Anaesthetics and Risk

Back to Preparing for Surgery

Most patients who require surgery will need a form of anaesthetic or sedation to allow this. Your anaesthetist will discuss these options with you on the day, including the risks and benefits and you will decide together which is best for you.

The Royal College of Anaesthetists has a series of leaflets that provide information about anaesthesia and what you might expect when having an anaesthetic and can be found on their website.

Types of Anaesthesia

Anaesthesia stops you feeling pain and unpleasant sensations. It can be given in various ways and does not always mean that you are asleep. There are different types of anaesthesia, depending on the way they are given:

General anaesthesia is a state of controlled unconsciousness during which you feel nothing. You will have no memory of what happens while you are anaesthetised.

A general anaesthetic is required for a wide range of operations and is the most common provided in hospital. This includes most major operations on the heart, lungs or in the abdomen, and many operations on the brain or the major arteries.

Anaesthetic drugs are injected into a vein, or anaesthetic gases are given to you to breathe. These drugs stop the brain from responding to sensory messages travelling from nerves in the body. Anaesthetic unconsciousness is different from a natural sleep. You cannot be woken from an anaesthetic until the drugs are stopped and their effects wear off.

While you are unconscious, the team in theatre look after you with great care. Your anaesthetist stays near to you at all times.

A local anaesthetic numbs a small part of the body where you are having the operation. It is used when nerves can be easily reached by drops, sprays, ointments or injections. You stay conscious, but free from pain.

Common examples of surgery using local anaesthetic are having teeth removed and some common operations on the eye.

This is when a local anaesthetic drug is injected near to the nerves that supply a larger or deeper area of the body. The area of the body affected becomes numb.

Spinal and Epidural Anaesthesia

Spinals and epidurals are the most common types of regional anaesthetics. These injections can be used for operations on the lower body, such bladder operations or replacing a hip. You stay conscious or receive some sedation, but are free from pain. For some surgery, you may be aware of some pressure sensations.

Other Types of Regional Anaesthesia

Other types of regional anaesthetics involve an injection placed near to a nerve or group of nerves, for example in the arm or leg. This is often called a ‘nerve block’ and can allow you to have the operation without a general anaesthetic.

Nerve blocks are also useful for pain relief after the operation, as the area will stay numb for a number of hours.

This video from RA-UK provides more information on nerve blocks:

Sedation involves using small amounts of anaesthetic drugs to produce a ‘sleep-like’ state. There are different levels of sedation. Commonly, sedation will make you feel drowsy and relaxed about what is happening. You may sleep for a period but the person giving your sedation will speak with you and you may be aware of where you are for some of the procedure.

Some people having a local or regional anaesthetic do not want to be fully awake for surgery. They choose to have sedation as well.

You may remember everything, something or nothing after sedation. However, sedation does not guarantee that you will have no memory of the operation. Only a general anaesthetic can do that.

How you feel afterwards depends mainly on the operation and the type of anaesthetic you have had.

Immediately after an operation you will be looked after in the recovery area. You may be aware of other patients in the recovery area and noise of monitors or staff talking. You will gradually become more alert and once you are awake, breathing comfortably, pain is controlled and stable you will be able to return to a bed on the post operative ward. It is common not to remember a great deal from your time in the recovery area.

You may feel tired or even exhausted for some days after an operation. After major surgery, this can last for weeks or months and is very unlikely to be caused by the anaesthetic. Causes of tiredness after surgery include:

  • Anxiety
  • poor sleep patterns
  • pain
  • blood loss causing anaemia
  • the condition that needed the surgery
  • poor eating and drinking.

These will gradually improve as you leave hospital and you are healing.

The effects of anaesthetic drugs may last for around 24 to 48 hours. You should not look after children during this time, use any dangerous equipment, drive or cook. You should also avoid making any important personal or work decisions.

Becoming confused is not uncommon after an operation and an anaesthetic, especially in older people. Behaviour, memory and decision making can be affected. This can be temporary or permanent. Most people make a full recovery.

Risks and Complications

All anaesthetics and surgery have a risk of complications or side-effects. However, very few people having an anaesthetic come to serious harm because of the anaesthetic. Modern anaesthetics are very safe. There are some common side effects from the anaesthetic drugs or equipment used which are usually not serious or long lasting.

Risk will vary between individuals and depends on the procedure, the anaesthetic technique used and your own health conditions and fitness.

Improving your health and fitness before surgery will lower your risk of serious complications. Your anaesthetist will discuss with you the risks that they believe to be more significant for you.

Your anaesthetist stays beside you all the way through the anaesthetic and they can adjust the dose to keep you unconscious and safe. They are trained to monitor you and what to do quickly if anything unplanned happens. They work with a trained assistant and have a range of equipment and medicines to bring you safely through your anaesthetic.

There is always a balance between risks and benefits. Some operations do not have a guaranteed success rate. And all operations have some risks attached to the surgery itself. So, if you want to make an informed decision, you will need to put together information from your surgeon and your anaesthetist.

The infographic from the Royal College of Anaesthetists below, is a summary that shows the common events and risks that healthy adult patients of normal weight face when having a general anaesthetic for routine surgery (specialist surgeries may carry different risks). 

The Royal College of Anaesthetists also has a series of leaflets on various risks associated with anaesthesia and can be found on their website.

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