Any anaesthetists about?

[FlippertyFlopperty]

I'm due to have surgery with a spinal block local anaesthetic. The truth is they terrify me. I'd much rather be put under with a GA. If I speak to the anaesthetist on the day of surgery are they likely to be able to offer me a GA there and then? Thank you.

Depends on the surgery and the hospital. I work in orthopaedics and quite regularly we have to cancel people on the day if they change their mind about anaesthetic type.
GA takes longer and believe me every second of theatre is planned for so if the list is full there won’t be time to change the plan. Or they might have a list full of blocks/spinal and therefore an anaesthetist won’t be prepared for the GA. You also might need further investigations before GA.

best bet: call the admissions clerk and advise you’re concerned about the block and that you’d prefer GA or a discussion with the anaesthetist about your options and they can arrange for you.

i used to be severely needle phobic and I had a spinal block for one of my children’s births, it’s was absolutely fine!

all the best x

Provided there isn't any safety reason why you couldn't and that you've correctly fasted 6h for food 2h for clear fluids, then no

If you're having a hip or a knee replacement, I'm guessing as they're our default anaesthetic types (unless csection), then would recommend spinal and sedation, spinals are amazing pain relief and from a patients perspective sedation is the same as a GA, just tell them you don't want to remember anything and they'll do that

Anesthetic nurse... it depends on any other health problems you may have. For some people it is just far safer to have a procedure under spinal anaesthetic than GA.

GA may be an option for you, but that would be up to your team on the day.

Is it an awake spinal or spinal-sedation? If you are to be sedated you would have little to no awareness of what is going on around you.

I've never known anyone to be cancelled for "it takes too long" perspective in 10y of Anaesthetics (unless you work privately). Takes me no longer to draw up for a GA than a spinal and often it's actually quicker to GA than spinal in the older population with tricky backs....and of course in labour ward cat1 sections are predominantly under GA as quicker than our default spinals

The people we prefer to spinal over GA for comorbidities reasons (frailty/bad lungs/ osa etc) will normally know well in advance that that's the case as we either see in clinic or phone to tell them they aren't suitable for GA. But in general most people can have GAs

Phone preop assessment and ask for a phone call from us in advance as it would be good to have a heads up (but equally we are v adaptable to pt preference I've changed at the last second for those refusing GA etc

Can I jump in and ask if it will be likely my sons surgery will be cancelled on Friday because he has a bit of a cough?

He’s due to have his stoma reversed. No other issues.

I had a spinal for my Hystoscopy a few months back … I’m a bit of a fatty, and the anaesthetist thought it would be best.

It was fantastic .. as well as the spinal, they give you a dose of something from a yellow syringe, I think it’s some kind of sedation, I was high as a kite - singing, and asking for more of the “yellow stuff”

You are awake much quicker.. the only thing I didn’t like was that it took ages to wear off, and I couldn’t head home until I had a wee

Apols my understand of why ops were cancelled when patients changed mind on the day of op re anaesthesia type must be wrong. But I regularly see cancellations on the day for that reason!

Thank you everyone. If I have a spinal can I go home the same day, and if so, will I need someone with a car to take me home and look after me? At pre op they did talk about keeping me in overnight, even for a spinal. Why would this be?

There are so many variables. It depends what the surgery is, how late it finishes. Whether you have feeling back in your legs in time (they will go numb from the spinal), if you need a catheter and if it needs to stay in for a bit. If your pain is under control.

If they've told you you'll probably need to stay in I'd prepare for that. After a spinal it can take several hours to fully regain feeling in your legs.

There are benefits to having a spinal anaesthetic. It offers fantastic pain relief in the immediate post operative period.

Thank you 😊

another anaesthetist... as per @Destiny123 - if the 'usual' plan for that operation is a spinal anaesthetic then that often means there's some advantage to having it done that way, either because of the operation you're having or because of your general health. So long as there's no major contraindication to a GA though then changing your mind is probably fine and no sensible anaesthetist is going to postpone an operation because of that (a GA is often quicker to do than a spinal so pp's suggestion that it'd interfere with the timing of the list doesn't make much sense). Going home on the day depends on you being comfortable, able to walk, pass urine, eat & drink and seem moderately sensible - there are many variables that can influence all of that. How long it takes for the numbness of a spinal to wear off depends on the drugs used, and that depends on the operation. You need to have an sensible adult and wouldn't be able to drive yourself whatever mode of anaesthetic you have.

anaesthetists are always prepared for GAs - they're always the back-up plan even if we're planning a spinal. The preassessment/optimisation processes should be the same whatever anaesthetic is planned. It's not that uncommon to have lists changed at the last minute so we don't know what we're turning up for anyway so we definitely don't turn up expecting to do spinals and refuse to do anything else. GA's are also often quicker than a spinal. Where there's advantage in having a spinal for a particular operation or where there's advantage in avoiding a GA because of the patient's medical condition then we're more persuasive about things, but generally if a patient understands the pros & cons and wants a GA then we're not going to postpone them just for that.

Definitely! The only thing that keeps u in is if the surgeons want you to stay. We have ultra short spinals that last an hour or longer ones which is 2-3h. You're actually potentially even more likely to leave sooner as not groggy/nauseous from the ga

Often can be if they want it under nerve block and havent prewarned us to put on a block-specialist list, as not all of us can do all blocks (esp to the degree of operating on without a ga, rather than to supplement a ga), but all anaesthetists can spinal someone (obv if the op itself is poss to do under spinal n not say shoulder surgery

Totally depends on the day. We don't do elective surgery on anyone with lower resp infections as GAs can make lungs more irritable and risk complications. If totally well in himself, no high temps, going to school, not systemically unwell then may proceed, if chest is clear and heart rate/oxygen levels normal. Otherwise cancel and rebook for 6wks

Sorry realised only answered half the q. You won't be being kept in for the fact you've had a spinal it will either be you have other medical health problems that warrant further monitoring or there's a risk of surgical complications that need monitoring for

Yes you still need to have someone take you home and look after you regardless of what anaesthetic you have

Not an anaesthetist and not sure if this will help you because I don't know why you're not wanting one but I had a spinal block (for c-section) and it really wasn't bad, not at all actually....and I am a massive bloody wimp.

Many people are petrified of the idea of awake surgery, we are used to that and ready to reassure, but having a spinal to watch you're cute little baby be born if different to say having cancer surgery etc from a mental perspective

Thanks.

He’s an inpatient because he has a high output stoma which means he needs 12 hours of TPN and replacement fluids but he of course has obs every 4 hours and his numbers are all normal.

I've had two sections both with spinals, honestly op it's just a scratch! Both times I got told I'd feel a twinge in my right thigh, that's how I knew it was working apparently ! Very strange feeling being so heavy legged but the actually spinal going in itself is nothing I promise

Very often they will give you something to chill you out as well as the spinal. My dad had a spinal for his bladder cancer op & whatever they gave him meant that the moment he was laid down he fell asleep & didn't wake up until they were finishing up on his operation.

I had a spinal for my stitches after labour- I had gone for GA when offered the 2, and the idea of GA terrified me a bit less so I took it! Then they retracted it… BUT the spinal was fab! It was a really positive experience for me and I wouldn’t hesitate to have one again.

Thank you all for your reassuring advice.

The op is over and went well. I went under with GA, which was the Anaesthetists preferred method. The only negative part was coming round from the GA and wondering where on earth I was. That was unsettling but staff were lovely. The Anaesthetist was lovely. I couldn't stop coughing when I was coming round neither from the pipe in my throat, but that's normal apparently. Oh, and I might have peed myself with all the coughing! Luckily they had a puppy pad down. Ha!

Hi there, someone on my bay had a bit of a lingering chest infection and her surgery was postponed because of this. The Anaesthetist and Doctor didn't want to take any chances.