ANAESTHETIC INFORMATION FOR GASTROSCOPY, ERCP, COLONOSCOPY AND BRONCHOSCOPY
It is important to read this information carefully before seeing your anaesthetist. The purpose of this website is to help you to understand your anaesthetic and to assist you in making informed decisions about your care. It contains a lot of information and you may need to read it more than once. Unfortunately, this amount of information is necessary to have you well informed. If you would like to, it is a good idea to discuss this information with a member of your family or a friend. The information provided is of a general nature and does not take your individual circumstances into account. It cannot replace specific advice given to you by your own anaesthetist. If you have any questions or concerns, or there is anything don't understand, talk to your anaesthetist.
In Australia, sedation for these procedures is usually provided by specialist anaesthetists or trainee anaesthetists under the supervision of specialist anaesthetists. However, this is not always the case. You should feel welcome to ask about the qualifications of the person sedating you for these procedures.
WHAT IS A GASTROSCOPY?
A gastroscopy is a procedure where your doctor uses a special flexible fibre optic scope that combines a light source and camera to produce pictures on a television screen. This scope is passed through your mouth to look at the inside of your oesophagus (the tube between the mouth and the stomach), stomach and the first part of your small intestine. Air is used to help your doctor to see well. A gastroscopy may include some surgical procedures, stretching of a narrowing, or taking small tissue samples for testing.
WHAT IS AN ERCP?
An ERCP is a similar procedure to a gastroscopy but uses a longer scope, which goes further down into the small intestine and can be used to place dye into the tubes of the pancreas and the tubes to the liver and gallbladder. This dye can be seen on X-ray. An ERCP can be used to find and remove gallstones, which can block the tubes, or to fix narrowings.
WHAT IS A COLONOSCOPY?
A colonoscopy is a procedure where your doctor uses a special flexible fibre optic scope that combines a light source and a camera to produce pictures on a television screen. This scope is passed through your back passage to look at the inside of your large intestine. The intestine is a soft tube and air is used to keep the tube open and allow your doctor to see well. A colonoscopy may include some surgical procedures such as removing a polyp (a type of growth inside the large intestine) or taking tissue samples for testing.
WHAT IS A BRONCHOSCOPY?
A bronchoscopy is a procedure where your doctor uses a special fibre optic scope that combines a light source and camera, which gives a picture on a television screen. This scope is passed through your nose to look at the inside of your larynx (voice box), trachea (windpipe) and airways in your lungs. A bronchoscopy may include some surgical procedures or taking small tissue samples for testing.
WHAT IS A GENERAL ANAESTHETIC?
The purpose of an anaesthetic is to remove the pain or awareness of an operation or procedure. There are a number of ways in which your anaesthetist can do this. Your anaesthetist will provide the type of anaesthetic most suited to your needs. This decision is based on a balance between your state of health, the specific risks and benefits for you, the type and length of procedure and your preference.
In addition to removing the pain or awareness of an operation, your anaesthetist looks after your general well being during and after your procedure. This may include giving intravenous fluids and, when required, blood transfusions to replace bloodloss caused by the surgery or the use of drugs to maintain optimal levels for blood pressure, heart rate and rhythm and breathing. Your anaesthetist also manages your postoperative pain relief. A general anaesthetic is given using a combination of drugs that are injected into you and gases that you breathe. It is used to make you unconscious in a carefully controlled way.
WHAT IS SEDATION?
Most gastroscopies, ERCPs and colonoscopies are performed using sedation. Sedation is a type of anaesthetic using injected drugs to make you sleepy, but not as deeply asleep as a general anaesthetic. The anaesthetist injects these drugs into a vein intermittently throughout the procedure to control the depth of sleep. Sedation can be used for a large number of investigations and procedures, often in combination with local anaesthetic injections, which make part of the body go numb. It is best suited to shorter, less painful procedures, but can also be used for some types of larger operations. It has advantages over a general anaesthetic in that it may be safer, causes less nausea or vomiting, and allows quicker recovery. It is not unusual for patients receiving sedation to wake up during the procedure and to be aware of what is going on around them. This is common and should not be of concern. If you are worried, you should discuss this with your anaesthetist. Most patients do not remember being awake after the procedure, but some patients do experience recall.
WHAT SHOULD YOU DO BEFORE YOUR ANAESTHETIC?
• You will need to follow the instructions your treating doctor gives you.
• You will need to fast before your anaesthetic. This means no food or drink, not even water. You need to fast for at least four hours and for some operations even longer. Your treating doctor will let you know how long you need to fast for. If you don't fast, there is a risk you will vomit while under the anaesthetic and that this material will go into your lungs.
• Keep taking your regular, prescribed medications, but remember to let your treating doctor or anaesthetist know what you are taking. It is especially important to take medication to control your blood pressure, asthma or angina on the day of the anaesthetic. If you are diabetic you will need to adjust your medications because of the surgery and must ask your treating doctor or anaesthetist what to do before the day of your procedure.
• If you are taking blood thinning drugs (anticoagulants) such as aspirin, warfarin, plavix, iscover, fragmin or clexane, you need to talk to your treating doctor or anaesthetist about whether you need to alter these medications before the operation. Some of these may need to be altered weeks before you can have the procedure.
• Stop taking herbal and alternative products for at least two weeks, as some of these products may interfere with the anaesthetic, blood clotting and blood pressure.
• You will need to tell your anaesthetist about all the drugs you take, including recreational drugs and alcohol, as these too may interfere with the anaesthetic or alter how much anaesthetic you need.
• Let your anaesthetist know before the procedure, if you have any health problems, especially lung or heart problems, or problems with anaesthetics in the past. You will receive better care, if your anaesthetist has all the information.
• Tell your anaesthetist if you are pregnant or may be pregnant.
• It is best to stop smoking for as long as you can before your anaesthetic.
• If you object to blood transfusions you should let your treating doctor or anaesthetist know. Donated blood is carefully screened, but the risks of infection or reactions cannot be totally eliminated. Your doctors will only consider giving you a blood transfusion if the benefits to you outweigh the risks.
• Your anaesthetist will usually see you on the day of your procedure, if you have any concerns or questions you would like to discuss before this, you should contact your anaesthetist prior to the day of the procedure.
WHEN YOU SEE YOUR ANAESTHETIST
When you see your anaesthetist on the day of your operation, you will be asked a number of questions about your general health, medical history, family medical history, dental history, anaesthetic history, especially any problems with past anaesthetics, medications and allergies. You will also be asked about how long since you last ate or drank. Bring all the medications you are taking with you to show your anaesthetist. It is helpful if you bring a list of the medications and doses you take as well.
Your anaesthetist will also collect personal details such as your name, date of birth, address, health fund and Medicare details, and motor vehicle or worker's compensation information if appropriate.
The personal information collected by your anaesthetist is used for the purposes of providing you with anaesthetic care, referral and discussion with other health care providers looking after you, billing and medical indemnity purposes. Government Privacy Legislation protects all the information collected.
Your anaesthetist will also perform a physical examination, concentrating on your heart and lungs.
Your anaesthetist will discuss the anaesthetic with you, including the associated risks, the usual side effects you may experience. You will have the opportunity to ask questions and are encouraged to do so.
Your anaesthetist may order a medication to relax or calm you before the procedure. Usually this is not necessary, especially when you are having day surgery, as this type of medication may keep you drowsy for longer and may delay your going home. For children, local anaesthetic cream may be used to reduce discomfort at injection sites and in some cases, patients may have their anaesthetic started by breathing gases instead of being given an injection of an anaesthetic drug.
If you are having a bronchoscopy, gastroscopy or ERCP, a small amount of local anaesthetic may be sprayed onto the back of your tongue and throat to make the passing of the scope more comfortable.
When you have a colonoscopy it is common to be given oxygen via a facemask. A special mouthpiece that allows oxygen to be given is commonly used for bronchoscopy, gastroscopy and ERCP.
DURING YOUR ANAESTHETIC
During the anaesthetic, your anaesthetist remains with you and monitors your anaesthetic including your breathing, blood pressure, heart and the level of anaesthetic. Your anaesthetist adjusts your anaesthetic as required.
Your anaesthetist routinely uses an intravenous line (drip), a pulse oximeter, blood pressure monitor and may use an ECG during your anaesthetic.
Intravenous Line. An intravenous line or drip is a small plastic tube or cannula that is inserted into a vein. A vein is a blood vessel that carries blood back to the heart. Your anaesthetist uses the drip to give you drugs or fluids during and after your anaesthetic. Risks associated with an intravenous drip include pain and bruising at the insertion site that usually resolves in a few days and infection.
Pulse Oximeter. A pulse oximeter is a small peg that your anaesthetist places on your finger, toe or earlobe to monitor your pulse and the oxygen level in your blood.
Blood Pressure Monitor. Your blood pressure is monitored via a cuff placed around your upper arm. The cuff can be inflated either manually or automatically in order to measure your blood pressure.
ECG. An ECG, or electrocardiograph, monitors the electrical activity of your heart. It is not invasive and small electrodes or leads are connected to sticky patches that are placed on your chest and limbs. Your anaesthetist uses the ECG to monitor the rate and rhythm of your heart. An ECG also provides information about whether enough oxygen is getting to the heart, past damage to the heart and how well your heart is functioning. The only side effect of an ECG may be some skin irritation from the sticky patches.
All needles, syringes, drugs for injection, intravenous equipment and fluids are sterile items that are used for one patient only. Other items of anaesthetic equipment are either single patient use, are sterilized before each use in accordance with Australian Standards, or are protected by viral and bacterial filters. These measures have been shown to be effective in preventing cross infection and it is extremely unlikely that cross infection will occur.
AFTER YOUR ANAESTHETIC
When the procedure is finished, you will be taken to the Post Anaesthetic Care Unit. You will remain in this specialized area for at least half an hour while you recover from your anaesthetic. It is standard to be given oxygen to breathe and for monitoring to continue at this time.
SIDE EFFECTS
Dizziness, drowsiness, headache and blurred vision are common and usually wear off quickly. Occasionally muscle weakness can be noticed immediately after the anaesthetic, and may cause difficulty with breathing. Occasionally patients wake up feeling agitated or teary. These problems recover quickly. Swelling and bruising at injection sites are common and recover within a few days.
Short-term memory loss is common. Most patients do not remember being awake in the Post Anaesthetic Care Unit. Short-term memory loss usually recovers by the next day, but may last longer in patients who undergo larger procedures under general anaesthetic or who are elderly.
Nausea and vomiting are uncommon following sedation. However if you have a general anaesthetic nausea and vomiting are common and occur in up to 30% of patients. There is a lot of individual variation, with some patients more likely to experience these side effects. If you have had problems with nausea and vomiting after anaesthetics in the past, tell your anaesthetist, as there are ways to tackle this problem.
Rarely your anaesthetist may need to place a tube in your airway to help maintain your breathing while you are anaesthetised. If this is required it may cause a sore throat or hoarse voice, which usually recovers within 24 hours.
RISKS AND COMPLICATIONS
Anaesthetics in Australia are among the safest in the world. For a fit and healthy person, sedation and general anaesthetics are no more hazardous than a couple of short trips in the car. This level of safety is because, in addition to being a medical practitioner, your anaesthetist has completed a high level of specialist anaesthetic training and participates in continuous education and other professional development. Your anaesthetist uses modern drugs and modern anaesthetic equipment that reduce your risks further. These risks may be higher for people who are less healthy, especially for those with heart or lung disease and those undergoing longer, more complex procedures.
However, as with driving a car, it is not possible to totally eliminate risk. Although very uncommon, anaesthetic complications do occur and these complications may be serious.
Death or serious complication. This may include conditions such as: heart attack; stroke; brain damage; fitting; pneumonia; DVT (blood clot in the leg) and pulmonary embolus (blood clot in the lungs); major allergic reaction; irregular heart beat; kidney, lung or liver failure; permanent nerve damage; permanent damage to voice; eye damage; and infections or reactions to blood transfusions. Even though many patients are worried about this, the chance of dying or having a serious complication because of an anaesthetic is extremely low. For a young healthy person, the chance is so low that it is not possible to measure it accurately. For those with poor general health, especially heart or lung disease, the risks may be greater. You should discuss your individual risks with your anaesthetist.
Postoperative pain. Your anaesthetist aims to have you as comfortable as possible following your procedure. Most people do not need any pain relief following the procedure. However, following a colonoscopy there can be abdominal discomfort until residual gas has been passed.
Damage to teeth. Every care is taken by your anaesthetist not to damage teeth (including false teeth, capped teeth and bridges). Although dental damage is uncommon, it is important to understand that with any anaesthetic there is a small risk that teeth may be damaged. Although very uncommon, injury may also occur to the larynx (voice box), vocal chords, lips or tongue.
Incidental injury. Very rarely, a patient who is unconscious or drowsy is injured accidentally. For example, falls from operating table, eye damage, pressure injury, stretching injury, back injury associated with being turned, or unintentional burns.
WHEN YOU GO HOME
Anaesthetic drugs can remain in your system and impair your judgment for 24 hours after an anaesthetic.
• Don't drive a car, operate dangerous equipment or tools, make important decisions, sign legal documents or drink alcohol for at least 24 hours after the anaesthetic.
• Arrange for a responsible adult to accompany you home and stay with you for 24 hours, rest quietly at home and arrange for someone else to care for small children. Make sure you have a clear understanding of which medications to take.
• If you have any concerns call your anaesthetist, treating doctor or the facility at which you were treated.
OUT OF POCKET COSTS
If you are treated as a private patient, there will be an out of pocket cost with most anaesthetic services. There are no standard charges, each anaesthetist sets his or her fees. The level of the ‘gap' or out of pocket cost will also depend on whether or not you have Private Health Insurance, the type of insurance you have, the type of procedure you are undergoing and how long the procedure takes. You should ask your surgeon or anaesthetist about the cost of your anaesthetic.
This information has been prepared by Dr G. Eastaugh MMBS, FANZCA and Dr L Eastaugh MBBS, MBA to give you a better understanding of your anaesthetic, but cannot replace professional advice regarding your individual circumstances. It is important that you are satisfied that you understand the information regarding both your procedure and the anaesthetic. If you are unsure or concerned about any of this information you should talk to your anaesthetist. Your anaesthetist can assess you and discuss your risks at the pre anaesthetic visit or earlier if required.
Copyright. © Tellwave Pty Ltd 2003 (Revised August 2007). All Rights Reserved.
Except as expressly stated otherwise, you are authorized to view, copy, print and distribute the content of the preop.com.au Web site subject to the following conditions: (i) it is used for informational, non-commercial purposes only; (ii) any copy or portion must include the Tellwave Pty Ltd copyright notice above and acknowledge authorship; (iii) no modifications are made; and (iv) Tellwave Pty Ltd reserves the right to revoke such authorization at any time, and any such use shall be discontinued upon written notice from Tellwave Pty Ltd.