Anaesthetic Bill:

1. As independent medical specialists the services we render attracts a fee that will be billed completely separately from the hospital or your surgeon.
2. The cost is based on the duration of the case and may change with unforeseen events or complications, and cannot be predicted precisely.
3. Our fees represent the service that is delivered and your medical aid might not cover the full amount, depending on the medical aid and plan option you have chosen.
4. Dr HW Morkel has contracts with Discovery Health, Bankmed and Fedhealth. If you are a member of these medical aids, there may be no co-payment payable. This is dependant on your plan option. This still depends on your fund rules with regard to certain procedures and if any limitations or exclusions are applicable to your plan option.
5. If you are not a member of these medical aids and your condition is not listed as a PMB (“prescribed minimum benefit”), then a co-payment on your account is likely.
6. You may contact us for a quotation if you are unsure about a co-payment or discuss this with your anaesthesiologist.
7. We may offer discount for prompt settlement of accounts.
8. It remains the responsibility of the patient or elected accountee to ensure timely settlement of this account. Failure to settle accounts within 60 days of services being rendered may lead to additional debt recovery costs and also incurs interest at 15,5% per annum.

Before your anaesthetic

Your anaesthetist will visit you beforehand and evaluate the anaesthetic questionnaire that you filled out during admission. Please disclose any medical conditions and history honestly and thoroughly, and note any allergies you may have.

Please bring along names and dosages (or alternatively the original packaging) of all medications (including homeopathic and supplemental products) you are taking. Your anaesthetist will tell you which medications to take (with a small sip of water) and which to skip on the day of surgery.

You may not take any food or fluid before your anaesthetic. This is important to ensure your safety: inhalation of stomach content during anaesthesia may be life threatening.

What is allowed until what time before anaesthesia:

• 8 hours - large fatty meals
• 6 hours - normal meals, dairy, and carbonated drinks
• 4 hours - breastmilk (only if exclusively breastfed)
• 2 hours - clear fluids (water, apple juice, black coffee or tea, non-carbonated energy drinks)

Your anaesthetic

The choice of the anaesthetic depends on the type of surgery, your general health and preference. Your anaesthetist will decide on the safest route after considering these.

Sedation: The patient is awake but sleepy or sleeping lightly. Used for shorter procedures that is uncomfortable but not painful or combined with regional anaesthesia for painful procedures.

Regional anaesthesia: A certain part of the body is anaesthetised and surgery is done without pain whilst awake. This includes spinal, epidural and limb blocks.

General Anaesthesia: The patient is sleeping deeply. Used for longer or painful procedures. May also be combined with regional anaesthesia.

Monitors used may include ECG stickers, a blood pressure cuff, a finger probe, urinary catheter or specialised drips in your wrist and neck.

While the surgeon focuses on the operation the anaesthetist vigilantly monitors all bodily functions ensuring these function well whilst keeping you fast asleep, comfortable and pain free.

When the procedure is complete, the anaesthetist wakes you up and transfers you to the recovery room or intensive care unit where you are monitored until fully awake and stable.

After your anaesthetic

Please inform a doctor immediately should you experience chest pain, shortness of breath, altered touch sensation, muscle weakness, back pain, incontinence, headache, neck stiffness, fevers, rigors, voice changes or severe nausea and vomiting. Mention that you received anaesthesia.

If you are returning home on the day of the procedure, somebody else must be available to drive you, care for you at home, and return you to hospital if necessary.

For 24 hours after the anaesthetic you should not actively take part in road traffic, operate heavy machinery or make any important decisions.

Risks of anaesthesia

Your anaesthetist is present throughout the procedure, and aims to prevent and treat adverse reactions and complications immediately and effectively. There are however risks associated with anaesthesia and despite vigilance, best anaesthetic practice and preventative measures, complications may still arise.

We therefore discuss some of the more common and more serious complications below. A more complete list with precise statistics on complications is available on request.

General risks:

Complications can occur at injection sites, including bruising, bleeding, infection, nerve injury, scarring or even limb loss in the worst cases.

Injections in the neck, shoulder and chest may cause a puncture of the lung leading to air collecting in the chest cavity outside the lung (pneumothorax), causing chest pain and shortness of breath. It necessitates the placement of a tube between the ribs inside the chest to remove the air.

Nerve injury caused by positioning on the theatre table may occur, which can lead to altered touch sense, partial paralysis or vision loss. Sensitivity to, or side effects of medications administered can lead to nausea, vomiting, itching and rashes. Serious allergic reactions may occur which can lead to asthma, low blood pressure or even heart and circulation arrest.

It may become necessary to administer blood or blood products and this may cause complications, including serious incompatibility reactions and transmission of infections (including hepatitis, HIV and mad cow disease).

Occlusion of blood vessels by blood clots, which can lead to shortness of breath, chest pain, or even heart and circulation arrest, may occur.

Risks of general anaesthesia:

General anaesthesia may cause nausea and vomiting.

Support of the airway by intubation or laryngeal mask may cause sore throat. Intubation may lead to tooth damage or even tooth loss. The throat, vocal cords or airways may also be damaged leading to difficulty in swallowing, hoarseness or difficulty of breathing.

Malignant hyperthermia is a rare inherited disease that is triggered by anaesthetic gases and agents. It necessitates immediate intensive care treatment.

Awareness under anaesthesia may occur.

Risks of regional anaesthesia:

Regional anaesthesia may fail resulting in pain and sensation.

After spinal or epidural anaesthesia your legs will be weak and numb, limiting your mobility, and you may have difficulty urinating which necessitates the placement of a catheter in your bladder. This weakness may spread to your arms and breathing muscles requiring assisted breathing.

Your blood pressure may drop after spinal or epidural anaesthesia, but this is usually easily treated.

Severe headache is a known complication after spinals and epidurals and is usually treatable. Backache may occur after spinals or epidurals. During and after pregnancy backache is very common, but rarely caused by epidurals or spinals.

Limb blocks can cause nerves other than those intended to be blocked causing hoarseness, drooping of the eyelids or difficulty breathing, but this usually wears off along with the block. Eye blocks may rarely lead to blindness.

All regional anaesthetics can cause direct injury to, bleeding in, inflammation or infection of the spinal cord or nerves leading to sensation loss and paralysis of the specific body part, incontinence, impotence and in the worst cases quadriplegia.