Patient Information
At Cape Gate Anaesthesia we promote a patient centred approach, where each and every patient receives an individually tailored anaesthesia care plan. From when we meet before your operation right until you are discharged home you can be sure we will be there every step of the way making you as comfortable as you possibly can be while managing your health meticulously .
We understand that having to have surgery and anaesthesia is an unpleasant experience for most people. Fear of the unknown plays an important role and on these pages we hope to allay these fears by answering any question you may have. Browse through our website or contact us directly – we are always available to you.
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 the 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 the surgery.
Also bring with the results of blood tests and investigations you may have with you.
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 how long before:
- 6 Hours - Usual meals and drinks
- 2 Hours - Clear fluids like water, apple juice, black coffee or tea, or Energade (but not fizzy drinks, milky drinks or drinks containing solids like fruit)
We encourage you to drink a small amount of clear fluid, like apple juice, 2 hours before your operation (Except patients with diabetes or acid reflux, which should stop all intake 6 hours before their operation). Please remove all jewelry (including piercing jewelry), make-up and nail varnish, contact lenses, dentures and dental plates.
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.
You may receive a sedation (light sleep), a general anaesthetic (deep sleep) or regional anaesthesia (you may be awake). 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.
General anaesthesia is a sleep like condition of unconsciousness. It is brought about by inhaling anaesthetic gases or by continuously administering anaesthetic drugs intra-venously. It allows for your procedure to be performed without you being aware or feel any pain.
Regional anaesthesia numbs a specific part of the body, allowing a procedure to be performed on that part without you feeling any pain, but without causing you to fall asleep.The main benefit is excellent pain relief, which often lasts for several hours after the operation and can be maintained for several days. It avoids some side effects of general anaesthetic (like nausea) and may be a safer option for certain health conditions. It can also be combined with general anaesthesia or sedation so that you still sleep during the operation.
What is general anaesthesia?
General anaesthesia is a sleep like condition of unconsciousness. It is brought about by inhaling anaesthetic gases or by continuously administering anaesthetic drugs via a drip. It allows for your procedure to be performed without you being aware or feel any pain.
How is general anaesthesia administered?
In theatre a drip is placed, typically in your hand or arm and you will be connected to monitors by stickers on your chest, a cuff around your arm and a probe on your finger. An oxygen mask will usually be held in front of your face – take relaxed, deep, slow breaths to fill your lungs with oxygen.
The anaesthetic drugs are now injected into your drip and you fall asleep soon thereafter. Some of these drugs cause a stinging sensation in your arm before you fall asleep. When you are asleep, a special tube is inserted into your throat, fitting either between your vocal cords (intubation) or over them (laryngeal mask). This allows assisted breathing and protects against inhaling stomach contents. This tube is removed again before you wake up.
Depending on the nature of your surgery and health, other monitoring devices might now be placed including but not limited to a urinary catheter in the bladder, a central line in the neck or an arterial line in the arm. Most of these will still be in place after you wake up.
As soon as your anaesthetist is satisfied that you are sound asleep and all bodily functions are stable, the surgeon can proceed with the operation. While the surgeon now focuses on the operation the anaesthetist continues to vigilantly monitor 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. To protect you against injury while you are not yet fully conscious, your movement may be restrained.
What is a regional anaesthesia?
Regional anaesthesia numbs a specific part of the body, allowing a procedure to be performed on that part without you feeling any pain, but without causing you to fall asleep.The main benefit is excellent pain relief, which often lasts for several hours after the operation and can be maintained for several days. It avoids some side effects of general anaesthetic (like nausea) and may be a safer option for certain health conditions. It can also be combined with general anaesthesia or sedation so that you still sleep during the operation.
How are spinal and epidurals administered?
A drip is placed and you are connected to monitors. You will now be asked to sit upright or turn on your side. Bend your head and upper body forward while pushing your lower back outwards toward the anaesthetist. This assists correct placement of the needle and your cooperation is very important. A local anaesthetic injection is given to numb the skin of the back. This stings for a few seconds.
The anaesthetist puts on sterile gloves and clothes and washes your back with an antiseptic solution, which feels cold. The epidural or spinal injection can now be given. This is usually not painful because the skin has been numbed, but the final positioning into the correct space in your back can be a bit sore. Once the correct space has been found the local anaesthetic is injected (spinals) or the epidural tube is inserted (epidurals).The needle is removed from your back and you can lie down again.
Spinals start to work within 5 minutes, while epidurals take about 30 minutes. Your legs and tummy may feel warm, numb and heavy after which all feeling disappears. As soon as the anaesthetist is satisfied that you have no sensation left in the body area to be operated, the surgeon can proceed with the operation, while the anaesthetist continues to vigilantly monitor bodily functions ensuring these function well whilst keeping you comfortable and relaxed.
After the procedure is complete you may remain pain free for another couple of hours or even days in the case of epidurals. You are now transferred to the recovery room or intensive care unit where you are monitored until stable and the spinal or epidural starts to wear off – characterised by a needles-and-pins sensation and finally complete return of feeling and movement.
What is a block?
A block causes a very specific part of your body, typically a part of your leg or arm, to become numb so that you don’t feel any pain in that part. This is achieved by injecting local anaesthetic close to the nerves of that part of the body. The precise position of the nerves are found by looking for them with an ultrasound machine and/or a nerve stimulator. This is useful for procedures on small specific areas for instance many orthopaedic operations.
How is a block administered?
A drip is placed, typically in your hand or arm. You are connected to monitors by stickers on your chest, a cuff around your arm and a probe on your finger. You may need to be positioned in a certain way, e.g. holding your arm or leg in a certain position – the anaesthetic assistant will help you. The area where the injection is to be given is thoroughly cleaned – the cleaning fluid might be a bit cold.
The first injection is now given to numb the skin over the injection site. The local anaesthetic that is injected under the skin stings a bit for a few seconds. An ultrasound machine is used to see where the nerves are located. The ultrasound gel feels cold.
Once the nerves are found, the block needle is inserted close to them. The needle may be connected to a nerve stimulator, which gives small electric shocks. When the needle comes close to the nerves, the muscles of the area to be blocked twitches. This helps to make sure the right nerves are blocked and is usually not painful, just a bit uncomfortable.
Local anaesthetic is now injected around the nerves and can sting a bit for a while. The needle is removed and you can relax in your normal position. Blocks can take about 30 minutes or longer to take effect. You will feel the specific body part starting to feel warm, numb and heavy after which all feeling will go away altogether. As soon as the anaesthetist is satisfied that you have no sensation left in the body area to be operated, the surgeon can proceed with the operation.
The arrival of a new family member it is a very special event. Whether you choose a natural birth or to have your child delivered by caesarean section you can depend on Cape Gate Anaesthesia to make sure your delivery happens safely and as comfortably as possible.
Typically caesarean sections are done under spinal anaesthesia and labour pains can be relieved by epidural analgesia. Both techniques allow you to be awake to experience those precious first moments with significantly less pain and very little risk to your baby. Furthermore epidural analgesia does not increase your chance of having a caesarean section but can be used for a caesarean section should it become necessary.
For more information on spinal and epidural anaesthesia, please see our regional anaesthesia section.
Having to have an operation can be very stressful for a child, and even more so for the parents. We take meticulous care of our paediatric patients, trying to minimise the disruption the illness or injury caused to their lives. Children are usually given general anaesthesia and for more information on this technique please see the specific section. A few of the differences between children and adult anesthesia will be discussed below.
Fasting
Your child must please stop eating and drinking anything from 6 hours before the planned operation. Babies may have breast milk (NB no other milk) up to 4 hours before the operation. Clear fluids (water, apple juice, energade etc., but not fizzy drinks, drinks containing dairy like Tropica, or drinks containing solid matter like pieces of fruit) can be taken up to 2 hours before the operation.
Premed
Your child might be prescribed a pre-med at the pre-anaesthetic visit. The aim of this is to help your child come to theatre in a sleepy, forgetful, relaxed state and minimise the trauma of the experience.
Gas inductions
Children are anaesthetised by gas induction, where the oxygen mask is held in front of their face and they are allowed to breathe the anaesthetic gases until they fall asleep. This happens within a few minutes in children compared to adults where is takes much longer, making it mostly unsuitable for adults. It avoids the trauma of an injection while awake.
Caudals
Caudal anaesthesia is similar to epidural anaesthesia in adults. While your child is sleeping an injection is given in the lower back above the coxyx. This numbs the nerves of the lower body and legs and prevents your child from feeling pain in these body areas. For more information on epidural anaesthesia, please see the specific section. After a caudal your child may temporarily have some weakness in his/her legs, and may need a urinary catheter.
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 by clicking here.
General risks
Complications can occur at injection sites, including bruising, bleeding, infection (which may lead to abscess formation or generalised sepsis), blood vessel inflammation and occlusion (with possible limb loss) nerve injury, or scarring. 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 (intercostal drain) to remove the air. This may cause similar complications as injection sites.
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.
Risk specific to general anaesthesia
General anaesthesia may cause nausea and vomiting after the operation. Vomiting during anaesthesia with inhalation of stomach contents can lead to asthma, inflammation of the lungs or even total occlusion of the airway and death. 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 swallowing, hoarseness or difficulty breathing.
Malignant hyperthermia is a rare disease that runs in families and is caused by anaesthetic gases and agents. It necessitates immediate intensive care treatment. Awareness under anaesthesia may occur
Will I definitely be asleep during the operation?
One of an anaesthetists primary concerns is to make sure you are completely asleep throughout the operation. This is done by paying close attention to the administration of anaesthetic agents and monitoring of various bodily functions. Despite our best efforts however, awareness may still occur and happens in about 0.1% of cases.
An awareness monitor, called BIS or Entropy, specifically measures how awake you are and improves an anaesthetist’s ability to make sure you are asleep. These monitors are not used routinely because some medical aids do not reimburse the hospital for them. Should you wish us to use such a monitor during your anaesthetic, check with your medical aid.
Will I wake up after my operation?
Not waking up implies serious ill-health before the operation or a serious complication during the operation and hardly ever happens unexpectedly or as a direct result of the anaesthetic. If you are reasonably healthy undergoing routine surgery you will almost certainly wake up after the procedure.
Risks for regional anaesthesia
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 but is usually not long lasting. During and after pregnancy backache is very common, but rarely caused by epidural analgesia. During labour, epidural analgesia may prolong the second stage and increases the chance of a ventouse or forceps delivery.
Nerves other than those intended may be blocked causing hoarseness, drooping of the eyelids or difficulty breathing, but this usually wears off along with the block. Pneumothorax as discussed under general risks may occur. Direct injury to, bleeding in, inflammation of or infection of the spinal cord or nerves leading to sensation loss, paralysis, incontinence, impotence and in the worst cases quadriplegia is possible.
Risks of a block
Direct injury of, bleeding in, inflammation of or infection of nerves can lead to altered touch, pins and needles sensations or paralysis, but usually recovers within a couple of months.
Nerves other than those intended may be blocked causing hoarseness, drooping of the eyelids or difficulty breathing, but this usually wears off along with the block. Pneumothorax as discussed under general risks may occur.
With certain block techniques local anaesthetic may enter the spinal cord and cause quadriplegia
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- As independent medical specialists the services we render attract a fee that will be billed completely separately from the hospital or your surgeon. The fees charged, and codes used by the anaesthesiologist fall within the guidelines of the Health Professions Council of South Africa and South African Society of Anaesthesiologists.
- The cost is based on the duration of the case and may change with unforeseen events or complications, and cannot be predicted accurately before your surgery.
- 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. This fee may be up to three times of what your medical aid is willing to cover.
- Each associate has their own payment arrangements with some of the healthcare funders. If you are a member of one of these medical aids, there may be no co-payment payable. 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. This is dependant on your plan option and fund rules with regard to certain procedures, which may be limited or excluded, and still lead to a co-payment. Please contact us if further information is needed.
- The cost of an anaesthetic is dependent on time and procedure complexity. Since it is impossible to predict how long a procedure will take, estimating the cost of an anaesthetic is extremely difficult. There may be additional costs for ICU care, pain control techniques, ultrasound, obesity, blood pressure control, paediatrics, fractures and emergency surgery cases not booked on routine lists.
- If the procedure takes longer than the estimated time, the cost will increase according to the duration of the procedure.
- If your BMI (Body mass index) is greater or equal to 35kg/m2 you will be charged an additional 50% of the anaesthetic fee.
- Explanations of the codes on the account can be obtained from the Board of Health Funders (011-537-0200) or your medical scheme.
- As all medical insurance companies offer cover at different rates, your medical aid will reimburse your anaesthetic account at a rate according to the plan you have selected and the rules of your medical aid fund. This may vary from 30% to 100% of the amount charged. Some medical schemes exclude or do not recognise or reimburse for some of the SASA and SAMA approved codes.
- An account will be sent to your medical aid to assist you with your claim, but you are still responsible for payment of your account to your anaesthesiologist.
- You may contact us for a quotation if you are unsure about a co-payment or discuss this with your anaesthesiologist.
- We may offer discount for prompt settlement of accounts.
- 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.