What is anaesthesia?

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Anaesthesia is the medical process of inducing a deep unconscious or altered conscious state so that pain and other sensations are blocked and surgical procedures can be undertaken. There are a number of forms of anaesthesia, including; General anaesthesia (GA), sedation, local anaesthesia, nerve blocks, spinal and epidural anaesthesia. 

General anaesthesia involves inducing a deep unconscious level so that all pain, awareness, and other sensations are blocked and surgery can be performed. 

Sedation involves inducing an altered conscious state so that minor surgical procedures can be done and tolerated.

Local anaesthesia is the blocking of pain in a specific area of your body by means of an injection, you will usually be fully conscious but no pain will be felt.

Nerve blocks are done to block specific nerves or nerve groups in a particular area of your body so that no pain will be felt in that area. These may be done while you are awake or while you are under sedation or general anaesthesia.

Spinal or epidural anaesthesia is the process of injecting local anaesthesia into specific areas around the spine so that the lower part of your body will not be able to feel any pain during procedures. 

Your anaesthetic will be tailored specifically for you based on your health status and surgical procedure. This will be discussed with you prior to your procedure. 

How can I prepare for my procedure?

Starving prior to any anaesthetic is very important to prevent any complications related to food in the stomach regurgitating and entering the lungs. You will need to be starved of food and milky drinks for at least 6 hours and clear fluids (no milk drinks or pulp drinks) for at least 2 hours prior to the anaesthetic. Therefore, if you are booked for an afternoon procedure starting after/at 13h00, you may have a light breakfast before 07h00.

Most chronic medications can be taken on the morning of the procedure with a sip of water, with the exception of some hypertensive (blood pressure) medications (ACE-inhibitors: perindopril, enalapril) and diabetic medications (Insulin). If you are taking any blood thinning medications (aspirin/ecotrin, Plavix, Warfarin, Xarelto, others), please consult your surgeon/anaesthetist for guidance in stopping these prior to your procedure.

If you have any poorly controlled or serious complications from any disease, you may need to be seen by your physician/cardiologist/endocrinologist/pulmonologist prior to your procedure, or you may be requested to be seen by one of our anaesthesiologists to make sure you are adequately prepared for your procedure. If you suffer from obstructive sleep apnoea and make use of a CPAP machine, using this for a couple of weeks prior to your procedure can be beneficial. Please bring your CPAP machine to hospital as this may have to be used after the procedure. 

Smoking should, ideally, be stopped at least 6 weeks prior to your procedure, but, any period of smoking cessation prior to your procedure will be beneficial in the prevention of complications. 

Alcohol consumption should, ideally, be avoided at least 24 hours prior to your procedure and none should be taken after your procedure while you are still taking pain medication.

What to expect on the day of your procedure?

One of our anaesthesiologists will need to see you prior to your procedure, where they will ask you some questions with regards to your health, examine you and may/may not order some other special investigations (ECG, blood tests, chest X-ray). Every effort will be made to see you in the ward prior, but sometimes this may not be possible due to circumstances out of our control and you will be seen in the theatre waiting area before the procedure. This pre-operative consultation involves a discussion and examination and is a vital step in your overall anaesthetic care. During your procedure the anaesthesiologist will be present and monitor you throughout.

Once the surgery is complete you will be moved to the theatre recovery room where you will remain under the care of your anaesthetist for 20-30 minutes for further observations and monitoring. 

Once you are awake and comfortable, you will be transferred back to the ward. The surgeon/anaesthetist will discuss eating/drinking with you. 

Occasionally, depending on your procedure, you will be able to go home the same day. However, you will not be able to drive and arrangements for your collection should be made prior to the procedure day. 

Is anaesthesia safe?

Modern anaesthesia is safe, and a complication arising exclusively from an anaesthetic is very low. However, it is important to realise that complications can occur and an incident-free procedure cannot be guaranteed. Please read the ‘Complications & Risks’ section. 

Any queries in this regard can be discussed with your anaesthetist on the day of your procedure.

Complications & risks

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Your risk of experiencing complications depends on your overall health status. Things like smoking, excessive alcohol consumption, BMI (body mass index) and age may also increase your risk.

Below will give you an idea of your risks:

Very common (more than 1in 10, equivalent to one person in your family): Feeling sick, vomiting, headache, bladder problems, aches and pains, bruising, confusion, memory loss, sore throat

Common (between 1 in 10 and 1 in 100, equivalent to 1 person in a street): Minor lip or tongue damage, itching

Uncommon (between 1 in 100 and 1 in 1000, equivalent to one person in a village): Chest infection, muscle pains, slow breathing, minor temporary nerve damage

Rare (between 1 in 1000 and 1 in 10000, equivalent to one person in a small town): Eye injury (scratch), severe allergy, damage to teeth

Very rare (1 in 10000 to 1 in 100000 or more, equivalent to risks we take on a daily basis): Awareness during your procedure, loss of vision, death, heart attack, stroke

BILLING 

We determine our professional rate based on the training and expertise required to be a specialist anaesthesiologist. In accordance with guidelines set out by our statutory body – South African Society of Anaesthesiologists (SASA) – our fees are determined by us and are independent of any medical aid rates. You will receive a separate account from the anaesthesiologist as our fees are not included in the surgeon or the hospitals fees.

As all medical insurance companies offer cover at different rates, your medical aid will reimburse your anaesthetic account at a rate based on the plan you have selected and the rules of your medical aid fund. This amount can vary from 30% of our fees (most so called ‘100%’ plans) up to the full amount (most ‘300%’ plans). Any amount not covered by your medical aid is for your own account and is your responsibility to pay. You may claim the additional amount from your gap cover (sometimes called ‘top up insurance’) if you have one. Our fees do not change based on your medical insurance or whether or not you have a gap cover. If you are concerned about being able to afford the outstanding amount you can speak to us in order to negotiate a payment plan. Patients without medical aid will be liable for the full account.

The cost of an anaesthetic is determined by pre-operative assessment, the length and complexity of a case, along with other factors including patient condition, pain control techniques and post-operative complications. As it is often difficult to predict in advance how long a procedure will take, it is not possible to give an exact estimate beforehand. You can phone us in advance for a cost estimate based on the average time taken for a particular procedure, but this is only an estimate and will be adjusted according the length of the procedure on the day, as well as the other factors mentioned.

Our cost estimates for anaesthesia do not include additional costs for ICU, pain control techniques, ultrasound, obesity (see note below), blood pressure control, age modifiers, fractures and emergency surgery or cases not booked on routine lists. These codes will be billed as per the South African Society of Anaesthesiologists’ coding guidelines and will increase the cost of your anaesthetic. 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 than 35 you will be charged an additional fee. This is due to the increased complexity and potential complications of these cases, and is standard charging practice.]

All payments must be made within 30 days of account receipt. All interest and legal fees that arise from any accounts that are not paid in full within 60 days will be for your account. 

Please note that treatment of complications arising from anaesthesia or surgery may not be covered by your medical aid. It is still your responsibility to cover these costs. These may include the costs of other medical professionals and additional treatments.

If you have any questions regarding our fees or feel that you don’t understand anything pertaining to your account please contact our office or speak to your anaesthesiologist when you meet them before surgery.