology.  People are wary about possible lawsuits and may not reply if they believe that you’re considering legal action.

Regardless of what actions you take, the anaesthetist, hospital or local health district organisation may not want to admit the truth about your allegations.  Their main concerns may be to protect their reputation and avoid legal action.  The anaesthetist might deny everything, only admit part of the truth, and/or give an alternative, inaccurate version of events.  The hospital or local health district organisation may not put much effort into investigating your complaint, take the anaesthetist’s word of events over yours, or give an inaccurate account of the situation. 

Even an official agency may not be as objective or put as much effort into investigating your complaint as you would like.  An organisation consisting mainly of medical practitioners may be more inclined to take the anaesthetist’s side than yours.

Despite that, it’s still worthwhile making a complaint.  The anaesthetist and/or hospital may apologise for your distress, even if they don’t acknowledge the truth.  The anaesthetist and hospital staff may think about your allegations and consider acting differently in future or changing procedures, even they don’t tell you about it.  The mere fact that you’ve made a complaint may act as a warning to them.

An official agency may make recommendations or suggestions to the anaesthetist or hospital.  If they accept your word of events, they may caution or reprimand the anaesthetist, ask him or her to do further training, or take other action.  If they don’t accept that your allegations are proven, they will still keep them on file and may look at them again if another patient makes a similar complaint in future.

These days, you can write about your experience online to inform and warn other prospective patients.  You can post in message forums, on your own website, on friends’ websites, on Facebook, Google reviews etc.  There are some websites set up specifically for patients to post about their experiences at hospitals and health organisations.  They will generally allow you to name the hospital but not the anaesthetist.

There is an Australian website set up specifically for patients to review individual medical practitioners – including anaesthetists – however, it’s less useful than it appears to be.  It won’t display a negative review unless the practitioner claims the profile and opts to make reviews publicly viewable, which he or she is unlikely to do if you’ve been critical.

You can try writing about your experience in an article to send to a hard copy magazine or anthology, however, even if they accept it for publication they probably won’t allow you to name the hospital or anaesthetist because of legal concerns.

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Further Information:

The following is some further information about anaesthetic, sedatives and sedation.


Local Anaesthetic:

This can also be called ‘local infiltration’.

It is a drug or drugs that make a small area of your body go numb. 

Local anaesthetic is usually used for minor operations such as cataract eye surgery, a biopsy, removing a mole or wart, repairing a toenail, or operating on your finger.  (Dentists also use it for dental procedures.)  Sometimes it’s used for brain surgery, because only the patient’s scalp needs to be numbed – the brain itself doesn’t feel any pain.

Unfortunately, local anaesthetic isn’t suitable for many types of operations.  That’s because it might not reach the appropriate nerves (some aren’t easy to reach) or affect the pain receptors in internal organs.  In some cases, the dose required for the operation would be too high and would be too risky for you or would cause problems for the surgeon e.g. by distorting tissues.

Usually local anaesthetic is given by an anaesthetist, but sometimes it’s given by someone else such as the surgeon. 

Often the doctor will give you a light dose of a sedative first to help you relax, because the anaesthetic is more likely to be effective if you aren’t anxious.  Note that the sedative will also cause some memory loss.

The doctor will apply the local anaesthetic drug near the area to be operated on.  It will be given by injections, drops, sprays, gels or ointments.  (It doesn’t go into your bloodstream.)  You might feel some tingling or pain.  It takes effect within minutes, making the area go numb.  You will still be able to feel pressure and movement, but not pain.  If it’s not effective then the doctor may be able to give you more local anaesthetic, or painkillers, or you might need to have a different type of anaesthetic.  Some people are resistant to local anaesthetic because of genetic factors.

You can remain conscious during the operation, or if you’re nervous, you can have sedation or a high or additional dose of a sedative to be in a light level of unconsciousness (often called ‘sleep’) to be unaware of what’s going on. 

Local anaesthetic usually lasts for a number of hours, even up to 24 hours.  After the operation is over you have to take care not to injure that part of your body, as you won’t be able to feel it.  After the anaesthetic wears off, you may need more painkillers.

Local anaesthetic sounds quite safe since it’s usually only injected into a small area of your body and is used for a simple operation, and it is safer than regional anaesthetic or general anaesthetic.  However, it still has a risk of side effects, a small risk of injury, and even a slight risk of death.  Common temporary side effects include bruising, bleeding or soreness.  Other problems are less common:  headaches, blurred vision, dizziness, vomiting or muscle twitching.  It’s possible to suffer some damage to your blood vessels, tissues, or nerves.  Nerve damage can cause numbness, weakness or pain in the part of your body that the nerve goes to.  It’s usually temporary, lasting between a few days and a number of months, but it’s occasionally permanent.  Other rare problems include infections, allergic reactions to the local anaesthetic drug (mild or severe), falling unconscious if a large amount of the drug gets absorbed into your blood, breathing problems, heart problems, or a heart attack.  Doctors should be able to help you if you have one of these problems, however, there’s a slight risk that it could be fatal.

The list of possible problems sounds alarming, however, you might not experience any of them, or might only experience one or two minor problems. You may prefer to take the risk of having local anaesthetic rather than leaving the medical problem untreated.

Be wary of private medical clinics and cosmetic clinics that perform procedures in-house under local anaesthetic with a sedative\sedation.  They aren’t regulated or monitored very well by the authorities.  Also, doctors who perform cosmetic surgery aren’t legally required to have the same qualifications and training as normal surgeons, and can even just be GPs.  You could be at increased risk of having problems during or after the operation and might not be happy with the result of the surgery, either.

Some private clinics advertise that they can perform major operations such as breast enlargements or hernia repair under local anaesthetic with a sedative\sedation, however, this might not be as comfortable or safe as they claim.  You might be in pain but unable to remember it afterwards.  The clinic might use dangerously high levels of local anaesthetic, or very high levels of the sedative\sedation to put you into a deep level of unconsciousness equivalent to general anaesthetic.  In 2016 the NSW Health Care Complaints Commission took action against a major cosmetic breast surgery clinic in Sydney for these practices.  It asked the clinic to stop performing breast operations under local anaesthetic with sedation and to perform them under general anaesthetic in licensed facilities instead.

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Regional Anaesthetic (other than a spinal block or epidural):

This can be called ‘local anaesthetic’ because it uses the same drugs, and can also be called a ‘block’ or various phrases that include the word:  ‘regional block’, ‘peripheral nerve block’, ‘anaesthetic nerve block’ or ‘nerve block’.  If it’s done in the leg region it can be called a ‘femoral nerve block’ and if it’s done in the arm or shoulder region it can be called a ‘brachial plexus block’. 

It numbs an area of your body such as part of your face, or your shoulder, arm, hand, ribs, thigh, groin, buttocks or ankle. However, it can only be used for some types of operationsand only if the anaesthetist is skilled and experienced enough.

You can remain conscious throughout the operation.  However, you might have a low dose of a sedative first to help you relax and reduce anxiety.  This will also cause some memory loss.

The anaesthetist performs regional anaesthetic by injecting local anaesthetic into an area near your nerves e.g. for an operation on your arm, the anaesthetist might inject it into your underarm area.  He or she will find the exact location of your nerves using an ultrasound machine (in the past, a nerve stimulating device was used), wipe the area with antiseptic solution, then inject the drug.  You may feel ‘pins and needles’, tingling, or pain, and then part of your body will go numb and you will be unable to move it.  It takes about 20 minutes to become completely effective.  The anaesthetist will use a pin, ice or cold spray to check that you can’t feel any pain in the area to be operated on. You will still be able to feel pressure and movement because the anaesthetic doesn’t affect the nerves that transmit those sensations, and only affects the nerves that transmit pain.

The anaesthetist may give you other drugs by IV, such as antibiotics, anti-inflammatory drugs, or painkillers.  Paracetamol may be included because it increases the painkilling effects of other drugs. 

Occasionally (1 – 10% of the time) regional anaesthetic is unsuccessful e.g. it might not completely numb all of the area that’s going to be operated on.  It might be possible for the anaesthetist to repeat the regional anaesthetic, inject some additional local anaesthetic near the area where the sensation is, or give you painkillers or additional painkillers.  However, sometimes the only options are to cancel the operation to try again on another day (if it’s not medically urgent), or to have general anaesthetic. 

Anaesthetists don’t always warn that regional anaesthetic could be unsuccessful, and may give you the impression that it’s guaranteed to work.  You might be in the operating theatre with everything prepared for the operation, find that the anaesthetic hasn’t been entirely successful and have to make a hasty decision about what to do, without adequate discussion.

Even if regional anaesthetic is successful, you might become very nervous when the operation is about to start.  It’s natural for your fear to suddenly rise when you’re in the operating theatre under bright lights, surrounded by unfamiliar medical equipment, knowing that the surgeon is about to start cutting into you.  It’s easy to have doubts about whether the anaesthetic will continue to be effective, especially when you can still feel pressure and movement.  The anaesthetist may offer sedation or a high or additional dose of a sedative to cause a light level of unconsciousness (often called ‘sleep’), or general anaesthetic to cause a deep level of unconsciousness (also often called ‘sleep’).  You might agree to one or the other without adequate discussion.

In the above scenarios, there’s an additional issue if you had already been given a low dose of a sedative to cause relaxation or drowsiness.  It can affect your decision-making ability, causing you to be more likely to agree to something.  It also causes some memory loss, so that after the operation, you might not remember what went wrong, what the anaesthetist said, or what you agreed to. 

Regional anaesthetic lasts for a number of hours, even up to 24 hours, so it provides excellent pain relief both during and after an operation.  It wears off gradually, and then you may need to be given painkillers.  Sometimes a tube is left in place to continue to provide local anaesthetic for pain relief for a longer period of time, even up to several days.

Like all types of anaesthetic, regional anaesthetic has a risk of unpleasant side effects, a small risk of injury, and a slight risk of death.  It’s common to have some pain and bruising at the injection site.  There’s a small risk of nerve damage, causing some numbness, weakness or pain in an area.  This is usually temporary, healing within a few days to several months, but is occasionally permanent.  Other uncommon problems include infections, damage to blood vessels or muscles, an allergic reaction to the drugs (mild or severe), heart problems or lung problems.  There are very rare occurrences of heart attacks or seizures.  Different websites have different statistics on the risk of death.  All of them record it as very low, however, some claim that regional anaesthetic has a lower risk than general anaesthetic, and some claim that it has a higher risk.

The list of possible problems sounds alarming, however, you might not experience any of them, or might only experience one or two minor problems. It might be safer to have the anaesthetic than to leave the medical problem untreated.

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Spinal Block:

This is a special type of regional anaesthetic.  It’s similar to an epidural in many ways, and patients often get the two confused.

It’s also called a ‘spinal’, ‘spinal anaesthesia’, ‘subarachnoid anaesthesia’, ‘subarachnoid block’ (SAB), ‘true spinal’, or ‘intrathecal anaesthesia’.  Like epidurals, it is a type of ‘neuraxial anaesthesia’, ‘neuraxial blockade’ or ‘neuraxial block’. 

For a spinal block, local anaesthetic and sometimes painkillers are injected into a particular area of your back to numb your whole lower body from the waist downwards.  It prevents you from feeling pain and prevents your muscles from reacting to the surgery.

It’s used for operations on your feet, legs, or lower abdomen below the level of your belly button (e.g. inguinal hernias).  It’s often used for caesarean sections or prostate surgery.  It can be used to prevent pain during childbirth, in which case, drugs can be used that still allow you to feel contractions and move around in bed.

It’s difficult to use a spinal block for operations on your belly button area (e.g. an umbilical hernia) and not possible to use it for operations higher up on your body because it can cause breathing problems or heart problems by affecting relevant muscles.

Some patients can’t have a spinal block because of medical problems such as low blood pressure, bleeding disorders, infections, previous allergic reactions to local anaesthetic, or back problems.  Patients also can’t have one if they’re taking particular types of blood-thinning medication.  Your anaesthetist can determine whether it’s safe for you to have a spinal block.

If you’re going to have a spinal block, you can remain conscious throughout the operation.  However, the anaesthetist might give you a low dose of a sedative first to help you relax and reduce anxiety.  The sedative also causes some memory loss.

Before starting the spinal block, the anaesthetist will either ask you to sit curled forward with your back rounded, or lie on your side with your knees pulled towards your chest.  This can feel awkward, but it’s necessary to open up the spaces in your back where the drugs will be injected.  You need to remain completely still.  The anaesthetist will wipe your back with antiseptic lotion then inject a small amount of local anaesthetic into a spot in your lower back near your spine.  He or she will temporarily insert a needle there, which you shouldn’t feel, and use it to inject more local anaesthetic, and sometimes painkillers, through a membrane into the fluid that surrounds your spinal cord (cerebrospinal fluid, or CSF). 

You will feel ‘pins and needles’ and tingling, your bottom will become warm, and you will gradually become numb.  The numbness will rise slightly up your abdomen and will also descend all the way down your legs to your feet.  The spinal block starts numbing you within 5 minutes, but takes up to 30 minutes to become completely effective.  The anaesthetist will use a pin, ice or cold spray to check that you can’t feel any pain in the area to be operated on.  You will still be able to feel staff moving your legs or lower body, because anaesthetic only affects the nerves that transmit pain, and not the nerves that transmit movement.

The anaesthetist may also give you other drugs by IV, such as antibiotics, anti-inflammatory drugs, or painkillers.  Paracetamol may be included because it increases the painkilling effects of other drugs.

Occasionally (1 – 10% of the time) a spinal block isn’t completely successful and doesn’t numb all of the area that’s going to be operated on.  It might be possible for the anaesthetist to repeat the injection, move you around to make the drug spread out more, give you additional local anaesthetic, or give you painkillers.  However, sometimes none of these options are possible or safe and the only options are to cancel the operation (if it’s not medically urgent) or to have general anaesthetic.

A spinal block lasts for one and a half hours or more, up to four hours (especially if the anaesthetist included painkillers during the injection to increase its duration and effectiveness). It’s possible for it to start to wear off during an operation, particularly if the surgery takes an unexpectedly long time.  In that situation, it’s not possible for the anaesthetist to give more of the spinal block drugs.  He or she can give painkillers or local anaesthetic, but if they’re ineffective then you will need to have general anaesthetic. 

Anaesthetists don’t always warn patients that a spinal block might not be effective, or last throughout the operation, and may give you the impression that it’s guaranteed to work.  You might end up having general anaesthetic without adequate discussion.

Even if the block is completely successful, you might become very nervous when the operation is about to start.  You’ll be under bright lights, surrounded by unfamiliar medical equipment, knowing that the surgeon is about to start cutting into you.  It’s easy to have doubts about whether the block will be effective, especially since you’ll still be able to feel staff moving your legs around.  The anaesthetist may offer sedation or a high or additional dose of a sedative to cause a light level of unconsciousness (often called ‘sleep’), or general anaesthetic to cause a deep level of unconsciousness (also often called ‘sleep’).  You might agree to one or the other without adequate discussion.

In those situations, there’s an additional issue if you had already been given a low dose of a sedative to cause relaxation or drowsiness.  It affects your decision-making ability, causing you to be more likely to agree to something.  It also causes some memory loss, so that after the operation, you might not remember what went wrong, what the anaesthetist said, or what you agreed to. 

As the spinal block wears off, you will gradually regain sensation, starting from your lower abdomen and continuing down your legs to your feet.  You might feel ‘pins and needles’ or tingling.  It can take a couple of hours to wear off completely.  If the anaesthetist included painkillers with the spinal block, it helps with pain relief for up to 24 hours.

You may need to be given oxygen (though a tube in your nose, or a mask) for up to 24 hours after having a spinal block because the drugs can lower the amount of oxygen in your blood.

It’s difficult for the anaesthetist to work out how much of the spinal block drugs to give you.  If he or she gives too little, it might not completely numb the area to be operated on – and it may not be safe to give you an additional dose.  If he or she gives too much of the drugs, they can rise too high up your body.  This can cause weakness in your arms, heart problems, breathing problems (by affecting muscles associated with breathing, or your diaphragm), or even loss of consciousness.

Even when the anaesthetist gives the correct dose, a spinal block still has a risk of unpleasant side effects, a small risk of injury, and a slight risk of death, as all types of anaesthetic do.

Unpleasant side effects can include nausea, itching on your face or body, and feeling as if you can’t breathe properly.  The latter is because the block numbs your abdomen and chest wall, preventing you from feeling the normal sensations of breathing. 

There are less common, but more serious risks.  These include real problems with breathing, a drop in blood pressure, infections, poor blood clotting, pressure on your brain from various causes, or heart problems.  Unfortunately, like all types of anaesthetic, spinal blocks carry a slight risk of death.  Some websites claim that it’s lower than the risk from general anaesthetic and some claim that it’s higher.

After a spinal block wears off, it’s possible to still have some unpleasant side effects such nausea, itching or severe headaches.  The headaches can start within a few days and last for several days or even weeks.  They’re caused by the needle used for the injection creating a small hole in the membrane around your spinal cord, allowing cerebrospinal fluid to leak out through.  They’re worse when you’re sitting or standing and somewhat better when you’re lying down.

There is a small possibility that you will suffer nerve damage from a spinal block.  Usually it’s temporary, lasting a number of days or weeks, causing numbness, a ‘pins and needles’ sensation, pain, or muscle weakness.  However, there is a very rare risk of permanent nerve damage causing paralysis of one of your limbs, or loss of control of your bowel or bladder. 

The list of possible problems sounds alarming, however, you might not experience any of them, or might only experience one or two minor problems. It might be safer to have a spinal block than to leave a medical problem untreated.

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Epidural:

This is a special type of regional anaesthetic.   It’s similar to a spinal block in many ways, and patients often get the two confused.

It can be called ‘extradural anaesthesia’.  Like a spinal block, it is a type of ‘neuraxial anaesthesia’, ‘neuraxial blockade’ or ‘neuraxial block’. 

It is different from an epidural injection of steroids (ESI) given by a doctor to treat medical conditions.

An epidural used for anaesthesia numbs your lower body from the waist downwards, using local anaesthetic and sometimes painkillers.  A plastic tube (catheter) is left in your back to provide the drugs for as long as needed.

Epidurals have a wider range of uses than spinal blocks. An epidural can be used for an operation on your lower body below the belly button area, for giving birth, or for pain relief after an operation. A high dose of the drugs is used for an operation, to completely numb your lower body and prevent your muscles from reacting to the surgery.  A much lower dose is used for childbirth or pain relief, which doesn’t completely numb everything or completely prevent you from moving your legs.  When an epidural is used for pain relief after an operation, it can be given for many hours or even for several days.

Some patients can’t have an epidural because of medical problems such as low blood pressure, bleeding disorders, infections, previous allergic reactions to local anaesthetic, or back problems.  Patients also can’t have one if they’re taking particular types of blood-thinning medication.  Your anaesthetist can determine whether it’s safe for you to have an epidural.

If you’re going to have an epidural then you can remain conscious.  This is particularly desirable when giving birth.  The anaesthetist might give you a low dose of a sedative first to help you relax and reduce anxiety.  The sedative also causes some memory loss.

The anaesthetist will wipe your back with antiseptic lotion and ask you to either sit with your back arched or lie on your side, curled up.  He or she will inject some local anaesthetic into a spot on your back to numb it then temporarily insert a needle near your spine, just outside of the membrane that contains cerebrospinal fluid and your spinal cord.  (A slightly different area from a spinal block.)  The level it’s inserted at depends on which area of your lower body needs to be numbed.  Sometimes ultrasound or fluoroscopy are used to help guide the needle.  The anaesthetist will thread a catheter through the needle, tape the catheter to your back, then use it to give more local anaesthetic and sometimes painkillers. After 20 to 30 minutes, the drugs will cause you to feel warm and numb and your legs will become heavy and increasingly difficult to move.  The anaesthetist can control how much feeling you have by the amount, strength and type of drugs.  If you’re having an operation, he or she will use a pin, ice or cold spray to check that you can’t feel any pain in the area to be operated on.

The anaesthetist may also give you other drugs by IV, such as antibiotics, anti-inflammatory drugs, or painkillers.  Paracetamol may be included because it increases the painkilling effects of other drugs.

There’s a possibility (1 – 10%) of an epidural not being completely effective.  The anaesthetist might be able to solve the problem by moving the catheter or inserting a second one.  Sometimes it’s not possible to solve it.  If you’re giving birth, the anaesthetist can give you additional painkillers.  If you’re going to have an operation, painkillers might not be sufficient, and the only options might be to cancel the operation to try again on another day (if it’s not medically urgent), or to have general anaesthetic.

Even if an epidural is effective for an operation, you might become very nervous just before it’s about to start, since you’ll be under bright lights, surrounded by unfamiliar medical equipment, knowing that the surgeon is about to start cutting into you.  It’s easy to have doubts about whether the epidural will completely block all the pain.  The anaesthetist may offer you sedation or a high or additional dose of a sedative to be in a light level of unconsciousness (often called ‘sleep’) or general anaesthetic to be in a deep level of unconsciousness (also often called ‘sleep’).  You might agree to one or the other without adequate discussion.

In those situations, there’s an additional issue if you had already been given a low dose of a sedative to cause relaxation or drowsiness.  It affects your decision-making ability, causing you to be more likely to agree to something.  It also causes some memory loss, so that after the operation, you might not remember what went wrong, what the anaesthetist said, or what you agreed to. 

If the epidural is effective then the anaesthetist can continue to give you drugs through the catheter for as long as required, so there’s no risk of it wearing off partway through an operation or childbirth.

After the operation or childbirth is over, the anaesthetist might stop giving you the drugs, in which case the numbness will wear off over a few hours.  Alternatively, you might continue to receive local anaesthetic and painkillers at low doses for pain relief, and this can be done for many hours or even for a few days.

You may need to be given oxygen (though a tube in your nose, or a mask) for up to 24 hours after having an epidural because the drugs can lower the amount of oxygen in your blood.

Like all types of anaesthetic, an epidural has a risk of unpleasant side effects, a small risk of injury, and even a slight risk of death.

Possible problems include nausea, vomiting, itching, dizziness, difficulty urinating, or backache or other pain.  Less common but more serious problems include low blood pressure, breathing or heart problems (especially if the epidural rises too high up your body), infections, difficulty in moving your arms or legs, allergic reactions, a seizure caused by the local anaesthetic, blood clots around your spine, or nerve damage.  There is an extremely rare risk of permanent paralysis.  As for all types of anaesthetic, there is a slight risk of death. Some websites claim that it is lower than the risk from general anaesthetic, and some claim that it is higher.

The list of possible problems sounds alarming, however, you might not experience any of them, or might only experience one or two minor problems. It might be safer to have an epidural than to leave a medical problem untreated.

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Combined Spinal Epidural:

This can be abbreviated to CSE.

This is when an anaesthetist performs both a spinal block and an epidural at the same time, with one injection. 

It combines the benefits of a spinal block and epidural:  it takes effect quickly (as a spinal block does) and can be used for continuing pain relief for many hours (as an epidural does).  It can be used for childbirth. 

The anaesthetist inserts a needle into your back then inserts a smaller needle inside it to inject drugs for a spinal block.  Then he or she removes the smaller needle, inserts a catheter to provide drugs for an epidural, and removes the larger needle.

It may not be possible to perform a spinal block first then later make another injection for an epidural because there may be too much risk of nerve damage.

See the sections on spinal blocks and epidurals for more information about them and the risks.

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General Anaesthetic:

This is also called a ‘general’, or abbreviated to ‘G.A.’ on medical records. Sometimes it can be called ‘light general anaesthetic’, depending on the drugs and procedures used.

It is a deep level of controlled unconsciousness.  People often call it ‘sleep’ as a euphemism or simplification.  Sometimes people more accurately call it a coma or coma-like state.  You’ll be unaware of everything, won’t feel any pain, won’t respond to anything, and will lose your usual reflexes.  You won’t feel rested afterwards.

It can be used for any type of operation.  Many types of operations can only be done under general anaesthetic, such as bowel, heart and lung surgery.

The anaesthetist might give you a low dose of a sedative first to help you relax and reduce anxiety.  It also causes some memory loss.

This is what you will experience when you have general anaesthetic:  the anaesthetist will ask you to wear a face mask to breathe in air.  He or she will give you drugs by IV which will cause you to feel drowsy then drift off into unconsciousness within a minute.  It’s possible that he or she might give you a gas through the mask to achieve the same thing, however, it can smell bad or be uncomfortable, so IV drugs are usually used.  You might dream briefly as you’re slipping off into unconsciousness.

The next thing you know, you’ll be waking up very slowly, possibly dreaming a little as you do so.  You might feel very cold.  Once you’re completely awake, you’ll see that you’re in the recovery room, wearing a face mask again.  A nurse will tell you that the operation has been done.  You’ll be surprised, because you’ll still be waiting for it to start.  No matter how long the operation took, it will seem as if almost no time has passed.  That will be disconcerting, and it will be difficult to believe that the operation took place.  You’ll feel the same way emotionally as you did before it happened.  (A small percentage of patients cry, as a side effect of the anaesthetic.)  You probably won’t remember becoming drowsy or falling unconscious.  If you had been given a low dose of a sedative first, you might not even remember having been taken into the operating theatre, and you might think and feel the same way as you had earlier.

You’ll feel groggy and find it difficult to think clearly or to concentrate on anything, might have a sore throat, and might not have as good reflexes as usual.  to experience these side-effects for 24 hours. It’s best to have someone stay with you during this time.  You mustn’t drive, operate machinery, make important decisions, sign legal documents, travel alone or to remote areas, or do anything that requires a clear mind or good reflexes.  Some hospitals will advise you to avoid doing these things for 48 hours. 

That’s what your memory of general anaesthetic will be, however, there are many aspects to it that you’ll be unaware of.  You won’t realise that you were given a number of different drugs and that while you were unconscious, your eyes were taped shut, a breathing tube was put down your throat and taped to your face, you were probably completely paralysed from drugs, and you were probably unable to breathe on your own so a machine called a ventilator breathed for you. 

This is a more in-depth explanation:

General anaesthetic involves a variety of drugs given by IV or gas or both.  Usually, it’s both.  However, if it’s given by IV only, it can be called Total Intravenous Anaesthesia, TIVA.

Some of the drugs, called ‘hypnotics’, cause you to be in a deep, unnatural state of unconsciousness where most of your brain is inactive. The higher the dose, the deeper the level of unconsciousness, and therefore the better painkilling effect. There are hypnotic IV drugs and gases. The gases are also called ‘volatile gases’, ‘volatile anaesthetic agents’, ‘volatile agents’ or ‘volatile anaesthetic’ and can be noted on medical records as just ‘volatile’.

Usually the anaesthetist gives you an IV drug first to cause unconsciousness then a gas to maintain it. A commonly used IV drug is Propofol (Diprivan). Its effect only lasts for about five minutes. Commonly used gases are Sevoflurane or Desflurane. (In the past, Isoflurane was frequently used.) A gas can be either mixed with nitrous oxide and air or just with air. Each anaesthetic machine allows the anaesthetist a choice of at least two anaesthetic gases in addition to nitrous oxide.

In addition to hypnotics, the anaesthetist will probably give you other drugs such as antibiotics, anti-inflammatory drugs, drugs that cause memory loss, painkillers (including paracetamol, because it increases the effects of other painkillers), and paralysing drugs called paralytics (also called ‘muscle relaxants’, ‘neuromuscular blockade’, ‘neuromuscular blocking drugs’ or NMDB). However, not all of these drugs are needed for all operations.

Although being at a deep level of unconsciousness keeps you pain-free and still, painkillers and paralytics are often needed to prevent your body from automatically reacting to the surgery e.g. by twitching your muscles; causing your muscles to pull your limb back; or increasing or decreasing your heart rate, blood pressure, temperature etc.

If you’ve had successful local or regional anaesthetic and want general anaesthetic simply to be unaware of what’s going on then it only requires a limited number of drugs, and the hypnotics will probably be low doses, causing a relatively light level of unconsciousness (still deeper than that caused by sedation or sedatives, however).

If you’ve had local or regional anaesthetic that hasn’t been completely effective then general anaesthetic needs to provide additional pain relief as well as unawareness.  It may also need to prevent your body from responding to the surgery.  This may require a wider range of drugs, and the hypnotics will be at higher doses.

If general anaesthetic is the only anaesthetic you have for an operation then it needs to provide complete pain relief, keep your body still, and prevent your body from responding to the surgery, as well as causing unawareness.  This requires a wide range of drugs and the hypnotics will be at high doses.

Your eyes don’t remain completely shut while you’re unconscious, and you can’t blink, so the anaesthetist will tape them shut, to protect them.  He or she might put some lubricant in them first to prevent them from drying out.

When you fall unconscious, your throat muscles relax, so the anaesthetist has to put a plastic tube (often called an ‘airway’) in your throat to allow you to continue breathing.  The tube is connected to the anaesthetic machine so that it can monitor your breathing.  If the anaesthetist uses a gas, then it’s given through the tube. 

A commonly used type is an endotracheal Tube (ETT) which goes all the way down your throat and past your vocal cords to the entrance to your lungs.  The anaesthetist has to use paralytics (either short-acting or long-acting) first to be able to insert it, because otherwise it probably wouldn’t get past your vocal cords.  The anaesthetist might or might not continue to use paralytics for the rest of the surgery.

Sometimes an anaesthetist puts in an ETT tube while you’re still conscious, in which case, he or she will use different drugs, such as local anaesthetic and painkillers, to insert it rather than paralytics.

Another type of breathing tube which can sometimes be used is a shorter one called a laryngeal mask airway (LMA) which goes down your throat and near your vocal cords.  It’s not necessary to use paralytics to insert it.  It’s less invasive and irritating and less likely to cause a sore throat, however, many patients can’t have it:  pregnant women, some diabetics, obese people, people who’ve eaten recently, and people who have serious reflux problems.  There are also many types of operations where it can’t be used:  surgery lasting longer than a few hours, surgery where you’re lying face-down, surgery in the nose or mouth, surgery where breathing must be carefully controlled (brain, heart, and chest or lung surgery), and some other types of surgery.

Usually, you can’t breathe on your own during general anaesthetic.  There are several possible causes.  The most common is that the anaesthetist uses paralytics.  Another possible reason is that the anaesthetist uses high doses of some types of painkillers.  A less common reason is that you’re in a very deep level of unconsciousness and your brain is so affected that it can no longer control your breathing (either because the anaesthetist put you into this level deliberately or because you unintentionally slipped into it).

If you can’t breathe on your own then a ventilator, which is part of the anaesthetic machine, breathes for you by pushing air (and probably anaesthetic gas) in and out of your lungs through the breathing tube.  It can be set to monitor your breathing and only take over at times that you stop breathing, or it can be set to completely control your breathing throughout the operation.  If a ventilator fails or can’t be used for some reason, nurses can keep you alive by doing manual ventilation with a bag, squeezing air into your lungs regularly.

Paralytics (also called ‘muscle relaxants’, ‘neuromuscular blockade’, ‘neuromuscular blocking drugs’ or NMDB) are used for many operations.  They are given by IV and completely paralyse all of the muscles in your body – including the ones used for breathing – except for your heart.  They are used because they prevent your muscles from reacting to the surgery and they keep you completely still.  Higher levels of anaesthetic gases can achieve the same effects, and that’s what was often used in the past.

For some operations paralytics are desirable and for others they are essential.  Types of operations where they are used include abdominal surgery, orthopaedic surgery, throat surgery and chest surgery that affects the heart or lungs.  It’s difficult to find information on what types of operations paralytics are essential for, but they include laparoscopy, delicate neurosurgery, ear surgery and eye surgery.  Some surgeons request that the anaesthetist use them for every type of operation because they believe that it results in better conditions for operating.

Paralytics are usually not needed if you have first had successful regional anaesthetic (including a spinal block or epidural) because the anaesthetic will already be keeping you still and preventing your muscles from reacting. If the anaesthetic was only partly successful then paralytics might or might not be needed. Local anaesthetic is less effective than regional, so it won’t make any difference to whether paralytics are needed.

Commonly used paralytics include the short-acting drug Succinylcholine (also called Suxamethonium, Suxamethonium Chloride or, colloquially, ‘Sux’) which is often used to put an ETT tube in, and longer-acting drugs such as Vecuronium, Rocuronium (Zemuron) and Cisatracurium (Nimbex).  Other drugs are Pancuronium, Atacurium and Mivacurium.  So the drug names often end in ‘onium’ or ‘urium’, unlike other drugs used for anaesthesia.

After the operation is over, the anaesthetist will follow a number of steps.  If paralytics were used then he or she will give you drugs to reverse the effects so that you are no longer paralysed.  If you had been given some types of powerful painkillers you will be given drugs to reverse their effects too (not because the anaesthetist wants you to be in pain, but because of their undesirable side effects).  You will be able to breathe on your own again.  The anaesthetist will stop giving you anaesthetic gases and other drugs, remove the tape from your eyes, and remove monitoring devices.  The anaesthetist will remove the breathing tube, either while you’re still unconscious (in which case, he or she might temporarily put in a shorter, rigid plastic tube called a Guedels’ Airway to help keep your throat open) or in 5 - 15 minutes time, after you’ve started regaining some consciousness. 

The anaesthetist and other staff will take you to the recovery room, where nurses will put a face mask on for you to breathe through, and keep an eye on you as you recover.

Regaining consciousness (usually called ‘waking up’) is a slow, gradual process.  Some websites state that patients can be awake enough to open their eyes and talk only 5 – 10 minutes after the anaesthetist has stopped giving them drugs.  However, they usually don’t remember it later because of the drugs causing memory loss.  Other patients take 30 – 60 minutes to reach that stage.  The nurses will check on you at regular intervals and mark your progress in the medical records (e.g. a score of 0/2 for complete unconsciousness then 1/2 for partial consciousness, then 2/2 for complete consciousness).  There’s nothing that staff can do to speed up the process.  If something went wrong (e.g. if the anaesthetist made a mistake with the anaesthetic, or there was a medical problem), you could remain unconscious for a number of hours.

No matter how long the operation took and how long you were unconscious for, you won’t have any sense of how much time has passed.  Presumably, this is because your brain is very inactive under general anaesthetic and, unlike during sleep, doesn’t monitor light, sound, touch, pain etc and doesn’t cause you to dream (other than briefly while going under or coming out of it).  Time is a series of changes but under general anaesthetic your brain doesn’t register the changes.

Sometimes anaesthetists use the term ‘light general anaesthetic’.  There doesn’t seem to be any official definition of it available online.  It appears to refer to the anaesthetist using lower doses of drugs so that you’re at a somewhat less deep level of unconsciousness (although still deeper than that caused by sedatives or sedation).  It might also mean that paralytics aren’t required and that you’re able to breathe on your own during the operation. 

Different doses of the drugs that cause unconsciousness are needed by different patients, or even by the same patient on different occasions, so it’s difficult for anyone to tell from studying medical records how deeply unconscious a patient was or whether it would be appropriate to call the anaesthetic ‘light general anaesthetic’. Websites and books usually don’t even use the phrase, and medical records just show ‘general anaesthetic’ or ‘G.A.’.

General anaesthetic, like all types of anaesthetic, has a risk of unpleasant side effects, a small risk of minor or major injury, and a slight risk of death.  Minor risks include bruising and soreness, nausea, vomiting, a dry mouth, a sore throat, aching muscles, headaches, itching, feeling cold, difficulty urinating, dizziness, small cuts to your lips or tongue, or some damage to your teeth.

 

More serious but rare problems include infections, breathing problems, damage to your eyes, nerve damage (usually temporary), allergic reactions, damage to your vocal cords or larynx from the breathing tube, pneumonia, lung damage from a ventilator, confusion or memory problems for days or weeks (mainly in elderly people), a heart attack, stroke, kidney failure, liver failure, paraplegia, quadriplegia, or brain damage.

Another risk of general anaesthetic is experiencing anaesthetic awareness, also called ‘unintended intraoperative awareness’.  It means not remaining completely unconscious throughout the operation but becoming aware of what’s happening.  This can happen if the anaesthetic machine is faulty.  If can also happen if you aren’t given enough of the drugs, which could be because it would be too dangerous for you, because the anaesthetist makes a mistake, or because you’re somewhat resistant to the drugs.  Different websites give different probabilities of anaesthetic awareness, ranging from 1 in 500 to 1 in 23,000.  Unfortunately, it’s more likely to happen during heart surgery, thoracic surgery, caesarean sections, and emergency surgery, because lower doses of anaesthetic drugs are used, for safety.  (Higher doses would affect your heart too much, or in the case of a caesarean section would affect the baby too much.)

Often when patients believe that they’ve experienced anaesthetic awareness they’re mistaken. They might mistake a dream that they had while going under the anaesthetic or coming out of it for awareness, or they might remember things from the recovery room while regaining consciousness and mistake it for awareness. Also, many patients who believe that they had general anaesthetic actually only had local or regional anaesthetic with sedation or a sedative which caused partial memory loss.

Sometimes patients really do experience anaesthetic awareness under general anaesthetic.  It usually happens at the beginning or the end of the operation, and usually lasts for less than five minutes.  However, it can last for longer, or even for the entire operation.  You might hear machines beeping, hear staff talking or moving, or feel touch or pressure.  You might feel like it’s extremely difficult to breathe.  There’s a small chance that you’ll feel pain, which could be minor (such as a sore throat) or major (such as pain from the surgery itself). 

Unfortunately, there are extremely rare cases where a patient initially falls unconscious, becomes paralysed from the paralytics, but then regains consciousness and goes through the entire operation paralysed and in excruciating pain.  Presumably, this is because the hypnotics and paralytics given by IV are effective but the anaesthetic machine fails and doesn’t deliver the anaesthetic gases correctly or at all. It’s a nightmare situation, one that no patient should ever experience – but it does happen.  A website run by the Australian Society of Anaesthetists discusses it.  Every now and then there’s a report of it in the media.

The anaesthetist should be able to tell that you’re experiencing anaesthetic awareness and solve the problem.  If he or she didn’t use paralytics then you will move or make a sound, to gain attention.  However, if paralytics were used then you will be completely paralysed and unable to do anything – a frightening scenario.  The anaesthetist should still be able to tell that you’re experiencing awareness by noticing your heart rate increasing (for anything other than heart surgery) or by monitoring your other vital signs such as blood pressure.  Sometimes specialised brain monitoring equipment can be used, especially if you’re at a higher risk of experiencing awareness.  The anaesthetist should be able to give you more drugs to send you unconscious again.  However, some anaesthetists have the attitude that they should just give you drugs to prevent you from remembering the experience afterwards, as if somehow it doesn’t matter that you’re suffering as long as you don’t remember it later on.

Patients who have experienced anaesthetic awareness – especially the worse scenarios – can suffer psychological problems afterwards, such as anxiety, sleep disturbances, nightmares, flashbacks, panic attacks, depression, or even Post-Traumatic Stress Disorder (PTSD).

Unfortunately, there is also a slight risk of going under general anaesthetic and never waking up again, so that your life is over.  It mainly happens to patients who are seriously ill or injured.  The risk increases the longer that you’re affected by the anaesthetic drugs, so it’s more likely to happen if you have a major, lengthy operation.  One website suggested that the overall risk is about the same as of dying from general anaesthetic from other reasons.

There is a slight risk of dying from general anaesthetic from a heart attack, stroke, allergic reaction to drugs, or other reasons.  There is also a possibility of the anaesthetic contributing to death but not being the sole cause.  A website run by the Australian Society of Anaesthetists suggests that the risk of dying from the anaesthetic alone is 1 in 185,056 or even less for a fit, healthy patient up to middle-age having straightforward elective surgery (less than 1 in 250,000).  However, different websites have different statistics, and some list the risk as being significantly higher.

The risks of general anaesthetic sound alarming, however, tens of thousands of patients have it every year in Australia and most of them don’t experience any problems, or only have minor problems. It may be safer to have general anaesthetic than to leave a medical problem untreated.

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Sedative:

A sedative can also be called an ‘anti-anxiety drug’ or a ‘premed’.

Its purpose is to reduce stress and anxiety so that it’s easier for you to get through the unpleasant experience of a medical procedure or operation. Everyone has natural instincts that cause them to try to avoid injury. Rationally, you know that a procedure or operation will help you by treating a medical problem, but because it involves your body being manipulated or cut into, your natural instincts cause you to be frightened and want to avoid it. A sedative can help to counter-act this.

It has several effects. It causes relaxation, drowsiness or sedation (a light level of unconsciousness, often called ‘sleep’) depending on the type and dose of drugs. If you remain conscious, it affects your decision-making ability, making you more likely to agree to things. It also causes memory loss: either minor, major, or total. It doesn’t provide any pain relief, even when it causes sedation (because it doesn’t cause a deep enough level of unconsciousness for that).

An anaesthetist, doctor or nurse can give you a sedative. It’s often given by IV.

One commonly used drug is Midazolam, which is from the same family of drugs as Valium. A low dose causes relaxation, a higher dose causes drowsiness, and a higher dose still causes sedation. The effects of Midazolam last from one to six hours.

If you remain conscious after being given a sedative then you will experience the memory loss effects, which are unnatural and unusual. You’ll be aware of what’s happening but not all of your perceptions, thoughts and feelings will be added to your long-term memory. Time will feel like it’s passing by very quickly. After the sedative wears off, you will have gaps in your memory (which you may be unaware of), only have faint fragments of memory, or not be able to remember anything at all (in which case, you might mistakenly believe that you had been unconscious). The higher the dose of the sedative, the worse the memory loss will be.

A sedative can also cause retrograde amnesia, that is, it can prevent you from remembering something that happened just before it was given. You might not remember the medical practitioner telling you that he or she was going to give you the sedative or administering it. You might not remember being taken into the operating theatre.

Anaesthetists and other staff usually don’t warn patients that a sedative causes memory loss or remind them of things that it may have caused them to forget. Anaesthetists are expected to warn patients about likely risks and side-effects of anaesthetic, but don’t seem to regard that as applying to sedatives as well.

You might have a sedative by itself for a procedure such as setting a fracture, draining an abscess or having an endoscopy. (Dentists also use it for dental treatment.) However, you could still suffer discomfort or pain at the time, even if you can’t remember it afterwards, so it’s questionable if it’s always ethical.

If you’re going to have local or regional anaesthetic for an operation then you might be given a low dose of a sedative first to help you relax and reduce anxiety. You need to remain conscious so that the anaesthetist can check how effective the anaesthetic is by asking you if you can feel anything in the area to be operated on. Once the anaesthetic has been done, you can either remain conscious during the operation or have a higher dose of the sedative, or sedation using other drugs, to be at a light level of unconsciousness. Being unaware of what’s going on can be less stressful.

If you’re going to have general anaesthetic then you might have a sedative first to help you relax and reduce anxiety.

There are some potential problems with having a sedative. Because it affects your decision-making ability, you’re more likely to agree to something that the anaesthetist, surgeon or other staff suggest, such as an additional procedure, or general anaesthetic (if you were originally only going to have local or regional anaesthetic). The situation isn’t truly informed consent, yet staff act as if it is.

Because a sedative causes memory loss, you may not remember afterwards what happened or why. Patients can be mistaken for years afterwards about what type of anaesthetic they had and whether or not they had been unconscious.

There are also numerous references in popular media to people being given a sedative without consent to temporarily sedate them because they’re extremely upset or agitated. This is despite the fact that strong emotions are natural and not always harmful, that people normally have a legal right to refuse medical treatment, and that a sedative is not going to solve the problem that the person is upset about.

A sedative isn’t essential for medical reasons, so it should be optional for a medical procedure or operation. However, staff sometimes give the impression that it’s compulsory.

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Sedation:

It is also called ‘procedural sedation’, ‘conscious sedation’ (a confusing and contradictory term), ‘twilight anaesthesia’, ‘twilight sleep’ or ‘deep sedation’. Sedation done while an anaesthetist is present can be called ‘monitored anaesthesia care’ (MAC).

It is a light level of unconsciousness, often called ‘sleep’. It also causes memory loss, so that even if you do drift in and out of consciousness, you may not remember it afterwards. It doesn’t provide pain relief (it’s not a deep enough level of unconsciousness) but is used to make you unaware of what’s happening, to reduce stress.

Sedation can be given by an anaesthetist, doctor or nurse. (Dentists also use it for dental procedures.)

It can be done using IV drugs, injections, gas, or pills. Different types of drugs can be used e.g. a high dose of a sedative such as Midazolam, or a low dose of a drug used for general anaesthetic such as Propofol (Diprivan). Propofol’s effects don’t last longer than five minutes, so the medical practitioner will need to keep on giving you doses of it by IV at regular intervals.

Sedation doesn’t cause you to stop breathing on your own or even to need a breathing tube in your throat to keep your throat open.

You can have sedation by itself for unpleasant procedures such as setting a fracture, draining an abscess or having an endoscopy. However, you could still be in discomfort or pain at the time even if you can’t remember it afterwards, so it’s questionable if it’s always ethical.

You can have sedation with local or regional anaesthetic for surgery, so that you’re unaware of what’s going on. This can reduce stress. However, the anaesthetic is generally done first so that the anaesthetist can check how effective it is, by asking you if you can feel anything in the area to be operated on.

Although sedation is often called ‘sleep’, it’s a drug-induced state, and you won’t wake up until after the drugs have worn off. If someone shakes you, you might respond by mumbling.

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Further Reading:

These websites have further information on anaesthetic.  Some use the euphemism ‘sleep’ or ‘deep sleep’ for unconsciousness.

https://www.betterhealth.vic.gov.au/health/SurgicalBrochures/anaesthetics-overview - a Victorian government health site.

https://www.asa.org.au/ASA/Patient_information/Patient_information.aspx – a site run by the Australian Society of Anaesthetists.

http://allaboutanaesthesia.com.au/ – a site run by the Australian Society of Anaesthetists.

http://www.anzca.edu.au/patients – a site run by the Australian and New Zealand College of Anaesthetists.

http://www.narcomed.com.au/ - a site run by Victorian anaesthetist Dr Mark Freedman.

http://bhhdoa.org.au/aip/index.html - a site run by Victorian anaesthetist Dr Con Kolivas.

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My Experiences:

Experience 1: The dramatic effects of a sedative.

Over 20 years ago I had emergency surgery for a fracture at Sydney Hospital, which is a public hospital.

When the surgeon discussed the operation with me she said, “You can either have general anaesthetic and be unconscious during the operation or local anaesthetic with a sedative and stay awake.” I chose the latter. The anaesthetist discussed the risk of bruising or nerve damage from the anaesthetic injections, but didn’t say anything about the effects of the sedative.

My experience felt odd. I was taken to the anaesthetic room and the anaesthetist prepared to use a nerve stimulating device before injecting the anaesthetic. The next thing I remember, I was waking up slowly, feeling very cold. I was waiting to be taken into the operating theatre, but a nurse told me that the operation had already been done. I was taken to a ward to recover. For about 24 hours I was tired and had difficulty concentrating, and also had difficulty urinating.

I looked at my medical records the day after the operation, but didn’t understand much of them. One form said that I’d been unconscious. The nurses’ progress notes said that I’d had the operation done under ‘sedation anaesthetic with block’. I’d regained consciousness 45 minutes afterwards.

For the next twenty years I assumed that I’d been given too much sedative and fallen unconscious by mistake, but then I decided to look into the matter. I obtained a copy of the medical records from the hospital to study them and I talked to the anaesthetist on the phone. I worked out that the sedative had caused memory loss from the point when he had been about to use the nerve stimulating device. He had successfully done a regional block and taken me into the operating theatre, but I had then become very nervous. He had offered to give me more sedative or to do general anaesthetic, and I had agreed to the latter. The anaesthetic nurse, Ms Feirson, had lied when filling out the progress notes afterwards. The anesthetist didn’t know why.

I later emailed feedback and suggestions to Sydney Hospital. It seemed too late to make a complaint about Ms Feirson. The AHPRA website didn’t list anyone with that surname as currently working in any medical field in Australia. She might have changed her surname, changed to a non-medical career, moved overseas, retired, or passed away.

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Experience 2: Cancelling an operation.

Just under 20 years ago I planned to have elective surgery at a private hospital in the northern suburbs of Sydney.

The surgeon was only willing to perform the operation under general anaesthetic. I had a consultation with the anaesthetist who would be treating me and he explained a number of risks, including ‘Sometimes people go under general anaesthetic and never wake up again.’ I also read about risks in medical books at the State Library.

When I was at the hospital for the operation, I became more and more nervous as the time for the surgery approached. I became extremely nervous when I was taken to the anaesthetic room. I believed that I’d never had general anaesthetic before. I kept thinking about the anaesthetist saying that sometimes patients didn’t wake up from it, and worrying that it would happen to me.

I told staff that I wasn’t sure if I wanted to go through with the operation. Nurses talked to me, and then the anaesthetist and surgeon came in and talked to me. They were all polite and respectful, although the surgeon was somewhat condescending. I asked to cancel the operation. The staff did so, and I was able to leave the hospital soon afterwards.

Not much happened after that. When I talked to the surgeon’s receptionist later, she was annoyed and disapproving at me having cancelled the operation. I had to pay some fees to the surgeon and to the hospital, however, the anaesthetist waived his fee.

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Experience 3: Choosing an anaesthetic.

A few years ago I had emergency surgery for a fracture at Westmead Hospital, which is a public hospital.

A doctor discussed the operation with me and tried to persuade me to have general anaesthetic. I was reluctant, and explained my concerns about it. (I still believed that I’d never had it, as it was before I looked into the Sydney Hospital operation.) She said that regional anaesthetic might be possible instead, and mentioned one or two minor risks and the rare risk of nerve damage. She asked me to sign a consent form for the operation even though we hadn’t agreed on the anaesthetic.

The next morning, I was taken to the anaesthetic room. I was very nervous and asked a nurse for something to help me relax but she refused, saying that I needed a clear mind to discuss anaesthetic options with the anaesthetist. When he came in he asked why I didn’t want general anaesthetic and I explained my concerns. He was willing to do a spinal block instead.

Staff then took me into the operating theatre. I became nervous again and asked the anaesthetist for something to help me relax but he refused because it might send me unconscious (which I didn’t want). I had some bad itching on my chest and he explained that it was a side-effect of the spinal block drugs. The bright lights of the operating theatre started to annoy me and I asked him to cover my eyes. I became relaxed and sleepy and dozed a little.

A day after the operation I developed severe headaches which lasted for three days then eased off over another four days. A doctor explained that it was a problem caused by the injection for the spinal block.

I thought that I had become relaxed and drowsy during the operation of my own accord. However, I eventually obtained a copy of my medical records from the hospital and also emailed the anaesthetist. After initially refusing to give me something to help me relax, he had compromised by giving me a low dose of a sedative. It caused retrograde amnesia so afterwards I didn’t remember him telling me about it or injecting it into the IV line near my wrist.

I later sent feedback and suggestions to the hospital and to the local health district organisation. I suggested, amongst other things, that patients be given a choice of anaesthetic.

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Experience 4: Misinformed consent.

A few years ago I had elective surgery at Westmead Hospital, a public hospital. It was to prevent a serious medical problem from occurring in the future.

At a surgical consultation a doctor tried to persuade me to have general anaesthetic, which I was reluctant to have. (It was before I’d found out that I’d had it at Sydney Hospital all those years ago, so I still believed that I’d never had it.) He wasn’t sure if local or regional anaesthetic was possible. He asked me to sign a consent form for the surgery even though we hadn’t reached any agreement on the anaesthetic.

At a later date I had a consultation with an anaesthetist named David. He also tried to persuade me to have general anaesthetic, and I explained my concerns, including some of the risks. The only one that he commented on was the risk of going under and never waking up again. He said that mainly happened to patients who were seriously ill or having major operations. However, he believed that an epidural should be possible instead. He said that if it wasn’t effective then general anaesthetic would be the only other option. He later talked to the anaesthetist assigned to the operation, Ian, and confirmed that I could have an epidural.

When I went to the hospital for the operation, I found out that Ian had changed his mind. He tried to insist on general anaesthetic and told me to go to a private hospital if I wanted a choice. I objected to general anaesthetic and mentioned a number of my concerns. He decided not to treat me and passed me onto another anaesthetist, Matt.

Matt asked why I didn’t want general anaesthetic and I again explained some of my concerns. The only one that he commented on was the risk of experiencing anaesthetic awareness during the operation, waking up paralysed and in pain. He said in that situation, a patient’s heart rate would increase (as an indicator). However, he was willing to do an epidural or spinal block instead, and decided on the latter.

He told me that when I’d had an operation the last time I’d been given an ‘anti-anxiety drug’ and asked if I wanted it again. That was before I’d looked into the matter, so I didn’t know what he was talking about. He didn’t explain about it causing memory loss. I didn’t agree to it, and he didn’t use it.

The spinal block wasn’t completely effective i.e. it didn’t rise high enough up my abdomen to cover the area to be operated on. Matt apologised and said that he’d had to be careful that it didn’t rise too high and interfere with breathing – a risk that I’d been unaware of. He said that perhaps we could wait for it to wear off then try again, but decided that it would be too late in the day by then.

He then said, “Perhaps I can address your concerns about general anaesthesia.” He said, “I can offer a part-general”, said that I wouldn’t be paralysed (from paralytics), would be able to breathe on my own, and said, “I can put you in a sleep-like state instead of being unconscious. You won’t dream, but you’ll be in a sleep-like state.” I asked twice, “So I’ll be sleeping instead of unconscious?” and he said, “Yes” both times. He said that I’d wake up as soon as he stopped giving me drugs, while I was still in the operating theatre. When I asked if a face mask was just for oxygen, he said that he would only give drugs by IV. I agreed to it all. An anaesthetic nurse was the only other person present during the conversation, and she didn’t say anything.

I woke up slowly in the recovery room and a nurse told me that the operation had been done. I worked out that almost an hour must have passed since it finished. I was tired and had difficulty concentrating, and that continued for about 24 hours afterwards.

I had doubts about whether Matt had told the truth, but thought that he might have used a sedative or done sedation instead of normal general anaesthetic, and I might have only been drowsy during the operation but unable to remember it afterwards.

At different times I looked up information online, talked to the surgeon at a check-up, got a copy of my medical records from the hospital, and sent a message through the local health district organisation’s complaints section (via their website).

I found out that Dr Matt Doane had lied to me. He had used ordinary general anaesthetic. The only things he had told the truth about were that he hadn’t used paralytics and that I’d been able to breathe on my own during the operation – although the latter hadn’t even been guaranteed. The situation was, at best, misinformed consent.

I wasn’t happy with the response to my complaint. An emailed letter signed by a hospital executive apologised for my experience, but gave an inaccurate account of events. It claimed that Matt had discussed risks and options that he hadn’t discussed, didn’t acknowledge the misleading language he had used, and implied that procedures were done specifically for me when actually they were standard procedures. It inaccurately said that the initial dose of drugs by IV was ‘a very light dose’ and made a vague, misleading claim that I had been ‘at a very light state of anaesthesia’ at all times. It implied that the situation had been informed consent. It sounded like whoever had looked into the matter on behalf of the executive had asked Matt what had happened, taken his word for everything, and not talked to the anaesthetic nurse or anyone else. It also sounded like he or she was more interested in protecting the hospital than in acknowledging the truth.

When I tried to follow up on my complaint, staff were reluctant to respond. I sent two messages to the executive’s assistant and she said that they had been passed on to Matt, however, it later turned out that he had never received them. The executive didn’t reply until I sent another message through the local health district organisation’s complaints section. Then she apologised that the words Matt had used to describe his anaesthetic technique had led me to feel that I had been deceived. She said that Matt had changed jobs and no longer worked for Westmead Hospital and claimed that she couldn’t contact him.

I made a complaint to the NSW Health Care Complaints Commission (HCCC) about Dr Matthew Doane. He sent them a long reply but asked for it not to be passed onto me. A case officer summarised it while I talked to him on the phone. Matt apologised for the use of any language I found misleading and said that he had believed that we had a mutual understanding of the anaesthetic to be used. He misleadingly told the HCCC, ‘We discussed cancelling the operation.’ He admitted that he had used the term ‘sleep-like state’ but not the rest of what he had said.

I found Matt’s email address and contacted him, and he replied to most of my messages. He said that he hadn’t intended to deceive me about the anaesthetic. He explained some things and didn’t comment on others. He worded some parts of his emails ambiguously to avoid admitting what he had said to me at the hospital. He wouldn’t comment on whether I had been taking the risk of going under general anaesthetic and never waking up again, other than to make a vague comment about ‘lingering effects of anaesthesia and some of the risks that may be involved with these’ and having tried for a quick wake-up time. He ignored me when I suggested that he update his AHPRA listing to reflect his new job, even though he was legally required to keep it up to date.

The HCCC didn’t do much about my complaint other than passing it on to Matt and reading his response. The case officer talked to him and to me but never attempted to contact the anaesthetic nurse, who could have verified what had happened. (I attempted to contact her but was unable to.) The HCCC consulted with the Medical Council of NSW as per standard procedure then sent decision letters. The letter to me basically took Matt’s word of events and claimed that he had provided sufficient anaesthetic within the parameters of my request - whereas I felt like I had been tricked into having general anaesthetic. The HCCC case officer said that the decision letter to Dr Matt Doane had included some comments on the importance of clear communication.

I sent feedback and suggestions to Westmead Hospital and to the local health district organisation. However, when I mentioned that I had made a complaint to the HCCC, the hospital executive replied to say that the hospital wouldn’t comment on the matter further.

I also told various people about my experience, and wrote about it online.

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