Anaesthesia is the practice of administering medicine to control or block pain during a medical procedure. Dr Jai Sungaran works with two highly qualified anaesthetists to make hand and wrist surgery virtually painless without compromising the safety of the procedure.

Types of Anaesthesia

General Anaesthesia

General anaesthesia puts patients in a carefully controlled drug-induced state of unconsciousness, where they cannot respond to any stimuli. When the anaesthetic is deep enough, patients will not feel or respond to pain. Patients are constantly monitored by an anaesthetist, who manages their airway, circulation and general responses.

Local Anaesthesia

Local anaesthesia is injected near the surgical site. Normally used for minor surgery, it is common in cases of toenail repair, skin lesions or a cut to remove something. Local anaesthesia may be used alone or in combination with sedation or general anaesthesia.

Regional Anaesthesia

Regional anaesthesia is injected in the vicinity of major nerve bundles that supply areas of the body such as the thigh, ankle, forearm, hand or shoulder. Sometimes a nerve-locating device like a nerve stimulator or ultrasound is used to locate the nerves before administering the anaesthesia.

Regional anaesthesia includes nerve blocks and spinal blocks. It may be used on its own or in conjunction with general anaesthesia. It produces a numbness and tingling in the selected area, and it may be difficult or impossible to move that area of the body.

Sedation

Procedural sedation allows patients to comfortably tolerate procedures that would otherwise be uncomfortable or painful. It is used for procedures where general anaesthesia is not required. Very deep levels of sedation, where patients lose consciousness and respond only to painful touch, may be associated with the patient having trouble breathing normally and their heart function is affected.

Conscious Sedation

Conscious sedation is a medication-induced state where a patient’s level of consciousness is reduced. Normally they cannot feel pain, but they can respond to verbal or physical cues. Common medications used for conscious sedation include benzodiazepines (e.g. ,midazolam) and opioids (e.g., fentanyl).

Which Anaesthesia Is Right for You?

Barring emergency situations, the specialist anaesthetist will consult with you and Dr Sungaran to determine the safest and most appropriate type of anaesthesia for your procedure or surgery. The following factors will be considered when selecting the type of anaesthesia:

• Your health and physical condition
• Your past experience with surgery
• Any allergies or adverse reactions to medicines
• The risks of each type of anaesthesia
• The size of the surgery and the time it will take
• Your surgical team’s preferences
• Your personal preference

What Are the Risks and Side Effects of Anaesthesia?

As long as an anaesthetist is administering the medication, modern anaesthesia is safe. However, there are always risks of side effects and possible complications.

Common side effects include nausea, vomiting, headache, sore or dry throat/lips.

Less common side effects include muscle aches and pains and weakness.

Uncommon side effects include being awake under general anaesthetic, damage to teeth/dental work, allergic reactions and/or asthma.

Most side effects are temporary, although in rare cases some may cause long-term problems.

Your overall risk will depend on:

• Whether you have other illnesses
• Personal factors, such as whether you smoke or are overweight
• The simplicity or complexity of your surgery
• The duration of your surgery
• Whether your surgery is performed on an emergency basis

Pre- and Post-Operative Instructions

Prior to Surgery

Please refrain from eating solid foods for a minimum of 6 hours prior to surgery and clear fluids 2 hours prior to surgery. Clear fluids include:

• Water
• Apple juice (no pulp)
• Black tea/coffee

Avoid milk altogether.

Breastfeeding can continue up to 2 hours prior to admission.

As we now stagger the arrival time for admission on the day of surgery, the above time should relate to the time of admission to the hospital.

Please bring all of your medications with you to the hospital, or bring a list with the dosage and strength of your medications.

It is important that you continue to take heart, blood pressure, asthma or reflux medications, even on the day of surgery. You can take them with a sip of water.

Please advise your surgical team if you take blood-thinning medication or diabetes medication. We may need you to stop these medications for a short time prior to surgery. These medications include:

• Warfarin
• Aspirin
• Clopidogrel (Plavic, Iscover, Coplavix)
• Prasugrel (Effient)
• Dipyridamole (Persantin or Asasantin)
• Ticagrelor (Brilinta)
• Ticlopidine (Tilodene)
• Apixaban (Eliquis)
• Dabigatran (Pradaxa)
• Rivaroxaban (Xarelto)
• Complementary/herbal/alternative medicines like fish oil and turmeric

After Surgery

If you are having day surgery, make sure you arrange for someone to bring you home. Additionally, you need to be in the company of another responsible person overnight. For the first 24 hours after surgery, do not drive, drink alcohol, operate heavy machinery, make important decisions or sign any legal documents.

Meet Dr Sungaran’s Anaesthetists

Dr Peter Chung – Serving Kareena and St George

Dr Chung has been a specialist anaesthetist since 2010 (FANZCA). He graduated from University of NSW with honors in medicine in 2001 ( B Sc. B med. (hons)). He has trained at S George Public Hospital, in cardiac/ lung transplant in St Vincent Hospital, Royal Women’s Hospital, Westmead Children’s Hospital and has acted as the provisional senior fellow Royal Prince Alfred Hospital. He has held specialist anaesthetist roles in Sydney hospitals including Royal Prince Alfred, Liverpool and Canterbury Public Hospitals. He currently holds consultant appointments at multiple public and private hospitals.

Dr Chung is an instructor in the Australian and New Zealand College of Anaesthesia essential module of CICO (Can’t intubate Can’t oxygenate). He has been the anaesthetic representative on the Medical Advisory Council Waratah Private Hospital for the last 5 years.

He has expertise in the provision of obstetric anaesthesia and analgesia, vascular, orthopaedics, paediatric, urology and chronic pain anaesthesia. He has a keen interest in both difficult airway anesthesia and the use of ultrasound in regional anaesthesia. He has facilitated the introduction of ultrasound to several hospitals.

Dr Robert Heavener – Serving the Inner West Area

Dr Heavener is an anaesthetist with clinical appointments at Royal Prince Alfred Hospital and Chris O’Brien Lifehouse, Camperdown as well as several private hospitals in Sydney. Dr Heavener obtained his medical degree at UNSW in 2001: MBBS (Hons1) BSc(med).

After anaesthetic training at St George Hospital, Sydney, Dr Heavener undertook further subspecialty training in obstetric anaesthesia and neuroaesthesia during his provisional fellowship year at Royal Prince Alfred Hospital. He is a fellow of the Australian and New Zealand College of Anaesthetists (ANZCA).

Dr Heavener has varied interests including anaesthesia for orthopaedic surgery, especially upper limb surgery and regional anaesthesia for hand surgery, urological surgery including robotic surgery, obstetric anaesthesia and ROTEM guided blood transfusion, neurosurgery, vascular surgery and reconstructive plastic surgery.

Dr Heavener is an instructor for ANZCA EMAC courses (Emergency Management of Anaesthetic Crises) and teaches obstetric anaesthesia and ROTEM, as well as Cardiac Arrest and CICO modules to fellow anaesthetists.

When not at work, Dr Heavener enjoys swimming, cooking and following the NRL.

Learn More about Anaesthesia for Hand and Wrist Surgery

If you would like to learn more about your anaesthesia options, please contact Southern Hand and Wrist today.