Health Report: Out for the count?
Anaesthetics have long been used to keep us unconscious
and pain-free during operations, but times are changing. Nicola
Gill looks at the increasing phenomena of how and why more of us
are staying awake during surgery.
Sheila Hope lies on her back
on the operating table and stares up at the ceiling lights, as the
surgeon performing her knee operation makes an incision in her
skin, then begins his exploratory surgery of the ligaments around
her kneecap. She doesn't flinch but she can feel a tugging and
prodding sensation. She can also hear everything the operating team
is saying in her fully conscious state.
Sheila is one of a new wave of patients having operations with a
local anaesthetic that would previously have been unthinkable
without a general. "I was scared when the anaesthetist told me
I would be fully awake," says Sheila, 44. "But when he
explained that I would bounce back much quicker afterwards and have
none of the side effects of a general anaesthetic, I could see the
advantages."
Anyone over 50 will recall when the overpowering smell of any
hospital was the pungent aroma of ether. Today ether is consigned
to the history books. Sophisticated modern drugs work by
suppressing the central nervous system and there is greater use of
local and regional or very light general anaesthetics. Intravenous,
rather than inhaled, drugs also allow much finer tuning of dosages,
as well as minimising side effects and recovery times. All of this
means fatalities from anaesthetic are now rare - fewer than one in
every 150,000 of the four to six million procedures carried out
each year in the UK.
Dr Peter Venn, of the Royal College of Anaesthetists, believes the
role of anaesthetists is vastly underrated by the general public,
and says that while most people believe their surgeon is the
pivotal medical person in any operation, it is the anaesthetist who
plays the biggest role. "Surgeons are very specialised in what
they do but we are responsible for all the medication for your
operation. It is anaesthetists who run most intensive care units
and we are also in charge of all the high-tech machinery that you
see when you go in for surgery."
Dr Venn says one of the biggest changes in most people's
experience of the NHS in the last 20 years - the introduction of
day surgery for operations that would previously have needed a stay
of several days - is also down to improvements in anaesthetics.
"Shorter-acting drugs that wear off more quickly, and
operations being carried out under local anaesthetics rather than
generals, all mean people can leave hospital sooner, feel less side
effects, and that we can safely operate on much sicker and older
patients."
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