ARU

Anaesthetic care

Anaesthesia during a surgery or other, usually painful procedures, ensures the elimination of pain perception, prevents the stress development and unwanted body reactions that would make the surgery impossible to perform or could endanger the patient's health or life. Prior to the anaesthetic procedure, it is necessary to undergo a thorough internal pre-operative check-up, including the laboratory blood tests. Prior to the surgery, the anaesthesiologist will evaluate all check-up results and all available information about your health condition, determine the risk level, and considers an appropriate type of anaesthesia. They will also determine the patient's preparation for the surgery, including the premedication (the administration of medication before the surgery, usually in the form of tablets or injections), which leads to sedation, counteracts pain and facilitates the introduction of anaesthesia. The choice of the anaesthesia type depends on the type and the extent of the surgery, the patient's health condition, the requirements of a surgeon and the patient's wishes as well.

General anaesthesia

General anaesthesia (narcosis) is an artificially caused loss of consciousness. Pain perception is pharmacologically eliminated too. In some surgeries, spontaneous breathing is suspended, and a special tube (intubation) is inserted into the air passages, while artificial respiration during the surgery is provided by a machine. Anaesthesia is provided either by the vein-administered drugs or by the anaesthetic-gas inhalation. Throughout the procedure, basic vital functions are monitored by the anaesthetic team and modern monitoring technology.

Local anaesthesia

Local anaesthesia is used to eliminate the pain perception in a specific body part. The most commonly used local anaesthesia techniques include subarachnoid and epidural anaesthesia. Local (topical) anaesthetic is administered through a special needle into the spinal-canal area. These techniques are particularly suitable for the surgeries on the lower part of the body. For some types of upper or lower limb surgeries, peripheral blockades can be performed to suspend the impulses from the operated limb. During the local anaesthesia, the patient is conscious, however, some sedation (drug-induced sleep) can be administered too. The local anaesthesia techniques can also be used to control the pain during the postoperative period or to control the labour pain - the so-called epidural analgesia. That is performed while a patient lies on the left side or sits up with the back arched ("cat's back"). A special needle is used to find the epidural space located between the vertebral arch and the dura mater. Once the needle is in, a local anaesthetic is administered, and a special tube (catheter) is inserted into this space. A mixture controlling pain can then be injected inside. Around 10 to 15 minutes after the catheter insertion and administration of the analgesic mixture, the effect - the relief of the labour or other pain - appears. Then, the uterine contractions are still perceived, but as a pressure only, since the complete numbness (anaesthesia) is undesirable in a spontaneous delivery; it would slow down the delivery progress. The birth, therefore, will not be completely painless, but much less painful and more bearable. The anaesthetic can be added to the epidural catheter by an infusion pump repeatedly or continuously. If a post-delivery birth-wound treatment is necessary, it is possible to add the local anaesthetic to the catheter and to perform this treatment painlessly under the influence of the local anaesthetic only.

Anglo-sedation

(monitored anaesthetic care) is a state of reduced pain perception and decreased consciousness after the administration of drugs, the patient can be awakened by a strong stimulus. It is most commonly used for the unpleasant methods of examination.

Risks of anaestheisa

No method of anaesthesia is without some risk. The risk estimation is based on the assessment of the patient's general health, the assessment of the burden which the planned surgery can be for the patient's body and the particular method of anaesthesia. With the current standards of monitoring techniques during the surgery, anaesthesia can be considered very safe. In the course of a surgery, the anaesthesiologist always monitors blood pressure, ECG records of the cardiac activity, oxygen saturation with the use of a painless finger clip, and the composition of inhaled and exhaled gases. In case of a very difficult surgery or in case of surgery complications, additional monitoring and measurements are performed. The most common complications of general anaesthesia are nausea and vomiting, dry or temporary sore throat, drop in the blood pressure, heart rhythm disturbances, an increase in the blood pressure, the heart attack (less than 1% of cases), death during anaesthesia (0.009% of cases, mainly patients in a critical state of imminent life danger who have to undergo the surgery under anaesthesia). The most common complications of local anaesthesia include technical problems in locating the correct spot for administering it, also some back pain, and headache can appear.

INSTRUCTIONS

Every anaestheisa is an intervention in the body. Please follow the following instructions for the safe conduct of your surgical procedure under anaesthesia:

• Your surgery will be postponed if you are in an acute phase of an infectious disease. The same will happen if you had an acute infectious disease (e. g. tonsilitis, flu) 14 days before the scheduled surgery.
• If you are a smoker limit the number of cigarettes a few days before the surgery. Do not smoke at all one day before the surgery.
• Please obey our requirement of fasting before the surgery. Your hospital department will instruct you when you can eat and drink for the last time. This precaution will prevent the risk of vomiting during anaesthesia and the risk of stomach contents entering your airway.
• Before the surgery, remove your dentures, eye lenses, prosthetic devices and glasses, as same as the jewellery including piercings, the hair clips and hair wigs. Longer hair should be bound up with an elastic band.
• A tattoo at the spot of the local anesthesia application may be a reason for refusing this anaesthesia method.
• Before anaesthesia, do not use make-up, eye shadow, an eyeliner or mascara - there is a risk of conjunctivitis, nail polish - it makes the monitoring during the surgery impossible.
• If you are scheduled to be discharged from the hospital to the home care on the day of a surgery or an examination, you must not drive, perform legal acts, make important decisions and you must avoid working with dangerous tools or equipment on that day. Arrange for an adult to accompany you and supervise you until the following day.