Pre-anaesthetic consultations are mandatory since 1994 before any intervention by an anesthetist-resuscitator in the context of a surgical operation or a medical procedure requiring anesthesia (source 1). What are they for ? What documents do I need to bring? How is the anesthetic treatment carried out? Answers from Dr Frédéric Le Saché, anesthesiologist and deputy general secretary of the French Society of Anesthesia and Resuscitation (SFAR).
Reminder: what is anesthesia? Why do we choose this or that technique?
The purpose of anesthesia is to eliminate – or at least reduce – the pain as part of a surgical or interventional procedure (fibroscopy, colonoscopy, etc.). There are two main types, each with their advantages and disadvantages: general anesthesia and loco-regional anesthesia.
What does general anesthesia consist of?
General anesthesia is an anesthesia technique that immerses the patient in a state comparable to sleep. Concretely, the doctor injects him with drugs intravenously and/or inhalatively (anesthetic gas) to make him lose consciousness. Thus, he no longer perceives the external environment, no longer feel the pain and completely relaxes his muscles.
What does loco-regional anesthesia consist of?
Loco-regional anesthesia makes it possible to put to sleep only the part of the body concerned by the intervention. “The patient remains conscious throughout the duration of the procedure (he can listen to music, look at a screen, etc.) but does not feel any pain”, indicates Dr. Le Saché. The principle is to block the nerves of the operated area by injecting a local anesthetic on the path of the nerve. There spinal anesthesia and theepidural anesthesia are two particular forms of loco-regional anesthesia, where the anesthetic product is injected near the nerves which come out of the spinal cord in the back.
The choice of anesthesia will be made with your agreement and according to your medical file.
You will be informed about the procedure, the advantages and disadvantages of each technique during the pre-anaesthetic consultation, and will be able to ask all the questions that concern you. A final checkpoint with the anesthetist will take place just before the anesthesia is performed (pre-anaesthetic visit).
When and why make an appointment with the anesthesiologist?
“The anesthesiologist is too often considered confined to the operating room. In reality, he works in concert with a surgeon or an interventional doctor as soon as the surgical indication is made“, underlines the anesthesiologist. And to add: “He is responsible for the care of the patient before, during and after the intervention”.
As stated above, the anesthesia consultation, or pre-anesthesia consultation, is mandatory as part of a surgical or interventional procedure. It allows the anesthesiologist to take note of your history and to present to you the different types of anesthesia, their advantages and their disadvantages. In detail, its main objectives are:
- from you prepare for the intervention by asking you to carry out certain additional examinations if necessary, to obtain the opinions of specialists.
- of inform you about the continuation or the cessation of your usual treatments, even the introduction of new treatments;
- to introduce you the different anesthesia techniques and options for pain management;
- of respond to any concerns you may have ;
- of obtain your consent enlightened.
A teleconsultation, ensuring the same level of quality and safety can be offered to you.
Note: in an anesthesia department, it happens that the anesthetist-resuscitator who will perform the anesthesia in the operating theater is not the one you met in the pre-anaesthetic consultation.
Do not worry about it, the doctors of the same team share common anesthetic and organizational procedures which allow to ensure a follow-up guaranteeing your safety and your comfort.
Pregnancy: when to make an appointment and how does it work?
For childbirth, an anesthesia consultation is mandatory during the eighth month of pregnancy : the doctor can thus learn about the different factors that would contraindicate the installation of an epidural during childbirth and consider alternatives. Anesthesia techniques for a caesarean may also be covered.
For any intervention during pregnancy, the anesthesia consultation remains essential. The course of the visit is therefore the same as for the other patients, with the difference that the doctor takes into account the physiological changes related to pregnancy to choose the most suitable anesthesia. He questions the pregnant woman about her general state of health, her medical history, the progress of her pregnancy, the medications she takes, etc.
Post-operative treatment prescriptions will take pregnancy into account. Some non-urgent interventions may be postponed after childbirth to limit the risks associated with anesthesia.
How does a so-called pre-anaesthesia consultation take place? What factors do we check with the patient?
The pre-anaesthetic consultation, for a non-urgent intervention, takes place at least 48 hours before the procedure, to give the patient time to reflect (except in the event of a life-threatening emergency). And Dr. Le Saché to specify: “A longer period of several weeks is often necessary for risky interventions, the time to implement actions aimed at improving the results of the intervention: correction of anemia, weaning tobacco, etc.
To prepare for the consultation, the patient is invited to answer a specific questionnaires which will ensure better completeness of the information transmitted to the anesthesiologist. It is also essential to bring the medical elements available: prescriptions, specialist reports, blood tests, etc.
During the consultation, the doctor asks the patient about his state of health:
- ses surgical history ;
- ses possible obstetric history (pregnancies);
- ses medical background ;
- THE medications taken daily;
- ses history of allergy ;
- ses history of bleeding disorder : haemorrhage or thrombosis;
- ses history ofaddiction : the use of tobacco, alcohol or drugs ;
- Ses ability to generate effort : running, climbing floors, etc;
- His weight and height which will make it possible to adjust the treatments administered? .
A physical examination will then be carried out with particular attention to the level of the mouth, teeth and neck, which will make it possible to evaluate the conditions for setting up the devices used during general anesthesia
Depending on each person’s history or risk factors, the doctor can prescribe additional examinations (blood tests, electrocardiogram, etc.). He can also prescribe a specialist consultation to obtain additional information on the patient’s state of health (cardiologist, pulmonologist, etc.). The choice of anesthesia can be postponed pending these examinations.
Then comes the time to discuss the course of the intervention and the different types of anesthesia and their benefit/risk ratio.
It is a precious time for discussion, says Dr. Le Saché. There are no silly questions: we are here to answer all patient questions and concerns.
Objective : reassure the patient and put him at ease.
How long does the appointment last?
It is difficult to define a fixed time for a pre-anesthesia appointment. This depends on several factors, including the complexity of the surgery and the medical history of the patient. It can last from 10 to 30, even 40 minutes. At any rate, do not try to evade questions to shorten the interview. The objective is to guarantee your safety and comfort.
What documents to present on D-Day to compile your file?
“Better to take the maximum of documents than not to have the elements”, indicates Dr. Le Saché. Each document will allow the doctor to assess the benefit / risk of anesthesia. Before the consultation, remember to bring:
- the results of your last analyzed the song or urine. “It is not mandatory to do a specific blood test before the consultation if it has not been prescribed, underlines the doctor. It is recommended in a large number of cases to perform the surgery without a blood test. Questioning the patient is then an essential part of the assessment.
- all the prescriptions for your treatments medicated;
- vos medical reports recent (cardiological, pneumological, allergic examinations, etc.);
- your Vital card ;
- etc.
Reminder: what are the main disadvantages and possible risks of anesthesia?
“Many patients are paralyzed at the idea of not waking up, which does not correspond to a real risk, assures Dr Le Saché. The main risks of anesthesia are minor and temporary. The vast majority of anesthesia takes place without any particular problem; however, anesthesia, even carried out with competence and in accordance with the acquired data of science, carries a risk, he continues.
Of the allergic reactionsof the respiratory complications or some heart problems related to anesthesia (cardiac arrest) can be observed. “But these risks are extremely rare, assures Dr. Le Saché. There are nearly twelve million anesthesias each year in France, in patients with very varied risk profiles and only a few dozen accidents related to anesthesia. “
than twelve million anesthesias each year and only a few dozen accidents.”
General anesthesia: what are the most common side effects?
- of the broken teeth (broken teeth);
- of the nausea and vomiting ;
- a fatigue and an somnolence persistent;
- or a loss of voice.
Local anesthesia: what are the most common side effects?
- of the insensitivities ;
- of the “ants” in the sleeping area ;
- of the small electric shocks.
“These elements must be reported to the anesthesiologist-resuscitator who will accompany the care of the patient (or will send him to a competent colleague)”, underlines Dr. Le Saché.
Once the said operation has been carried out, is there a follow-up with the anesthesiologist?
The anesthetist-resuscitator is responsible for the patient before anesthesia, during the time of anesthesia and during post-operative follow-up.
After the intervention, we accompany the patient during his rehabilitation: his awakening, his hospitalization and his return home, etc., specifies Dr. Le Saché.
In other words, the anesthesiologists take care of the pain, the possible resumption of medication and the complications on awakening linked to the intervention which fall within their field of competence.
Price: how much does a consultation cost on average? Is it supported?
The price of the anesthesia consultation defined by social security varies from 23 to 55 euros depending on the patient’s medical history. The reimbursement basis for a pre-anesthesia appointment is 70% of the agreed rate and 100% during pregnancy.
Note: anesthesiologists in the private sector are authorized to practice fee overruns which must be announced before the consultation and which will be your responsibility or that of your complementary health insurance.