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Anaesthesia

General

There are various ways in which the feeling of pain can be stopped during surgery. Under general anaesthesia, you are asleep during the procedure, while choosing regional spinal anaesthesia allows you to follow some stages of the operation on a monitor. All our theatres are equipped with state-of-the-art anaesthetic devices and monitoring equipment. A large proportion of our operations are carried out under a combination of regional anaesthesia or general anaesthesia with subsequent continuous pain therapy.

Prior to anaesthesia

You will receive individual advice from the anaesthetist regarding the anaesthesia that is best for you and any points of note. However, the following recommendations apply in general:

  • Do not eat or drink on the day of the operation ("nil by mouth").
  • In the 8 days prior to a planned operation, please do not take any aspirin or other medication containing ASS such as ASS 100 or Thomapyrin, as these can impair blood clotting.
  • Special rules may apply to any medication prescribed for diabetes both before and after the operation. Please contact us beforehand to discuss this.
  • Other than that, please continue to take your normal morning medication (particularly medication to control high blood pressure) as usual on the day of the operation with a small sip of water. Prior to the operation, please visit your GP for a checkup including blood tests and an ECG.
  • If you suffer from any severe chronic disorders, e.g. of the heart, circulatory system, lungs, or from diabetes, you should arrange to see us a few days prior to the planned operation in order to discuss anaesthesia and preparatory measures. This gives us time to conduct any examinations or check-ups that may be required. The same also applies to patients who for a number of different reasons take blood-thinning medication such as Marcumar.

For major surgery such as hip or knee replacements, please contact us at least six weeks prior to the planned operation to clarify questions such as the donation of blood for later retransfusion.

Pre-anaesthetic preparation

Prior to the administration of anaesthesia, an infusion cannula will be placed your vein and you will be given a mild sedative. Small electrodes will be stuck to your chest to monitor your ECG while you are anaesthetized.

General anaesthesia

To induce general anaesthesia, well-tolerated narcotic and analgesic agents will be administered through the infusion cannula fitted earlier and continuously topped up with a syringe pump while you are under anaesthesia. Once you are asleep, a respiratory aid (laryngeal mask) is inserted into your mouth. Ventilation with a laryngeal mask is a simple and comparatively gentle procedure that has no negative effect on the vocal cords. If the operation requires the patient to lie on his/her stomach or side, endotracheal intubation is generally carried out to ease ventilation, combined with a muscle relaxant. Under visual control using a laryngoscope, a tube is inserted past the vocal cords into the windpipe. During the whole time you are anaesthetized, your coronary circulatory and respiratory parameters are continuously monitored using an automatic system, allowing us to react immediately to any deviation from the norm. The length of the anaesthesia is adjusted precisely to the duration of the operation; this means that you will wake up immediately after the end of the operation. You will then be cared for in the intensive care unit where you can have a drink shortly after the operation and also see your family.

Spinal anaesthesia

For spinal anaesthesia, a very thin cannula is used to inject a local anaesthetic between the 3rd and 4th or the 4th and 5th spinous process of the lumbar vertebrae (far away from the spinal cord!) into the space also occupied by the nerve tracts to the legs. It is much easier for us to find the spinal channel if you arch your back for the cannulization, i.e. bend forwards and place your chin on your chest. Immediately after the injection, you will first experience a sensation of warmth, soon followed by one of heaviness in the legs. This method of anaesthesia is well suited for operations of the legs or abdomen. Once the effect of the local anaesthetic has worn off, you can move your legs again as normal. In some cases, the effect of the anaesthesia on bladder nerves might cause temporary urinary retention. In rare cases, younger patients in particular may develop headaches after spinal anaesthesia .

Peridural anaesthesia

Peridural anaesthesia (PDA) is a procedure close to the spinal cord. In contrast to spinal anaesthesia, the hard outer membrane (dura) surrounding the spinal cord and the nerves branching from it is not punctured. This means that more local anaesthetic has to be administered than with spinal anaesthesia and that the effect of the anaesthetic is slightly delayed. In principle, PDA could be used as a stand-alone anaesthesia for surgical procedures on the lower part of the body; however, because of the long delay before it takes effect, it tends to be used in major operations as an additional method to deliver postoperative pain therapy. The thin catheter inserted into the peridural space for this procedure can be used to deliver continuous pain therapy during the first days after the operation.

Peripheral regional anaesthesia

Nerve blocks (plexus anaesthesia)

For some operations, it may make sense in addition to the methods described above to apply isolated peripheral nerve blocks for postoperative pain treatment and to keep the amount of intraoperative anaesthesia as low as possible.

Typical nerve blocks on the main trunks of the nerves to the arms or legs are described below:

Leg nerve blockades

(3-in 1 blockade (femoral catheter))

Indications: cruciate ligament operations, knee joint replacement

Procedure: An electrical nerve stimulation device is used to identify in the groin the nerve supplying the front of the knee and the knee extensor and hip flexor muscles. A single injection of a local anaesthetic results in lasting pain relief. Placing a thin catheter close to the nerve allows top-up injections in the days following the operation, thus permitting largely pain-free physiotherapeutic treatment.

Arm and shoulder block anaesthesia

(axillary, supraclavicular or infraclavicular (VIP) plexus brachialis anaesthesia)

Indications: operations on hands, elbows or shoulders

Procedure: Here, too, a nerve stimulator is used to localize the nerve that is to be blocked and a local anaesthetic injected. For extensive shoulder operations in particular, the administration of postoperative pain treatment through a plexus catheter makes sense. In this case, a thin catheter is inserted into the nerve stimulation cannula mentioned earlier, which can then be used for continuous pain therapy. For shoulder operations we generally place a modified vertical infraclavicular plexus (VIP) catheter, with the insertion site underneath the clavicle.

Depending on the kind of local anaesthetic used, blocking a main nerve trunk has the effect of temporarily reducing the strength of the muscle groups supplied by the nerves in question, e.g. knee extensors and hip flexors. For this reason, you should always be accompanied by another person when you take your first steps after the operation.

Peripheral nerve blocks

For operations on hands and feet, satisfactory postoperative pain therapy can also be achieved by nerve blocks administered further away from the main nerve trunk, i.e. peripheral blocks. This includes foot, hand and knee blocks. They have the advantage of causing only a small impairment to muscular activity in the affected limbs.

Experienced anaesthetists will advise you as to the best choice of anaesthesia and post-operative pain therapy in your particular case. Extended monitoring can be used for patients who for various reasons might present with poor circulation during the operation or suffer from pre-existing, particularly cardiac, conditions, including measuring central venous pressure and direct arterial measuring of blood pressure. A bronchoscope is at hand in case of anticipated or unexpected difficulties in intubation and ventilation.