Anaesthetics

Gynaecology services patients are referred to a preoperative clinic prior to most elective surgical procedures. This is a nurse led clinic. If deemed necessary, a consultant anaesthetist will provide a notes review and/or a face-to-face assessment to plan safe anaesthetic management. 

Appointments will be offered within two weeks after a date for surgery is proposed. 

Maternity services patients are referred by their midwife or obstetric team. They will be reviewed by a consultant anaesthetist in this antenatal clinic. Follow up appointments are offered, and referrals are made by midwives, obstetric colleagues or anaesthetists. 

All patients undergoing day surgery or general surgery will normally be offered an appointment for a preoperative assessment before surgery either on the same day as their gynaecology clinic appointment or certainly soon after. At this appointment, we assess your suitability for surgery. You will also be asked to complete a health screening questionnaire. 

Our specially trained preoperative nurse practitioners will discuss any health issues that may affect your anaesthetic and operation and will provide you with information regarding aspects of your care. The Royal College of Anaesthetics provides lots of detailed and useful information about anaesthetics for patients and visitors. 

All patients undergoing any type of surgery will first attend what is known as the forward waiting area.

Depending on a patient’s personal circumstances, they can either walk to this area or can be collected and taken to this area by member of the theatre team.

In the forward waiting area, you will be checked in by a member of the reception team.

Thorough checks are completed ahead of your surgery to ensure we have all the necessary information. We also ensure that all women are always looked after by at least one female member of staff. 

Patients who attend for minor procedures or day surgery are selected to be surgically, socially and medically fit for discharge within hours of surgery.  

Surgical fitness 

Day surgery is suitable for operations that do not require prolonged observation or bed rest and where pain control does not require injectable medication for prolonged periods. Such operations include procedures such as hysteroscopy, cystoscopy, diagnostic laparoscopy and laparoscopic tubal occlusion.   

Social fitness 

All patients must have a responsible adult, able and willing to care for the patient at home for at least the first 24 hours after they come home. Patients and their carers should have 

easy access to a telephone. The patient’s home must be suitable with adequate kitchen, bathroom and toilet facilities.  

Medical fitness 

Patients should either be fully fit or have well controlled chronic disease such as diabetes, asthma or hypertension. This will be assessed by the preoperative assessment clinic. Patients with complicated medical or anaesthetic problems might be discharged on the same day but they will need to prepare for an overnight stay and should be admitted to the gynaecology wards.  

Role of the anaesthetist in day surgery 

The anaesthetist will meet you on the admissions lounge before surgery and will use their skill and expertise to ensure that your recovery from anaesthesia allows you to go home soon after surgery.  

• Waking up promptly: Short acting anaesthetic drugs are used that will wear off as quickly as possible to help reduce the time to discharge from hospital
• Pain control: Drugs such as paracetamol and anti-inflammatory drugs are used to provide pain relief and reduce the need and dose of sedative drugs such as morphine
• Nausea and vomiting: all patients will have their risk assessed and will be given appropriate drugs to prevent the risk of nausea and vomiting
• Hydration: it is important to remain well hydrated before surgery by drinking still water until 2 hours before the operation as this enhances your recovery. Your anaesthetist may also give you intravenous fluids to ensure that you are not dehydrated. 

Patients whose surgery, social or medical fitness does not allow day surgery will be admitted to the general gynaecology wards.  

The same principles of anaesthesia apply. We aim to ensure that patients are fully awake promptly after surgery and comfortable with controlled nausea and vomiting. However, admission to the ward allows us to use additional techniques to control pain:  

Patient controlled analgesia 

Patient controlled analgesia, or PCA, is a method of pain control that allows you to give yourself some pain relief as and when you need it.  

Regional local anaesthetics 

Transversus Abdominis Plane (TAP) block is a local anaesthetic block and is given by the anaesthetist or surgeon when you are asleep and will help numb the nerves supplying sensation to the front of the abdomen. This works with other pain medication to control pain after abdominal surgery such as hysterectomy or laparotomy. Rectus sheath catheters (RSC) may be inserted for certain ‘open’ operations to remove the womb, tube and/or ovaries. These catheters are connected to an infusion pump. These RSC are used in combination with a PCA  

Spinal anaesthesia 

Certain gynaecological procedures can be performed under spinal anaesthesia alone. There may be a good reason why your anaesthetist recommends this procedure. Often spinal anaesthetics are offered in conjunction with general anaesthesia for certain operations. The aim would be to reduce comfort upon waking from your operation and reducing post operative pain and the amount of strong painkiller provided through the PCA 

The operating department 

The operating department includes a reception waiting area, anaesthetic rooms, operating theatres and a recovery room. It looks and feels quite different from other hospital departments. Operating theatres are brightly lit and are purposely quite cool in temperature. As it is important for you to keep warm, a blanket will help if you feel cold.  

The staff 

Theatre staff normally wear coloured 'pyjamas' and paper hats. Because of this, they all look much the same, but you will probably recognise your anaesthetist having met them already.  

Reception 

If you have walked to theatre, you will now need to get onto a theatre trolley for your anaesthetic. This is narrower and higher than a hospital bed and may feel quite cold and hard. A member of staff will help you climb onto it. Theatre staff will check your identification bracelet, your name and date of birth and will ask you about other details in your medical records as a final check.  

The anaesthetic room 

You will then be taken into the anaesthetic room or, sometimes, into the operating theatre. Several people will be there, including your anaesthetist and the anaesthetic assistant. There may also be an anaesthetist in training, a nurse and a student doctor or nurse. All the checks you have just been through will be repeated once again. If you are having a general anaesthetic, you will probably now need to remove your glasses, hearing aids and dentures to keep them safe. If you would prefer to leave your dentures in place, ask your anaesthetist if this would be alright. During your operation, your anaesthetist will attach you to machines to monitor: 

• Your heart: sticky patches will be placed on your chest (electrocardiogram or ECG) 
• Your blood pressure: a blood-pressure cuff will be placed on your arm 
• The oxygen level in your blood: a clip will be placed on your finger (pulse oximeter)
• Occasionally a monitor measuring brain wave activity may be attached. This monitor allows us to taylor the anaesthetic and will ensure ‘just the right amount’ of anaesthetic for you. This avoids an excessive hangover if you are sensitive to an anaesthetic or informs of when you need more anaesthetic to keep you safely asleep. 

More monitoring may be needed for major operations and will be discussed with you prior to your surgery.