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Thread: Local or general anaesthetic for day surgery?

  1. #1
    Master Rocket Man's Avatar
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    Local or general anaesthetic for day surgery?

    A Consultant reviewed my CT scan this morning and has booked me in for surgery tomorrow to re-unite a badly fractured scaphoid bone in my left wrist.

    First time I've ever gone under the knife and I'm a bit nervous. Should I go for local or general anaesthetic? What questions should I ask the anaesthetist tomorrow to help me decide? Thanks for any help or advice you can give.

  2. #2
    Master Onelasttime's Avatar
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    Quote Originally Posted by Rocket Man View Post
    A Consultant reviewed my CT scan this morning and has booked me in for surgery tomorrow to re-unite a badly fractured scaphoid bone in my left wrist.

    First time I've ever gone under the knife and I'm a bit nervous. Should I go for local or general anaesthetic? What questions should I ask the anaesthetist tomorrow to help me decide? Thanks for any help or advice you can give.
    Unless they've already told you it's a general, it will be a local. If it's a general anaesthetic you should be on a water-only diet after 9pm until the operation. Or at least that was my experience 6-7 years ago.

  3. #3
    Master Franco's Avatar
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    It is usually a regional anaesthesia, with mild sedation. This is detailed enough:

    http://sussexhandsurgery.co.uk/downl...0Fractures.pdf

  4. #4
    Master Rocket Man's Avatar
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    The Consultant said it would be general and that I shouldn't eat anything after 10pm because my surgery will be in the afternoon. But later on the doctor who checked me in said that I could choose local if I wanted and that I should discuss it with the anaesthetist tomorrow.

    - - - Updated - - -

    Quote Originally Posted by Franco View Post
    It is usually a regional anaesthesia, with mild sedation. This is detailed enough:

    http://sussexhandsurgery.co.uk/downl...0Fractures.pdf
    Very helpful, thank you!

  5. #5
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    I had a trapeziectomy and had a regional anaesthetic and nerve block (which helps with pain relief) which worked really well although arm doesnít feel real for a few hours after.

  6. #6
    FWIW I had mine done under local, primarily because I didn't want an overnight stay but also it was quite interesting to watch the proceedings. Having said that, the anaesthetist ok'd it and I'd always go with their advice.

    R
    Ignorance breeds Fear. Fear breeds Hatred. Hatred breeds Ignorance. Break the chain.

  7. #7
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    I would take a local over a general anyday.

    If you are awake you are capable of hearing and they speak to you - if it's a general you are a piece of meat.

    Good luck whichever you choose.


    B

  8. #8
    Grand Master Dave E's Avatar
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    I'd take the general, thanks. I really don't enjoy being a spectator at any surgery, particularly if I'm on the end of the scalpel (but then I really don't like medical stuff).

    I've had day surgery under general in the past, and I found the experience fine (to the extent that you can find any surgical procedure fine).
    Dave E

    Skating away on the thin ice of a new day

  9. #9
    Grand Master number2's Avatar
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    General, I'm not in the least squeamish but why bother being awake, let the professionals crack on and do their stuff.
    Last edited by number2; 10th June 2019 at 22:48.
    "Once is happenstance. Twice is coincidence. The third time it's enemy action."

  10. #10
    As I anaesthetise people for a living the type of anaesthetic will depend firstly on your state of health and any underlying medical conditions. It will also depend on the Anaesthetist as some specialise in regional anaesthesia, others do not.
    In terms of fasting the recommendations we work to are a fast period of 6 hours prior to surgery and clear fluids (water) up to an hour before surgery.
    I notice a forum member describing patients undergoing a general anaesthetic as being a piece of meat. I can assure you that you are not and will be appropriately and safely managed by a professional.
    I would also mention that that the choice of anaesthetic is down to the Anaesthetist. You may be offered a choice if this is deemed suitable but ultimately you will be anaesthetised in the most appropriate way tailored to you as an individual.

  11. #11
    Grand Master PickleB's Avatar
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    RCoA Patient information leaflets...link.

    If you don't have a personal preference, I'd discuss the pros and cons with anaesthetist and ask questions such as "will they need to drill anything?", "what will I see?" and "can I listen to some music?". Depending upon the answers and his advice...then I'd make my choice.

    Myself, I think I'd prefer the regional option, but when I went in for a hernia repair they'd set up for general anaesthesia and I didn't argue.

  12. #12
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    Had a small operation on my feet a while back, which only required a local and meant I could go home soon afterwards. Prior to starting, the surgeon said you won't feel any pain but you might feel some "pulling and pushing". He wasn't wrong, it felt most bizarre. Then he had to roughen up the bone surfaces with a hammer and chisel, that was disconcerting. Given the choice I'd go for the local, but if you're squeamish maybe the general is better.

  13. #13
    Grand Master VDG's Avatar
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    What ODP said. If you're fit and do not have any underlying conditions, personally, I'd go for GA. In and out = new you. Make sure you have someone with you on the day (if poss) and ask for painkillers after the op if the arm is bothering you to make sure you get a rest and comfortable before you go home, which most likely will be on the same day. Very best of luck for tomorrow, it's no biggy you are in a good hands
    Fas est ab hoste doceri

  14. #14
    Grand Master Seamaster73's Avatar
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    I love a general anaesthetic. You never get sleep of that quality naturally.

  15. #15
    I had an ear surgery two week ago in general anaesthesia. If I could choose, I'd choose local like I had 10 years ago. It was fun to see what doctor was doing on a monitor screen. And then there was waking up - it took me good half an hour to fully open my eyes.

  16. #16
    Master raptor's Avatar
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    General anesthesia can have severe side effects
    IF you are unlucky

  17. #17
    Master Rocket Man's Avatar
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    Quote Originally Posted by ODP View Post
    As I anaesthetise people for a living the type of anaesthetic will depend firstly on your state of health and any underlying medical conditions. It will also depend on the Anaesthetist as some specialise in regional anaesthesia, others do not.
    In terms of fasting the recommendations we work to are a fast period of 6 hours prior to surgery and clear fluids (water) up to an hour before surgery.
    I notice a forum member describing patients undergoing a general anaesthetic as being a piece of meat. I can assure you that you are not and will be appropriately and safely managed by a professional.
    I would also mention that that the choice of anaesthetic is down to the Anaesthetist. You may be offered a choice if this is deemed suitable but ultimately you will be anaesthetised in the most appropriate way tailored to you as an individual.
    Thank you for taking the time to write this, it's very reassuring.

  18. #18
    Quote Originally Posted by raptor View Post
    General anesthesia can have severe side effects
    IF you are unlucky
    Though you might never know.

  19. #19
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    Quote Originally Posted by ODP View Post
    As I anaesthetise people for a living the type of anaesthetic will depend firstly on your state of health and any underlying medical conditions. It will also depend on the Anaesthetist as some specialise in regional anaesthesia, others do not.
    In terms of fasting the recommendations we work to are a fast period of 6 hours prior to surgery and clear fluids (water) up to an hour before surgery.
    I notice a forum member describing patients undergoing a general anaesthetic as being a piece of meat. I can assure you that you are not and will be appropriately and safely managed by a professional.
    I would also mention that that the choice of anaesthetic is down to the Anaesthetist. You may be offered a choice if this is deemed suitable but ultimately you will be anaesthetised in the most appropriate way tailored to you as an individual.
    As an anaesthetist, do pain killers have an effect on a general anaesthetic working effectively?

    I had a general once for a back op and it didnít seem to go down as planned (well as far as I thought) Ad I lay there during the anaesthetic I asked how long itíd take to go under & received a laugh & a countdown... I remember just laying there asking if I should be asleep after a while. Lot of puzzled looks & dashing about resulted in some sort of gas mask type thing being shoved on and I seem to remember them pumping something into me as my chest kind of convulsed as I was deep breathing, that went on for a bit then thatís all I remember.

    My theory is they didnít read my notes as I was on a lot of morphine, tramadol and codine. I know it took the nurse finally reading my notes half way through the next day to realise Iíd probably take more morphine in the morning than theyíd loaded into a slow syringe driver for hours of work. He was the only one that seemed to spot it and said about it.

  20. #20
    Administrator swanbourne's Avatar
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    Last time I had a general anaesthetic I suffered a lazy bowel for 2 weeks afterwards, that wasn't pleasant.

    Eddie
    Whole chunks of my life come under the heading "it seemed like a good idea at the time".

  21. #21
    Grand Master Velorum's Avatar
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    I go for local every time. A few times I have gone private mainly because the NHS would only do certain things under a GA where as independents have offered local. GA makes me feel as sick as a dog for days and I absolutely hate it. The affects of a local pass in no time. The bonus is that I find medical procedures very interesting so its great to see whats going on if possible. Unfortunately when I had some work done to my nether regions they erected a screen so that I couldn't.

  22. #22
    Grand Master Der Amf's Avatar
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    A few years ago, coming up to an operation, I found I had developed a real fear of generals. The operation could be done without one, so I was undecided. Talking to the nurse immediately beforehand, I mentioned this. She took a look at what was going to be done and said, you don't want to be around to see that. So one cowardice trumped another, and under I went.

  23. #23
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    Iíve had both. Which I would choose (if given the choice) would 100% depend on the type of surgery Iím having.
    I had my neck cut open to try and find some glass in there and a vasectomy with a local. Both fine as I couldnít see what was going on with either.
    Iíve also had numerous other surgeries and they were all with a general anaesthetic.

  24. #24
    Administrator swanbourne's Avatar
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    It was discovered during routine screening 5 years ago that I have an abdominal aortic aneurysm. It has been regularly monitored and has given no cause for concern until a year ago, when it had grown 0.6cm in a year so I've been on 3 monthly monitoring since then. In the last quarter it grew a further 0.5cm and has now reached a size where surgical intervention is necessary.

    There are two procedures available; up through the femoral artery to insert a stent, which can be done under local anaesthetic and open surgery to remove the aneurysm and replace with a synthetic tube which is carried out under a general. The latter is considered a permanent repair, the former still needs to be monitored.

    I had my heart and lung function assessed by an anaesthetist last week and I'm back at the hospital tomorrow to see which procedure is most suitable. Whichever it is, I'll be closed for a while, recovery can be slow.

    Eddie
    Whole chunks of my life come under the heading "it seemed like a good idea at the time".

  25. #25
    Quote Originally Posted by swanbourne View Post
    Last time I had a general anaesthetic I suffered a lazy bowel for 2 weeks afterwards, that wasn't pleasant.

    Eddie
    That probably was not due to the anaesthetic though.

  26. #26
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    Quote Originally Posted by ODP View Post
    As I anaesthetise people for a living the type of anaesthetic will depend firstly on your state of health and any underlying medical conditions. It will also depend on the Anaesthetist as some specialise in regional anaesthesia, others do not.
    In terms of fasting the recommendations we work to are a fast period of 6 hours prior to surgery and clear fluids (water) up to an hour before surgery.
    I notice a forum member describing patients undergoing a general anaesthetic as being a piece of meat. I can assure you that you are not and will be appropriately and safely managed by a professional.
    I would also mention that that the choice of anaesthetic is down to the Anaesthetist. You may be offered a choice if this is deemed suitable but ultimately you will be anaesthetised in the most appropriate way tailored to you as an individual.


    Sorry John - didn't mean to step on your pipes but it is referenced elsewhere

    https://www.quora.com/Do-surgeons-co...pieces-of-meat

    It was not meant with malice

    B

  27. #27
    Grand Master Seamaster73's Avatar
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    Quote Originally Posted by swanbourne View Post
    It was discovered during routine screening 5 years ago that I have an abdominal aortic aneurysm. It has been regularly monitored and has given no cause for concern until a year ago, when it had grown 0.6cm in a year so I've been on 3 monthly monitoring since then. In the last quarter it grew a further 0.5cm and has now reached a size where surgical intervention is necessary.

    There are two procedures available; up through the femoral artery to insert a stent, which can be done under local anaesthetic and open surgery to remove the aneurysm and replace with a synthetic tube which is carried out under a general. The latter is considered a permanent repair, the former still needs to be monitored.

    I had my heart and lung function assessed by an anaesthetist last week and I'm back at the hospital tomorrow to see which procedure is most suitable. Whichever it is, I'll be closed for a while, recovery can be slow.
    Good luck with this and thank God this was spotted, has been monitored, and will be operated upon. And fingers crossed for a speedy recovery.

    My late father had an aortic aneurysm he knew absolutely nothing about, and despite no ill health whatsoever died suddenly as a result.

  28. #28
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    Quote Originally Posted by swanbourne View Post
    There are two procedures available; up through the femoral artery to insert a stent, which can be done under local anaesthetic and open surgery to remove the aneurysm and replace with a synthetic tube which is carried out under a general. The latter is considered a permanent repair, the former still needs to be monitored.
    Eddie
    My father had the latter. It's a pretty major operation but he was totally fine afterwards, and never had to think about it again, which must be a relief. Good luck for yours.

  29. #29
    Grand Master GraniteQuarry's Avatar
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    Last general I had was around 1990, enjoyed the kip and most vivid memory was waking momentarily in a recovery room with a hot young nurse sitting next to me

    Always been locals since then, as mentioned sitting watching the action is pretty cool.

    Good luck to all, in and out no worries.

  30. #30
    Quote Originally Posted by jameswrx View Post
    As an anaesthetist, do pain killers have an effect on a general anaesthetic working effectively?

    I had a general once for a back op and it didnít seem to go down as planned (well as far as I thought) Ad I lay there during the anaesthetic I asked how long itíd take to go under & received a laugh & a countdown... I remember just laying there asking if I should be asleep after a while. Lot of puzzled looks & dashing about resulted in some sort of gas mask type thing being shoved on and I seem to remember them pumping something into me as my chest kind of convulsed as I was deep breathing, that went on for a bit then thatís all I remember.

    My theory is they didnít read my notes as I was on a lot of morphine, tramadol and codine. I know it took the nurse finally reading my notes half way through the next day to realise Iíd probably take more morphine in the morning than theyíd loaded into a slow syringe driver for hours of work. He was the only one that seemed to spot it and said about it.
    In terms of onset of anaesthesia, this is governed by your arm to brain circulation time so varies. It is also dependant on age and size (generally if you are old and frail you need very little, if you are young and fit you will need a lot more).
    Your analgesia regime would be of more relevance post op as you do build a tolerance if you are a regular opioid user so your requirements for adequate post op analgesia will be higher.
    Your GA would have been maintained by either inhalational volatile anaesthetic agents or possibly a propofol infusion running into your IV.
    With regard to your experience I cannot really comment other than to say the mask placed on your face is a routine and intrinsic part of the very beginning of the anaesthetic and is used to provide pre oxygenation before the anaesthetic agents are given.
    The Anaesthetist would have been aware of your drug regime as these are noted on the anaesthetic chart during the assessment stage which helps form an overall picture of the patient you will be responsible for.

  31. #31
    Quote Originally Posted by GraniteQuarry View Post
    Last general I had was around 1990, enjoyed the kip and most vivid memory was waking momentarily in a recovery room with a hot young nurse sitting next to me
    Sadly not many of those now (unlike the videos).

  32. #32
    Grand Master VDG's Avatar
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    Quote Originally Posted by swanbourne View Post
    It was discovered during routine screening 5 years ago that I have an abdominal aortic aneurysm. It has been regularly monitored and has given no cause for concern until a year ago, when it had grown 0.6cm in a year so I've been on 3 monthly monitoring since then. In the last quarter it grew a further 0.5cm and has now reached a size where surgical intervention is necessary.

    There are two procedures available; up through the femoral artery to insert a stent, which can be done under local anaesthetic and open surgery to remove the aneurysm and replace with a synthetic tube which is carried out under a general. The latter is considered a permanent repair, the former still needs to be monitored.

    I had my heart and lung function assessed by an anaesthetist last week and I'm back at the hospital tomorrow to see which procedure is most suitable. Whichever it is, I'll be closed for a while, recovery can be slow.

    Eddie
    Best of luck with it tomorrow Eddie, it's a tough choice to make given multiple pros and contras for the each option, the good thing is, it was spotted in time and there is a treatment available for it.
    Fas est ab hoste doceri

  33. #33
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    @ Swanbourne Good luck tomorrow.

    I have had both and I was really nervous the first time i had a General ! Once you have had one, there is nothing to be worried about, apart from feeling a bit groggy.

    I have possibly got to have another operation in a month or so , I am going to see a doctor shortly for consultation.

  34. #34
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    I had an ulna collateral ligament stitched back on my thumb under a Biers block, they numb your arm with a pneumatic tourniquet and you canít feel it,weird but awake with no recovery time.

  35. #35
    Master Rocket Man's Avatar
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    ...and I'm back!

    Didn't get a choice in the end, they just gave me general. Now I know what it feels like to go 'out like a light'!

    Took me a fair while to come round but it wasn't unpleasant. The Medical Director was overseeing the surgery so I knew that I was in safe hands.

    I have tramadol for pain management at home, which is also not unpleasant.

  36. #36
    Administrator swanbourne's Avatar
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    After an appointment with the consultant this morning, I'm booked in for open surgery in August.

    Eddie
    Whole chunks of my life come under the heading "it seemed like a good idea at the time".

  37. #37
    Master Rocket Man's Avatar
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    Quote Originally Posted by swanbourne View Post
    After an appointment with the consultant this morning, I'm booked in for open surgery in August.

    Eddie
    I hope it all goes well, wishing you a successful outcome and a speedy recovery.

  38. #38
    Master raptor's Avatar
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    All the best Eddie

  39. #39
    Quote Originally Posted by swanbourne View Post
    After an appointment with the consultant this morning, I'm booked in for open surgery in August.

    Eddie
    All the very best with your op and recovery.

    Tom

  40. #40
    Quote Originally Posted by Brian View Post


    Sorry John - didn't mean to step on your pipes but it is referenced elsewhere

    https://www.quora.com/Do-surgeons-co...pieces-of-meat

    It was not meant with malice

    B
    I've read that, it's not really very helpful or well worded.
    I'm a surgeon, all my patients are people and not pieces of meat throughout the whole process.
    We certainly empathise with patients' problems rather than sympathise, so the emotional attachment is different, but the link to deliver safe and thoughtful care is still there.
    I operated on an 8 yr old yesterday and I treated them as I would my 7 yr old child.
    I would not however operate on my child.
    We are caring.

    Also, you don't see any meat when you fix the scaphoid, it's skin and bones with ligaments nearby.

    :)

  41. #41
    Master Rocket Man's Avatar
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    Just wanted to say that the surgeon who treated me at Lewisham Hospital this week was very empathic and respectful. The Medical Director was overseeing the procedure and he came to speak with me beforehand as well. I certainly felt like I was in very safe hands.

  42. #42
    Grand Master Velorum's Avatar
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    Good to hear it went well Jon.

    Good luck with yours Eddie.

  43. #43
    Grand Master VDG's Avatar
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    Quote Originally Posted by Velorum View Post
    Good to hear it went well Jon.

    Good luck with yours Eddie.
    Hear hear.
    Fas est ab hoste doceri

  44. #44
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    Quote Originally Posted by Seamaster73 View Post
    Good luck with this and thank God this was spotted, has been monitored, and will be operated upon. And fingers crossed for a speedy recovery.

    My late father had an aortic aneurysm he knew absolutely nothing about, and despite no ill health whatsoever died suddenly as a result.
    My father had the same thing, out of the blue whilst we were on a family holiday in Menorca. Went to his room with a sore stomach, found him flat out coughing up blood a few hours later. Air lifted to Majorca son espases hospital (told only 10% chance of survival due to current low blood pressure, the local hospital that diagnosed him could not carry out operation but were able to diagnose him VERY quickly), survived the flight, operated on, stent inserted and made full recovery (over time).

    Travel insurance paid for the air ambulance (£20,000+) and EHIC card paid for the hospital care, not that costs at the time were even thought of but, NEVER travel without insurance or an EHIC card. Son Espases Doctors were gob smacked he made the flight and survived (he had lost a lot of blood). It's a holiday that will never be forgotten.

    I wish you a speedy recovery and am glad it has been spotted early.

  45. #45
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    Quote Originally Posted by swanbourne View Post
    After an appointment with the consultant this morning, I'm booked in for open surgery in August.

    Eddie
    Good to hear you have been monitored closely Eddie. You wouldnít want this condition to catch you unawares. Wishing you all the best with your surgery and a speedy recovery.

    My father had his Aortic Aneurysm repaired via the endovascular route last year and is doing well.

    Dave

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