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Home: Anesthetics

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Anesthetics

General, Regional or even No-Sedation

Anesthetics are an essential part of any operation and hip replacements are no exception

Nowadays we tend to think of a hip replacement as a pretty run of the mill procedure. After all there are tens of thousands of them carried out successfully each year. But although the operation may seem quite common place it is classified as major surgery and it requires a high degree of skill to ensure you are kept free of pain and in a sufficiently deep sleep throughout the operation.

What is available?

In theory, good practice insists that the patient is fully involved in the choice of anesthetics used. To this end during my preoperative assessment I was given a booklet that covered all the available options and asked to select one. I spent quite a bit of time reading around the subject and doing additional research on the internet. However when I told my surgeon that an epidural sounded right for me he gently persuaded me to opt for a spinal. A decision with which the rest of the team readily concurred.

In the end, unless you have very strong objections or in-depth knowledge, the chances are you will go along with whatever is favored by your surgical team. If you trust them to enough to replace your hip you're going to trust them enough to choose you anesthetic!

• General anesthesia - These effect your brain and entire body. They are rarely used alone as they are probably the most risky type on offer. They are also expensive.
• Regional anesthesia (often referred to as blocks) - These work around the operation site. Two sorts are widely used: spinal and epidural both of which are normally administered in conjunction with a light general
• No sedation - this is only possible with a regional anesthetic but allows you to stay awake during surgery. A few patients opt for conscious sedation where you are given enough sedative to make you drowsy.

N.B. Local anesthesia is only used to numb the site where a spinal or epidural will be administered.

The majority of hip replacements are done under a combination of a regional and a light general.

Precautions

Fasting

Before surgery you will be asked to fast. Normally you will be told not to eat, drink or even chew gum after midnight on the day of your operation (this might be a bit later if you are on the afternoon list). It is essential you comply with this precaution. The danger is that stomach contents may enter your lungs whilst you are unconscious causing aspiration pneumonia which can result in death.

You will be allowed a sip of water to take your usual medication (your surgeon will have reviewed your medication list with you prior to surgery and told you which of your regular medicines you should take and which you should avoid.)Even if you are scheduled for a regional with a light general combination you must obey this rule as there is always the possibility that the anesthetist may need to switch to a general during the operation.

Familial and individual history

Have you or any of your close relatives had a problem with an anesthetic? If so make sure your surgical team are aware of this. It might sound weird but some people actually forget to mention they have had a previous allergic reaction.

Life style

Your daily habits like smoking, alcohol consumption and recreational drug use may also affect the choice; as will your weight. Smoking, in particular, is a risk factor associated with strokes and myocardial infarction and this risk is greater during surgery carried out under a general alone. This is not a time to hide habits you may be embarrassed by. Your surgical team is not going to judge you they just want to keep you safe and healthy. Help them help you.

Waking up

As the surgery comes to an end the anesthetist will start to adjust the amount of anesthetic being administered. They will know precisely how much to give you to keep you under and free of pain and when to start adjusting the mix to allow you to wake up. This process can be speeded up by administering extra oxygen.

As you start to wake up you will be moved to the recovery room and monitored closely by a specialist nurse. Coming out of any general, even the light version, can be a disorientating experience.

Once you've stabilized the nurse will arrange for you to be moved back to your ward where your vital signs will continue to be monitored.

You've done it!

When you reach this stage you'll have your brand new hip in place.

I hope you love yours as much as I love mine.

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Learn more about:

Preparing for Surgery 
Preoperative Assessment 
Preparing for Recovery