Gynaecological Surgery

Anaesthetic Consultations

Most patients will be seen by their Anaesthetist either on the day of surgery or the night before. If you have had problems with anaesthesia in the past, if there is a family history of significant anaesthetic problems, or if you have significant medical problems, you should see your Anaesthetist at an earlier time. Your Gynaecologist may refer you or you can make an appointment personally by ringing 8273 5666.

Fasting

Fasting prior to surgery is necessary to reduce the risk of inhaling stomach contents. You should not have any solids for at least 6 hours prior to surgery. Clear fluids may be consumed up to 2 hours prior to surgery.

This means solids up until 2am and a glass of water or cordial (not milk, tea, coffee or orange juice) may be consumed before 6 am if your surgery is in the morning, or a light breakfast up until 7am and clear fluids up until 11am if your surgery is in the afternoon.

Pre-Medications

Pre-medication is medicine which is used to reduce anxiety prior to surgery. With current anaesthetic practice only those patients who feel particularly anxious receive a pre-med. The drugs most commonly used are Temazepam or Midazolam – short acting sedative drugs related to Valium. This is given in a liquid or tablet form, taken orally. Day surgery patients recover more rapidly without a pre-med.

Anaesthetic Techniques for Gynaecological Surgery:

General Anaesthesia

This is the most commonly used technique for all forms of gynaecological surgery. It is essential for laparoscopic surgery. Most general anaesthesia involves insertion of an intravenous needle and administration of intravenous drugs to induce anaesthesia and provide pain relief. Anaesthesia is generally maintained by breathing anaesthetic gases or further intravenous anaesthetic drugs. More major surgery involves insertion of a tube into the airway after you are asleep and using a ventilator to maintain breathing. This tube is removed prior to awakening. It may contribute to a sore throat.

Other common side effects of general anaesthesia include nausea and drowsiness. Rare side effects of general anaesthesia include severe allergy to anaesthetic drugs – these occur in approximately 1 in 20,000 patients. Other side effects relate to patients’ medical conditions and need to be discussed on an individual basis. If you have specific concerns regarding anaesthesia please discuss them with your Anaesthetist prior to surgery.

Spinal and Epidural Anaesthesia

Some gynaecological operations can be performed using spinal or epidural anaesthesia. With this technique you have local anaesthesia which produces temporary numbness and loss of movement below the waist. This may be combined with sedation. This is mainly used in elderly patients or those with medical problems. It may also be used at patient request if the surgery is suitable for this form of anaesthesia. Epidurals may be combined with General Anaesthesia in major cases for post-operative pain management.

Local Anaesthesia and Sedation

Minor procedures of the vagina and cervix may be performed using local anaesthesia and sedation. Sedative and analgesic drugs are administered intravenously by the Anaesthetist. Local anaesthesia is injected by the surgeon. The sedative drugs induce a state of calm relaxation, marked analgesia and amnesia. With the appropriate surgery and careful sedation techniques, patients may have no recall of the surgery. The additional benefit is a more rapid recovery with very few side effects such as nausea.

Pain Relief

The form of pain relief varies with the type of surgery and whether you stay in hospital overnight.

Most day surgery patients will receive a combination of local anaesthetic, short acting intravenous analgesia, Panadol/codeine, oxycodene/ paracetamol tablets and sometimes an anti-inflammatory suppository or tablet.

Major gynaecological surgery may receive intravenous analgesia or analgesia injections with Pethidine or Morphine in combination with Panadol/Codeine tablets. Intravenous analgesia may be administered with a PCA machine – Patient Controlled Analgesia.

This is a very effective technique which will be shown to you prior to surgery, if appropriate to your surgery.

Regular Medications

Most regular medications may be continued on the day of surgery – especially blood pressure, heart and asthma medications.

Medications which should be stopped are listed below:

• Diabetes – no diabetes tablets or insulin on the morning of surgery
• Aspirin – none for 10 days prior to surgery
• Warfarin – none for 3 days prior to surgery – discuss this with your Anaesthetist or Surgeon/Specialist

If you have any queries regarding medications please phone 8273 5666.

Post-Operative Problems

If you have problems which may be related to your Anaesthesia you should contact your anaesthetist for further advice, contact us on 8273 5666.

Problems which are likely to be due to the surgery should be referred to your Gynaecologist.