Anaesthetists Counselling Patients on Surgery Risks
12 October 2017
Anaesthetists Counselling Patients on Surgery Risks
Anaesthetists look after you before, during and after your operation.
Most people recognise the role of anaesthetists as ‘knocking you out’ for surgery, but their responsibility extends far more widely than that. There remains a lack of awareness about what “sometimes invisible” anaesthetic clinicians are trained to do, hence the importance of World Anaesthesia Day on October 16.
Northland DHB has 19 specialist anaesthetists, all of who are qualified medical doctors with more than 10 years of medical and anaesthesia training.
Northland DHB anaesthetic department also has four medical officers, six registrars who rotate from training in Auckland, and one senior house officer. They are supported by 17 anaesthetic technicians
Caring Before, During and After Surgery
Ensuring the best outcomes for patients requires anaesthetists to optimise patients for surgery – or optimise surgery for patients, especially as our population ages.
Anaesthetists are crucial in the process of ensuring that every patient facing high risk surgery is fully informed about the likely outcomes following surgery with anaesthesia.
Sometimes, surgery may not be the best option for older people. The new High Risk Anaesthesia Clinics (HRACs) at Whangarei Hospital involve an anaesthetist and an intensive care physician sitting down with a patient and their family and having a discussion.
The aim is to work out what the risks are, based on the patient’s medical conditions, and the surgery they require.
There are various risk scoring tools, and they use these to help the patient and family make an informed choice. They also try to work out what benefit the patient will get from the surgery, and if the benefit outweighs the risk for them. At times they are able to explore alternative options, such as physiotherapy or a chronic pain team review.
“Anaesthesia has adopted perioperative medicine as a concept” - the aim of perioperative medicine is to deliver the best possible care for patients before, during and after major surgery. This involves input and collaboration between various medical specialties, as well as other health professionals, such as physiotherapists and dieticians.
“It’s about weighing up the equation carefully, plus ensuring the patient is fully prepared for the possible outcomes and the hospital have organised backup intensive care facilities,” says Dr Jo Coates who set up HRAC clinics with ICU doctor and fellow anaesthetist Richard Harding.
Evaluating how surgery affects a patient’s independence
The goals of the High Risk clinics align with the Choosing Widely initiative, supported by the Australian and NZ College of Anaesthetists. Choosing Wisely looks at ‘Five Things Clinicians and Consumers Should Question’. These five position statements, among other things, advise anaesthetists to;
• avoid initiating anaesthesia for
patients with limited life expectancy, at high risk of death
or severely impaired functional recovery, without discussing
expected outcomes and goals of care
• avoid initiating anaesthesia for patients with significant co-morbidities without adequate, timely preoperative assessment and postoperative facilities to meet their needs.
The concern is that, for an elderly patient undergoing high risk surgery, he/she may not regain their functional status afterwards. In other words, a previously independent person may end up needing additional help at home, or even require residential or rest home care. ,
The natural ageing process can make patients more sensitive to anaesthetic drugs, more likely to develop complications and infections, and older patients may take longer than younger ones to recover.
In addition, older patients are more likely to have medical conditions that must be taken into account when considering the need to have an operation or anaesthesia. (Ref. ANZCA Age and anaesthesia leaflet, 2017)
Many of the discussions include Advance Care Planning (ACP). ACP is the process of thinking about, talking about and planning for future health care and end of life care. It is the process of exploring what matters to you and sharing that information with your loved ones and your health care team so treatment and care plans can support what is important to you.
It helps people understand what the future might hold and to say what treatment they would and would not want. This makes it much easier for families and healthcare providers to know what the person would want - particularly if they can no longer speak for themselves.
ACP is a theme Jo says she does her best to tie into her work whenever possible.
“In an ideal world people would be seen by ACP experts – but not everyone has that offered to them,” Jo says.
“Our high risk clinic is generously resourced and each patient gets one hour with the specialist. As you can imagine, these conversations take a lot of time and we encourage people to bring their whānau.”
In the year July 1 2016 to June 30 2017, over 10,000 people received anaesthesia for surgery at Whangarei Hospital.
These included around 700 people aged 80-89, 102 people aged 90-99, and three people aged over 100.
There are nearly 20 different types and ways to administer anaesthesia in Northland’s surgical theatres.
If you have surgery coming up and have not yet had anaesthetic options explained to you, please see the Anaesthesia page under Surgical Services on the website of Northland DHB, where you can read about
Different anaesthetic and sedative
Complications from anaesthesia
Frequently asked questions about anaesthesia before, during and after surgery
Patient information sheets from ANZCA covering what anaesthesia is, what types of anaesthesia there are, pain relief when having a baby, an sheets about anaesthesia and children, endoscopy, eye surgery, cardiac surgery and joint replacement
A hub for information about Advance Care Planning http://www.advancecareplanning.org.nz/