Some patients ask about surgical technique for forty minutes and leave without asking a single thing about the anaesthetic. It is not that they do not care: it is that the question they have sounds childish said out loud in front of a doctor, so they keep it to themselves.
They keep it and take it home, where it grows. So it is worth telling in order, because the anaesthetic is the one part of an operation a person takes no part in, and what cannot be controlled can at least be known.
What happens, in order
It starts earlier than people think, and the first part is not dramatic at all.
- The consultation with the anaesthesiologist. Days beforehand, not at the theatre door. They go through your tests and ask about illnesses, allergies, medicines, previous operations, and how you or your family got on with earlier anaesthetics. The plan comes out of that conversation.
- The fast. The hours you are given, counted from the last thing you swallowed, water included. It is not a formality: it is what keeps the contents of your stomach out of your lungs while you are asleep.
- The cannula. In your arm or the back of your hand, with the usual pinprick. Everything else goes in through there, and it is the only part you genuinely feel.
- The theatre. It is cold, it is bright and there is the noise of monitors. You will have a blood-pressure cuff, a sensor on your finger and ECG stickers. That part takes a few minutes and you are awake through all of it.
- The oxygen. A mask over your nose and mouth, and the instruction to breathe normally. That is oxygen; it is not the anaesthetic yet.
- The ten seconds. The anaesthesiologist puts the drug through the cannula. Almost everyone notices an odd taste or a cold feeling travelling up the arm, and sometimes a warning that they are about to feel sleepy. After that there is nothing. It is not drowsiness setting in: it is a cut.
What patients describe afterwards is not having slept. It is that four hours passed between one sentence and the next.
The three questions nobody asks out loud
"What if I do not wake up?"
Always the first one. In a person without significant illness, having planned surgery in an accredited theatre with an anaesthesiologist doing nothing but that, the risk of death attributable to the anaesthetic is very low — on the order of a few cases per several hundred thousand procedures.
Two honest additions. The first is that the figure is not everyone's: heart disease, untreated sleep apnoea, significant obesity or an emergency all move it, and moving it is exactly what the pre-anaesthetic assessment measures. The second is that the good figure depends on the place. A general anaesthetic is not given in a consulting room, and it is not monitored by the person doing the operating.
"What if I wake up during the operation?"
It exists, it has a name — intraoperative awareness — and it is rare: somewhere around one or two cases per thousand general anaesthetics, and considerably fewer with the monitoring used today. In planned plastic surgery it is among the least likely scenarios, because none of the circumstances that favour it apply: an emergency caesarean, major trauma, a deliberately light dose in an unstable patient.
One detail is worth knowing, because it is the one that produces the stories that circulate. Muscle relaxants are used during surgery, and a relaxed person neither moves nor speaks. So the depth of sleep is not judged by watching for movement: it is measured, through the concentration of anaesthetic, the heart rate, the blood pressure and, where indicated, the electrical activity of the brain.
"What if I say something?"
This one gets asked as a joke and feared in earnest. The short answer: you do not talk. Once the anaesthetic is in there is no conversation to be had, and what people remember saying belongs to the waking up, when they are still disoriented and it is usually a complaint about cold or pain.
Sedation is a different matter. There you do talk, you do answer, and sometimes you do not remember afterwards. If the plan is sedation — some procedures under local anaesthetic include it — you will be told, because it is not the same thing.
Waking up
Nobody wakes up in theatre. You wake up in recovery, and it usually goes like this:
- Cold and shivering. The most common and the most uncomfortable. Theatre is deliberately cold and the body compensates by shivering. It is treated with warm blankets and passes within a while.
- Thirst, dry throat or hoarseness. From the fast and from the tube that kept the airway open. It lasts hours, sometimes a day.
- Nausea. Very person-dependent. If you have been sick after a previous anaesthetic, say so: it is prevented from the start and it works.
- Sleep in patches. Dozing through the first hour and remembering the second in fragments is normal. It is not a bad sign.
- Pain. It is planned so that you do not wake in pain, and the aim is to have it controlled before you leave recovery. If it is not, that is said there and not at home.
The first hours being remembered as a blur is expected. That is why a patient who has had a general anaesthetic makes no decisions and signs nothing that day, and does not go home alone.
Who is watching
This is the most reassuring part and the least explained, because it is taken for granted.
The anaesthesiologist is a specialist doctor whose job for those hours is you and nothing else: your blood pressure, your oxygen, your temperature, your depth of anaesthesia and your fluids. They are not operating, they do not come and go, and they are not a monitor with an alarm. They are at the head of the table from start to finish.
So the useful question before an operation is not which anaesthetic you will be given, but two more specific ones: who administers and monitors it, and in what facility. Surgery under general anaesthetic takes place in a licensed operating facility, with an anaesthesiologist present and resuscitation equipment to hand. It is a normal question and it has an answer.
What does depend on you
Not much, but what there is carries weight:
- Keeping the fast, water included, to the exact hour rather than roughly.
- Bringing the full list of what you take. All of it. Supplements, herbal remedies and anything bought without a prescription included: several of them affect clotting, and nobody mentions them because they do not think of them as medicines.
- Saying the things that are hard to say. That you smoke, that you smoked until yesterday, how much you drink, whether you use anything recreational. It does not change how you are treated; it changes the dose and the plan, and not knowing is the one thing that genuinely complicates an anaesthetic.
- Sleeping, and arriving with time to spare. Arriving in a rush and short of sleep is not dangerous, but it is a poor start to a day worth starting calmly.
And one last thing: if you have this question, ask it. At the pre-anaesthetic assessment, or at ours, or both. It is one of the few questions about an operation that can be answered in full in five minutes.