Anaesthetic Assessment Unit

The department has clerical/admin staff, nurses, doctors and other healthcare professionals, working in collaboration to make your visit as stress free and as time efficient as possible.

Reception

At Reception, one of the clerical/admin staff will sign you in and give you a small electronic questionnaire to fill in while you’re in waiting room (if you haven’t filled this in previously), if your not sure of any of the questions, leave it until you see the Health care assistant or nurse and ask them for advice.

Healthcare support workers

Healthcare support workers will take some basic observations which may include: blood pressure, pulse, ECG, spirometry, height, weight etc.

Nurse-led preoperative assessment

You will be seen by a registered nurse who will assess your general health, medical and medication history. Please bring either a copy of the repeat prescription from your GP or all of your current medication in their original package. This allows the nurse to complete an accurate record.  If you have any questions or concerns, please discuss them with the nurse at this appointment.

Anaesthetist Preoperative Assessment clinic

In some instances, you may need to see an Anaesthetist, they may examine you and talk through any health issues you may have, or what type of anaesthetic might be best for you.

Perioperative Medicine Clinic

For patients who potentially require major surgery or have significant co-existing medical conditions, an appointment will be made with our preoperative medicine clinic, led by an anaesthetist. In this clinic we assess your baseline fitness, by asking you to undertake a cardiopulmonary exercise test (CPET).

There are several aims of this appointment, these include identifying your expectations from surgery and a discussion with you around your individual risks proceeding with or without surgery. We will also look at how these choices may affect your quality of life. We use these as a basis for a shared decision-making (SDM) discussion.

A CPET is used by anaesthetists to test your fitness before certain surgery, as it evaluates how your body copes with exercise (heart, lungs and muscles). The ability to undertake exercise is linked with our ability to ‘tolerate’ surgery and recover well. CPET can be a guide to inform us how well you may do both during and after an operation. The results also help us decide if you may require a higher level of nursing and medical care after your operation, should you choose to proceed.

A key role of these clinics is to ensure you are as well prepared for your potential surgery as you can be. Occasionally we find that patients are anaemic (a low haemoglobin level) during these assessments. We may require you to start iron replacement therapy prior to your surgery. Iron replacement therapy can be tablets to take or an intravenous infusion of iron (which will require a separate hospital appointment).

Other departments

At the end of your visit to AAU, you may need to go to another department, it could be to have blood taken, Xray or cardiac department for imaging or tests. The nurse will give you any paperwork you might need and directions on how to get there.

Questions you may have

You can ask the staff in AAU questions about anything you’re not sure of or would like to know, regarding your stay, operation or anaesthetic.

In the time leading up to your operation it is vital to consider if there are changes you could make to improve your general health. If you are able to make positive changes to your health it is more likely you will have a good outcome from your operation which can include a lower chance of post operative complications, quicker recover and return to your baseline abilities.

Try to improve your fitness by finding a form of exercise you enjoy doing 2-3 times a week. If this is not already part of your routine start with 10-15 minutes and work up to at least 45 minutes to an hour, anything that has you breathing fast enough so you can just about talk to someone. If you don’t fancy joining a gym, try some of these with a friend or small group,

• Brisk walking
• Ti Chi
• Swimming
• Dancing
• If you have a rowing machine/static bike or know someone who might lend you one, consider trying these
• Walking up and down stairs will soon strengthen your legs and get your heart pumping.

Here are some links to trusted websites with more information:

• Preparing for surgery
• Preparing for surgery: British Sign Language version

Smoking

Smoking as many negative impacts on the body. If you are able to stop smoking before your surgery you are more likely to experience a straightforward recovery. Oxygen is vital for the healing process and smoking reduces the amount oxygen available within your body tissues. You will also be less likely to suffer chest problems after your surgery. Though it may take days for your to ‘feel’ the difference from stopping smoking the benefits are evident in your body after 24 hours.

• Quit smoking for good

Weight

Being under- or overweight can both cause problems after your surgery. We assess your weight by calculating your body mass index (BMI). If you BMI falls above the normal range we will discuss things that can be done to lower this. In some situations we may discuss if your surgery should be postponed to allow time for lowering of your BMI.

Diabetes

If you are diabetic and your diabetes is not well controlled it can affect recovery due to complications and taking longer for your wounds to heal. If your blood sugar and/or markers of longer-term blood sugar control (HbA1C) are raised we will discuss with you delaying your surgery (if appropriate). It is extremely important to ensure you control your blood sugar levels as early as possible leading to your operation.

Further information

The Royal Collage of Anaesthetists have a very informative website with lots of patient-centred information.:

• What is anaesthesia?
• Information leaflets and video resources

It is important to keep active by doing some exercise (this includes walking at a reasonable speed). Keeping active and mobile is good for you mental health, helps with balance, gives you some structure to your week and can be a social activity too.

If you were ever to need surgery in the future, having good baseline fitness will help you recover faster afterwards.

Here are some links to trusted websites with more information:

• Active Essex: Find Your Active Lifestyle
• Cardiac rehabilitation at home - BHF
• Cardiovascular disease: the facts
• Your medications and why they matter
• Quit smoking for good
• Healthy Eating for Healthy Hearts and Minds
• Physical activity and exercise
• Minding your heart
• Mindfulness for anxious hearts and minds
• Cardiac rehab relaxation
• Honest information about drugs
• Alcohol awareness: unit and calorie calculator

NOTE: Some of these videos have been produced by colleagues from the Western Trust in Ireland. There may be some reference to their local service, which is not applicable to us.

How we help you prepare for your procedure

Getting fitter for your procedure to enable you to have a quicker recovery - visit https://www.rcoa.ac.uk/patients/patient-information-resources/preparing-surgery-fitter-better-sooner

How your weight may affect your anaesthetic - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/anaesthesia-your-weight

Anaesthesia and how we care for you - visit https://www.rcoa.ac.uk/patient-information/about-anaesthesia-perioperative-care

How we look after you during your anaesthetic, visit:

You and your anaesthetic - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/you-your-anaesthetic

Your airway and breathing during anaesthesia - https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/your-airway

During your procedure

Sedation. Often combined with local anaesthesia, peripheral nerve blocks or spinal anaesthetics - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/sedation-explained

Peripheral nerve blocks - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/peripheral-nerve-blocks

Spinal anaesthesia - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/your-spinal-anaesthetic

Depending on the procedure you require we may talk you about epidural anaesthesia (pain relief) - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/epidural-anaesthesia-during-after-surgery

If you require intensive care after your operation - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/your-anaesthetic-major-surgery

Some specific surgical procedures

Eye surgery - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/local-anaesthesia-your-eye-operation

If you are having a hip or knee replaced - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/anaesthetic-choices-hip-or-knee-replacement

Recovering after your procedure - visit https://www.rcoa.ac.uk/patients/patient-information-resources/leaflets-video-resources/caring-for-someone-recovering-from-ga

Some generic information for patients.

Anaesthesia and the environment - visit https://www.rcoa.ac.uk/patient-information/about-anaesthesia-perioperative-care/your-anaesthetic-environment

Some generic FAQ’s - visit https://www.rcoa.ac.uk/patients/patient-information-resources/patient-faqs

If you wish to become involved with the Royal College of anaesthetists as a patient representative - visit https://www.rcoa.ac.uk/patients/patient-public-involvement