Anaesthesia: what anaesthetists do, types of anaesthetic and how to prepare

An anaesthetist is a doctor who has completed medical school and a long period of hospital specialist training in anaesthesia, which usually includes intensive care and pain medicine. They are best known for the operating theatre, but the work begins earlier and ends later. They assess your fitness, decide with you which type of anaesthetic suits the operation, stay with you throughout the procedure monitoring heart rate, blood pressure and oxygen levels, and plan your pain relief for recovery.

The same skills are used outside theatre: in labour wards for epidurals, in intensive care, in resuscitation, in endoscopy and radiology suites where sedation is needed, and in pain clinics that treat long-term pain with nerve blocks and other procedures. Because of that range, the specialty overlaps with critical care and pain management, and consultants often have a particular interest in one of these areas.

Sometimes the types are combined: an epidural or nerve block can be used with a general anaesthetic so you need less of it and wake with less pain.

For planned surgery the NHS says you will usually be asked to attend an appointment a few weeks before to check you are well enough for the procedure and anaesthetic. It might involve blood tests, an X-ray, an ECG to check the heart and a fitness test. You may meet the anaesthetist then, or on the day.

Tell the team about every medicine you take, any long-term conditions, previous reactions to anaesthetic or other medicines, and any worries such as a fear of needles. The NHS suggests that you can help your own recovery by managing long-term conditions such as diabetes, high blood pressure or anaemia, staying as active as you can, stopping smoking and treating any dental problems, since teeth can be damaged by the breathing tube.

Fasting rules matter. You will be told when to stop eating and drinking, which is usually a few hours before, so that the stomach is empty, and whether to keep taking regular medicines. Remove jewellery, piercings and nail varnish, and use any disinfecting shower gel you were given.

The anaesthetist stays with you throughout. You may first be given medicines to help you relax, reduce stomach acid, prevent sickness or ease pain. After the injection or gas, sleep follows within about a minute. You wake in the operating theatre or recovery room, drowsy, sometimes with an oxygen mask, and staff give medicines for pain or sickness.

Common side effects, which usually settle within minutes or hours, include thirst, drowsiness, a hoarse voice or sore throat, shivering, nausea, bruising or soreness from the injection and short-lived confusion or memory loss. For regional techniques, numbness in the legs wears off over a few hours and you may be asked to rest until feeling returns.

For at least 24 hours after a general anaesthetic the NHS advises that you have someone stay with you and avoid driving, cycling, cooking, using machinery, drinking alcohol, smoking, looking after dependants alone and making important decisions. Be cautious about posting on social media, as you may not be thinking clearly.

The NHS lists possible complications of a general anaesthetic as a serious allergic reaction, breathing difficulties, a chest infection, damage to teeth or mouth, eye damage, nerve damage causing numbness or weakness, and longer-lasting confusion, especially in older people, while stressing that these are rare. Being accidentally awake is described as very rare because the anaesthetist monitors you carefully.

For epidurals, the risks listed include low blood pressure, temporary loss of bladder control, itching, sickness, headache and nerve damage. Your own risk depends on your age, fitness, weight, smoking, heart and lung health and the type of surgery, so ask the anaesthetist to explain what applies to you rather than relying on general statistics.

Many anaesthetists also run pain services. These include nerve blocks to treat pain that has not responded to tablets, radiofrequency treatment of small spinal joint nerves, and infusions used in selected chronic pain conditions. NHS patients usually reach these services through a GP or hospital specialist, whereas private pain procedures may be offered after an initial consultation and imaging. The evidence for each procedure differs, so ask what outcome to expect, how long it may last and what the alternatives are.

In the NHS you do not usually refer yourself to an anaesthetist; the surgical team arranges your assessment. Pain services are accessed by GP referral, and the maximum waiting time for non-urgent consultant-led care in England is 18 weeks.

In private care the anaesthetist normally bills separately from the surgeon and the hospital, so check whether the quote includes anaesthetic fees. Insurers usually have their own fee schedules for anaesthetists, and gaps between the schedule and the fee charged are a common source of unexpected bills. The Private Healthcare Information Network lists information about private hospitals and consultants.