Is there a problem?

Do anaesthetics actually cause problems?

Anaesthetics are not treatments in themselves. Patients do not go into hospital to have an anaesthetic, but to have an operation for which they need an anaesthetic. As a result, any complication is usually regarded as an unwanted effect. Many anaesthetists recognise that most problems in anaesthesia relate to a complex set of factors, including the patient’s condition, the actions of those who provide care, equipment, and the environment in which the operation is performed – the hospital, and the regulatory agencies. Thus, perfect outcome after anaesthesia is unlikely to be achieved in every case.

Patients, too, have changed their thinking about anaesthetics. When any operation carried a high risk of death from shock, blood loss, and infection, patients who did survive counted themselves lucky. For example, Samuel Pepys, the famous writer of the 1600s, celebrated the anniversary of his surviving an operation to remove a stone from his bladder. Today, with certain procedures described as ‘virtually problem-free’, patients are more likely to speak up about any complaint that they have.

One factor that makes it hard to determine if patients have suffered even minor complications is the difficulty with follow-up. Many patients are discharged home the same day. Patients who have had major operations may be sent to a smaller facility to recover. It is therefore more difficult for anaesthetists to see patients postoperatively. Anaesthetists are dependent on patients letting them know if there has been an unexpected problem, or upon the surgeon to relay such information. Unfortunately, such communication frequently does not take place. In some facilities, patients who remain in hospital are routinely visited or given questionnaires about their anaesthetic care. Other facilities telephone patients within a day or two of the anaesthetic and operation to determine how things have gone, or patients are given telephone numbers they can use 24 hours a day in order to contact an anaesthetist.

Another factor to remember is that complications rarely result from the anaesthetic alone. As stated above, patients do not come into hospital to have an anaesthetic but to have an operation. In addition, the patient may have any number of medical problems before the operation. Large studies that have followed-up patients after anaesthesia and surgery have shown that the two factors which are responsible for approximately 90 per cent of deaths postoperatively are the patient’s disease(s) and the surgical operation.

Although an anaesthetist may be able to influence a patient’s condition through careful preoperative assessment and management, the same is not possible for the surgical factors. For example, the probability of complications increases with the duration of the surgical procedure. If an operation takes longer than three to four hours, then the patient has a slightly increased chance of developing heart and lung problems. As a general rule, few patients die from the anaesthetic alone. Only about 10 per cent of patients suffer some other kind of anaesthetic-related complication, nearly all of them minor.


If you think something has gone wrong

Although the anaesthetic may not be the major contributor to how you feel after an operation, if you think something has gone wrong with your anaesthetic, then it is very important to sort this out right away. Don’t wait twenty years until you suddenly find that you need to have another operation.

Ask to speak to your anaesthetist or to another anaesthetist. Ask to have the anaesthetic record reviewed and, if possible, get the anaesthetist to show you the record and explain what each notation means.

If the anaesthetist suggests that you have special tests, then have them done. These tests could include those for allergy; for plasma (or pseudo) cholinesterase; or for malignant hyperthermia. Once the results are available, ask to have a copy that you may keep in your purse or wallet, or in the glove compartment of your car.

If your test results are positive, then your anaesthetist may recommend that you obtain a Medic-Alert bracelet or some similar type of medical information system. These kinds of alerting and informing systems are particularly useful if you become incapacitated and are unable to explain your condition to the anaesthetist or to other doctors.

Above all, do not be afraid to find out what happened. Some patients worry for years that ‘something dreadful happened to me during my anaesthetic’, and put off having another needed operation. Visiting an anaesthetist and having the previous worrying events explained and demystified has freed these patients from unnecessary concerns.