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WHO ARE ANAESTHETISTS?

All members of Anaesthesia Associates are specialist anaesthetists. Specialist anaesthetists are fully trained medical specialists holding a Fellowship awarded by the Australian & New Zealand College of Anaesthetists (F.A.N.Z.C.A.) or equivalent College. This qualification is awarded when, after obtaining a medical degree and completing at least three years of general hospital training, the anaesthetist completes five or more years of intensive specialist training and passes higher level examinations.

All anaesthetists are encouraged to attend continuing education seminars to upgrade their skills and knowledge of new drugs, electronic equipment and techniques. Most are also members of the Australian Society of Anaesthetists which publishes its own journal and stimulates research into all aspects of anaesthesia.

The primary goal of your anaesthetist is your safety. The level of safety patients can expect in Australia is amongst the highest in the world and is almost exclusively due to the efforts of the College of Anaesthetists and the Society.

Your anaesthetist will be present with you throughout your procedure and will be carefully monitoring your vital functions including your responses to the stress of anaesthesia and surgery. Judgements will be made continuously and the management of your anaesthetic will be adjusted accordingly. Your anaesthetist will then escort you to the recovery room after your operation and, in conjunction with the recovery room staff, will supervise your recovery period to ensure that you are as comfortable as possible. In total your anaesthetist will spend more time looking after you while you are in the operating suite or procedure area than any other single person.

PREPARING FOR YOUR ANAESTHETIC AND WHAT YOUR ANAESTHETIST MIGHT WANT TO KNOW:

There are several things that you can do to improve your general condition prior to your procedure. These include:

Cease smoking as soon as possible, ideally six weeks prior to surgery, and reduce alcohol consumption.

Continue regular medications (such as drugs used to control high blood pressure) which have been prescribed for you. Do not take un-prescribed aspirin for 14 days prior to your operation. Paracetamol may be used.

Notify your surgeon or anaesthetist of any medical problems, such as heart disease or severe asthma well in advance, as your anaesthetist may wish to see and examine you before your admission to hospital.
If you are anxious about anaesthesia you should make an appointment to consult your anaesthetist in his consulting rooms before admission to hospital. This could provide you with the information necessary to reduce your anxiety.

You may be visited by your anaesthetist before the operation and asked about your health and medical history. You should give your anaes-thetist information about your overall health, recent illness and previous operations, any abnormal reactions or aller-gies to foods, drugs (medicines) or to any other substance, any previous untoward reactions to anaesthesia by you or other direct family members, any history of asthma, lung or heart problems or any other medical conditions, the cur-rent drugs you are taking including birth control tablets, whether you smoke or drink alcohol, and whether you have loose teeth, bridgework, caps, plates or dentures. Bring all your medications, any recent X-rays or blood test results to the hospital with you.

WHY YOU MUST NOT EAT OR DRINK BEFORE SURGERY?

Under normal circumstances your body prevents the acidic stomach contents from entering and damaging your lungs. When you are unconscious this protection is lost. It is important therefore to have an empty stomach to reduce the risk to the lungs. You should therefore have no food (including lollies and chewing gum) or drink for up to six hours before your operation. Some patients need medication preoperatively and this can be taken with a sip of water under the direction of your anaesthetist.

If your period of fasting is inadequate your operation may be postponed for your own safety.

WHAT FORM OF ANAESTHETIC WILL YOU HAVE?

Your anaesthetist may prescribe a "premedication" (injection, tablets, or medicine) to help you relax and make you drowsy before your operation. On arrival in the operating suite, various monitoring devices such as cardiograph, blood pressure cuff and oximeter (a probe put on your finger to measure the oxygen in the blood) will be attached to you in order to monitor the way your body will react to the anaesthesia and surgery. You will then have either "General Anaesthesia", "Regional Anaesthesia", or a combination of these.

In General Anaesthesia the anaesthetist will inject a drug into a vein either through a needle or a small cannula which may have an intravenous infusion attached. This will make you unconscious quickly. In some cases a face mask may be used to allow the breathing of oxygen or oxygen and an anaesthetic gas. Once you are unconscious other drugs are administered to keep you anaesthetised. The doses of these drugs will be continuously adjusted to maintain an appropriate level of anaesthesia. A tube may be inserted through your mouth into your windpipe after you are asleep. This is usually removed well before you wake up.

In Regional Anaesthesia, a local anaesthetic is injected near a group of nerves to make an area of your body numb. You may remain awake or receive sedatives to make you drowsy. Some sensations such as pressure may be felt but there will usually be no painful sensation. If unpleasant sensation is felt your anaesthetist may take additional steps to make you more comfortable. The area being operated on will be screened off so you cannot see what is happening. This form of anaesthesia includes epidurals (which are used for the relief of pain in labour and for Caesarean section and major orthopaedic procedures), spinals (which are used for prostate surgery), and injections to numb the eye during cataract surgery.

AFTER SURGERY:

When the operation has been completed, your anaesthetist will reverse the anaesthetic effects to wake you up and then transfer you to the recovery room. Trained and experienced nursing staff, under the supervision of the anaesthetist, will continue to monitor your vital functions until you are fully awake. To assist this process you will be given oxygen to breathe via a plastic mask. If you have pain or nausea from your operation, you will receive medication to help control it. When you are fully awake and comfortable you will be taken back to your own room. Many operations can now be performed on a "day only" basis where you can go home the same day if you are fit to do so. New short acting anaesthetic drugs and improved surgical techniques make this possible. If you go home on the day of your procedure you must be accompanied by a responsible adult and must not drive a car, make important decisions, use dangerous equipment or sign any legal documents for 24 hours.

WHAT COMPLICATIONS OF ANAESTHESIA CAN OCCUR?

It is important to realise that the vast majority of anaesthetics are quite uneventful and that most complications of anaesthesia, when they occur, are minor and temporary in nature. The more serious complications fortunately occur only very rarely.

The commonly occurring side effects or complications of anaesthesia include post operative nausea and vomiting, dizziness, sore throat, blurred vision and shivering.

Other complications, which occur much less frequently, include bruising, pain, or vessel injury at the site of injections, temporary difficulty breathing, temporary nerve damage, muscle pains, asthmatic reactions, headache, awareness (especially with Caesarean Section and emergency procedures), damage to teeth and dental prostheses (including bridgework and caps), lip and tongue injury, temporary difficulty in speaking and epileptic seizure.

Very rare complications which have been reported in association with anaesthesia include stroke, severe allergic or sensitivity reactions, brain damage, kidney failure, liver failure, lung damage, paraplegia, quadriplegia, death, permanent nerve or blood vessel damage, eye injury, damage to your larynx (‘voice box’), and vocal cords, pneumonia and infection from blood transfusion. If you require more detail regarding your particular situation, you must discuss this with your anaesthetist prior to the administration of your anaesthetic. This is best done at the pre-anaesthetic consultation. If you feel you have any serious problems then you should contact your anaesthetist prior to coming into hospital to make special arrangements.

PAYING YOUR ANAESTHETIST’S ACCOUNT:

The services provided by your specialist anaesthetist are provided after referral from your surgeon, gynaecologist, physician or dentist and, as with referral to other medical specialists, these services attract a fee. The anaesthetist will forward an account. You are responsible for arranging payment of this account.

Patients covered by Workers' Compensation Insurance, Third Party Insurance, the Dept. of Veterans' Affairs or those who do not hold Australian resident status should discuss their situation with their anaesthetist. If you are not included in one of these categories then you may be entitled to benefits from Medicare. Not all procedures or operations are covered by Medicare however.

If you are covered by Medicare then, after paying the account, you can receive a rebate (cash or a cheque payable to you) from the government through Medicare and from your private fund if you are a member. Alternatively you can approach Medicare and your fund to make "pay doctor" cheques to which you will need to add your own payment to cover the full fee.

The need to make a personal additional payment (the “gap”) arises because, the Federal Government, through its Medicare legislation, controls the size of the rebate you are allowed to receive from Medicare & your private fund . The result is that your anaesthetic fee will be fully covered on only rare occasions. In fact, sometimes the amount the Government is prepared to rebate to you may be only one third to one half of the actual fee.

Regardless of which hospital you attend, the size of the shortfall or "gap", for which the government prevents you being covered, is usually between $150 and $600. For some procedures which require unusually long or complicated anaesthesia the shortfall may be greater than this.
The reasons for this “gap” are many and complex but mostly relate to the effects of inflation since 1972 (when the rebates did cover full fees charged), the relative value of anaesthesia services, and the government reductions in your Medicare benefits relative to inflation since then.

The term "schedule fee" is the name used by the government to refer to the maximum benefit, or rebate, it allows you to receive. It is determined unilaterally by the government and is not an arbitrated or "agreed" fee as some people believe.

If you feel you may have difficulties with the shortfall, or you would like more information about the "gap" for your own anaesthetic, you should discuss the matter with your anaesthetist prior to your operation.
Anaesthetists as a group are most concerned about the unfair and inadequate rebates the government has allowed you for anaesthetic services and will do their best to assist you.

CONCLUSION:
The anaesthetist to whom you have been referred will be looking after you personally. As such you should feel free to discuss any matter you consider relevant to your care with him or her at any stage. It is best however if any concerns you may have are resolved before any anaesthetic agents are given to you.

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