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Anaesthetists are doctors responsible for ensuring that a patient undergoing an operation is asleep during the surgery (if under general anaesthesia), does not have pain during and after the procedure, is free from sickness and has stable vital signs during the operation. In order to achieve a high level of expertise in this role and to become a ‘Consultant Anaesthetist’, they have to successfully complete a rigorous seven year ‘specialist training programme’ in Anaesthesia after their initial seven year general training in medicine. Anaesthetists in training always work under the supervision of a named consultant.
Birmingham and Midland Eye Centre has an excellent team of anaesthetists who are highly trained and experienced in ophthalmic anaesthesia. They offer a range of anaesthetic techniques including general anaesthesia, regional anaesthesia and sedation. The anaesthetic department at the BMEC is the ‘regional centre for training’ in ophthalmic anaesthetic techniques and offers training modules from ‘basic’ to ‘advanced’ levels.
With increasing life expectancy and advances in surgical techniques, more ‘complex’ patients with multiple health conditions are presenting for surgical procedures. The optimal technique of anaesthesia for you is decided based on your general health condition, nature of surgical procedure and personal choice when possible. Well before your planned operation, you will be asked to see a nurse at the pre-operative assessment clinic to check on your health status. Additional blood tests or investigations will be done if required. If you have complex medical problems, you may be required to be assessed by a Consultant Anaesthetist. This will also give you an opportunity to discuss any concerns that you may have regarding the anaesthetic.
Operations under Local Anaesthesia:
Most eye operations are now performed under ‘local anaesthesia’. This is a technique where the eye is ‘frozen’ using an injection around the eye. This leads to ‘numbing’ of the eye and allows the surgeon to do the operation without the risk of accidental eye movement. Although it sounds scary to be receiving an injection around the eye, the pain of the injection itself is similar to that given by dentists. Any pain during injection disappears after a few seconds. Some simple surgical procedures can also be performed using local anaesthetic eye drops to numb the surface of the eye. With any kind of local anaesthesia, you will usually be awake throughout the operation. However, the eye will be numb and you should not feel any pain. Sensation will gradually return over the next few hours as the effect of local anaesthetic wears off. If an anaesthetist gives you some ‘sedative medication’ prior to the local anaesthetic injection, you may not remember having the injection being administered. One main advantage of local anaesthesia is that you can eat and drink as normal on the day of surgery (compared to general anaesthesia when there is need for fasting beforehand). In addition, recovery is quicker with reduced likelihood of nausea and vomiting. Also, the pain relief effect of the local anaesthetic continues for a few hours post operatively. Essentially, you are back to your ‘normal’ status much quicker than a general anaesthetic.
On the day of surgery, an anaesthetist will normally visit you in the ward / day unit. They will reassess you, ensure that there is no new factor which is going to increase the risk of operation, explain the anaesthetic technique and answer any questions that you may have. Sometimes it may be appropriate to offer sedation to patients having eye surgery under local anaesthesia. Anaesthetists are responsible for administering sedation during the operation.
Operations under General Anaesthesia
Some operations are not suited for local anaesthesia. These procedures are done under general anaesthesia. Some patients are best given general anaesthesia (children, patients who are unable to lie still or have communication problems etc.). Some patients may request general anaesthesia due to their personal preference. The letter confirming the date of your operation under a general anaesthetic will include instructions not to eat or drink for six hours before your operation. Water is allowed up to two hours before surgery. On the day of your operation, your anaesthetist will visit you and explain the anaesthetic. Most people have a tickly dry throat after a general anaesthetic which lasts less than a day. Rarely, some people feel nauseous and if needed, this will be treated with medications. The relevant risks for you (if any) will be discussed by your anaesthetist and an opportunity will be given for you to ask any questions. With modern technology and newer anaesthetic agents, the serious risks due to a general or local anaesthetic are extremely small for the majority of patients. Most patients recover quickly and are able to go home the same day, thanks to the team efforts of the hospital staff including the surgeon and the anaesthetists.
If you would like to get in contact with any part of BMEC, please dial our central number 0121 507 4440.