Anaesthetic Techniques and Risks – Ear, Nose and Throat Surgery

The role pf your Anaesthetist:

Anaesthetists ensure patients are optimally fit for the surgery and plan their overall care before, during and after the procedures, sometimes known as the perioperative period. Relief from pain is at the centre of the practice of anaesthesia. Your anaesthetist is a highly trained specialist doctor whose job is to keep you safe, comfortable and to closely monitor your body, heart and breathing to safety have surgery without pain.

What types of anaesthetic techniques are available?

There are several types of anaesthesia that may be used individually or in combination, depending on the surgery. Except in emergency situations, a specialist anaesthetist will consult with the patient and the surgeon to decide on the safest and most appropriate type of anaesthesia for the clinical situation.

The anaesthetist will consider several factors when planning a patient’s anaesthesia including:

• Your prior experience with surgery.
• Health and physical conditions.
• Reactions or allergies to medicines.
• Risk of each type of anaesthesia.
• Preferences of your surgical team.
• Your preferences.

Local anaesthesia

local anaesthesia involves injecting or spraying local anaesthesia solutions into or around the tissues and nerves. This is to make the tissues and body part having surgery numb and pain-free. Very few procedures are performed with local anaesthesia alone, but it is commonly combined with sedation medication or general anaesthesia. This combination gives you pain relief after you wake up. Before surgery, anaesthetic may be sprayed into your nose, or throat before going to sleep which may taste strange or be uncomfortable for a brief time.

Sedation anaesthesia

Conscious, light or deep sedation is sometimes called ‘twilight’ anaesthesia. This reduces your level of awareness or consciousness when doing the surgery. This is to help you relax, reduce anxiety, pain and often forget the procedure. You may be wide awake or asleep but remain breathing by yourself. You may feel touch like pressure, but no pain, and are able to talk to the teams if needed. This helps you recover quickly, be more alert and awake after the procedure and go home early.

General anaesthesia

General anaesthesia involves using strong medications to put you asleep in a state of carefully controlled and measured unconsciousness. You will be given a selection of drugs for pain, relaxation and for prevention of nausea and vomiting, and remember nothing of the surgery. General anaesthesia also changes your ability to breathe by yourself and changes to blood pressure and heart rate, so these will be monitored closely at all times by your anaesthetist. After you are asleep you will usually have a mask or tube placed into your mouth or throat and you will wake up with a light clear plastic oxygen mask on your face to ensure you are breathing again safely.

What are the anaesthetic risks?

* Definitions used

• Very common (1 in 10) such as getting the flu or food poisoning this year.
• Common (1 in 100) such as winning any prize in one game of Saturday Lotto.
• Uncommon (1 in 1000) such as winning the trifecta in a 13-horse race.
• Rare (1 in 10,000) such as being struck by lightning.
• Very rare (1 in 100,000) such as dying from a snake, bee or other venomous bite or sting.

Local anaesthesia risks

• It is uncommon^* to get damage to the lining of the airway, which would result in temporary bleeding or sore throat lasting hours or days.
• Overdose of an anaesthetic or other drug is uncommon^* and may result in dizziness or a seizure. It usually has no lasting effect.

General anaesthesia risks

• Sore throat, shivering or bruising at the injection site are very common.
• Nausea, vomiting, confusion or dizziness are common. These complications range from mild to severe and usually go away within hours or days.
• With sedation or general anaesthesia there is a risk of dental damage. Tooth damage, such as chipping, dislodgement or breakage of a crown or bridge, is uncommon. The hospital is not liable for treatment or repair of dental damage.
• Serious complications such as being partly awake or drug allergy are rare^*, and nerve damage, equipment failure, brain damage or death are very rare.

What is your role to prepare for surgery?

1. Exercise: Keep your fitness up, go for walks. Even a little bit of exercise makes a big difference to a fast and easy recovery.
2. Check your medications or herbal treatments and bring a copy of current doses.
   1. If you are taking blood thinners such as aspirin, clopidogrel (Plavix), Warfarin, Pradaxa, Eliquis or Xarelto you should again discuss this with your anaesthetist or surgeon at least a week before your procedure. Please bring all your current medications in their original packaging.
   2. If you are taking any diabetes medications, please inform the hospital as you may need to cease these 3 days before surgery.
3. Stop smoking: even 24 hours helps remove toxins from your blood and increase the safety for your anaesthesia. Ideally 6 weeks make a huge improvement.
4. Inform your anaesthetist and surgeon of any prior blood transfusions
5. Report any recreational drug use to your anaesthetist
6. Report any allergies, prior reactions, difficulty breathing or problems with anaesthesia in your family or yourself to your anaesthetist.
7. Report any coughs or colds, (including COVID) as this may impact on your breathing.
8. Discuss and report any prior medical issues including recent changes or illness.
9. If you are concerned, please call to make an appointment prior to surgery with the anaesthetist to discuss your health and options at the Pre-Assessment Clinic 03 9929 8647.

Fating

• The hospital will advise you how long to fast, this is usually from midnight the day prior to surgery, or from 7am for afternoon surgery. You will usually be advised NOT to eat or Drink (or fast) for 6 hours before your anaesthesia.
• If you don’t follow this rule of fasting, the operation may be postponed in the interests of your safety as food or fluid in your stomach could enter your lungs while you are unconscious and cause damage to your lungs and breathing.
• You may drink a small amount water up to 2 hours before surgery with medications.

Do you want more information before the day of surgery?

If you wish to discuss in more detail the risks, proposed technique or possible complications of your anaesthetic, please ring the Pre-admission Clinic on 03 9929 8647 (Monday to Friday between 9am and 4pm) and arrange an appointment with a specialist anaesthetist.

On the day of your surgery, please discuss these issues with your anaesthetist who will be keen to answer your questions and together you will decide on the anaesthetic technique for you. We look forward to helping you and answering any questions or concerns. Please note this document is a general summary only.