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PATIENT INFORMATION

Frequently Asked Questions about Anaesthesia

What are anaesthetists?

Anaesthetist at work with patient Anaesthetists are highly-specialised doctors who look after their patients’ wellbeing before, during and after surgery. They can manage patients with complex medical conditions for a wide range of surgical operations, and are also specialists in resuscitation, intensive care and the treatment of pain.

Who are the GAS anaesthetists?

All GAS anaesthetists are NHS consultants from the local Gloucestershire Hospitals NHS Foundation Trust, and have therefore been appointed to the highest grade of hospital doctor in the U.K.

They are all registered as specialists with the General Medical Council and are fully appraised and up to date with continuing professional development.

They work together in a group to ensure they are able to cover all surgical specialties in Gloucestershire, 24 hours a day and 365 days a year. All members of GAS are listed on the Our Consultants page.

Are GAS anaesthetists “recognised” by my insurance company?

Because all GAS anaesthetists are in substantive NHS consultant posts, your insurer cannot demand any higher quality or standard of doctor. They are therefore all “recognised”, or “registered”, as specialist anaesthetists with the General Medical Council and The Royal College of Anaesthetists. Please note that being “recognised” is not the same as agreeing to abide by your insurance company’s fee reimbursement schedule.

How do I pay my anaesthetist? Could there be a shortfall?

If you are self-funded, anaesthetic fees have already been agreed with the hospital and are included in the quote given for your procedure, except in the case of Cheltenham General Hospital, where anaesthetic fees are billed separately. If you have private medical insurance, the anaesthetist will send you a bill for their services. This is because GAS anaesthetists are not in contract with, or affiliated to, any of the insurance companies. Sometimes there may be a shortfall between the anaesthetic fee and the amount reimbursed by your insurer. GAS employs the specialist medical billing company Medserv to issue and process our invoices.

Shortfalls arise because...

Different insurance companies provide different levels of cover for any given procedure
A minority of insurers do not reimburse for certain services, such as nerve blocks or preoperative assessment consultations (see below).

How can I find out what my anaesthetic fee will be?

You need to find out the specific procedure code(s) for your operation from your surgeon’s secretary. You can then enter the code in our fee calculator. Alternatively you can telephone the GAS Office for an estimate. Please note that where multiple procedures are involved, we bill according to insurers’ guidelines, whereby a second procedure incurs a 50% additional charge and a third procedure 25%.

Do operations and anaesthetics carry any risks?

Having an operation and an anaesthetic always carries a risk of some kind; your anaesthetist will discuss those which are relevant and significant to you. Risks are primarily determined by your own medical history and general health, hence the importance of preassessment, and also the type and complexity of surgery.

What risks do anaesthetics carry?

The majority of people who undergo anaesthesia have no complications. It is also difficult to separate the risks of anaesthesia and surgery, as they are inextricably linked. However, serious complications are rare, although the possibility does exist. These include drug reactions, chest infection, heart attack, stroke or blood clots (deep venous thrombosis or pulmonary embolus) and, very occasionally, death.

Minor complications are more common. These include nausea or vomiting, sore throat, bruising, corneal abrasions and lip or dental damage.

How do anaesthetists ensure these risks are minimised?

Anaesthetists are specifically trained to minimise the risks and ensure your safety. We gather all the information we can about your medical history, including previous anaesthetic experiences, medications, allergies and smoking history. The Preassessment Clinic Team, which includes nurses and anaesthetists, uses questionnaires and direct interviews and will organise any necessary blood tests, ECGs or other investigations.

If your medical history or surgery are complex then you may require a consultation with an anaesthetist who will need to establish that any medical conditions you have are being optimally managed. Any such consultation will occur a charge. If you have private medical insurance, it may be possible to seek reimbursement from your insurer – but you will need to check the terms of your policy.

In some cases, we may organise an additional investigation called an echocardiogram, which is designed to assess the function of the heart. Occasionally we will refer you to another medical specialist, such as a cardiologist, for an additional opinion.

When will I meet my anaesthetist?

You will always meet your anaesthetist on the ward prior to your surgery.

What will my anaesthetist talk to me about?

Your anaesthetist will discuss your anaesthetic and pain relief options with you, depending on the type of surgery you are having. They will identify any risks and discuss these with you, together with the risks and benefits of the alternative anaesthetic options. They will answer any questions or concerns you may have, and obtain your verbal consent to proceed with the proposed plan.

What are the different anaesthetic options?

The type of anaesthetic varies from individual to individual and between different types of surgery.

There are two principle types of anaesthetic...

General Anaesthesia
The anaesthetist uses a combination of drugs to produce a state of controlled and monitored unconsciousness. Patients will not be awake or aware at any time during surgery.
Local or Regional Anaesthesia
Part of the body is rendered numb, comfortable and pain-free. Not all types of surgery are suitable, but in many cases regional anaesthesia provides specific advantages. Local anaesthetic agents can be injected in the skin or around nerves to make an area numb; such as a finger, toe, arm or leg. Spinals and epidurals involve an injection of local anaesthetic in the back to numb the spinal nerves, which supply sensation to larger areas of the body from the chest down. Spinal anaesthetics are slightly simpler to perform and are more commonly used than epidurals, especially in operations on the prostate and hip or knee replacements. Your anaesthetist will also control how sedated you are, ie. awake, drowsy or completely asleep. Spinals and epidurals typically provide excellent pain relief and enable you to wake up comfortable at the end of your surgery.

How long before an anaesthetic must I stop eating and drinking?

If you are having a general anaesthetic, or a local anaesthetic with sedation, the following principles apply:

No food or milky/particulate drinks for 6 hours before surgery
Clear fluids (ideally water, but may include squash or cordial) can be taken until 2 hours before surgery

In practice you should have nothing to eat after midnight for surgery scheduled in the morning, but may have a light early breakfast (before 8 am) for afternoon surgery scheduled at 2 pm or later.

What are the options for pain relief?

Anaesthetists are experts in pain relief whose aim is to help you avoid severe pain after surgery. Pain relief options include:

Local anaesthesia, nerve blocks, spinal or epidural anaesthesia
Combinations of different types of pain relief, including simple painkillers (paracetamol, codeine and anti-inflammory agents) and more potent opiates, such as morphine.

For major surgery, morphine is often used in a patient-controlled anaesthesia (PCA) pump. This enables patients to administer morphine themselves in a controlled way, and provides a high quality of pain relief.

Are there any other useful sources of information?

Our resources page can take you to the Royal College of Anaesthetists website, which has a section devoted to information for patients undergoing surgery and their relatives. This site also has a collection of articles concerning the specific risks associated with certain types of anaesthesia and surgery.

Who do I contact if I have any queries before my operation?

Our Contact Us page gives our email address and telephone numbers. While the GAS Office can address most queries, there is a separate telephone number for patients having surgery in one of the Gloucester hospitals.

Please note that although we will endeavour to provide you with the name of your anaesthetist at the earliest opportunity, we cannot always guarantee this in advance.