Ask the Doctor: ‘The thought of surgery under general anaesthetic terrifies me — How safe are they?’

“I have never had a surgery under general anaesthetic before and the idea terrifies me. I am soon to have a procedure which will require me to be fully anaesthetised and I can’t stop worrying about it. I have read so many horror stories online about people waking up midway through their operation unable to move or talk, and also about people who have had a reaction to the anaesthetic and have not woken up again after. I have never had an allergy to anything but I have also never had an anaesthetic. How safe are they?”

Answer from Dr Sabina Stanescu, Consultant in Anaesthesiology & Intensive Care Medicine at Beacon Hospital.

Fear of general anaesthesia is a primal response to handing over your consciousness, your life, to a stranger. It is a more serious version of the trust game where you let yourself fall backwards to be caught by a trustworthy friend. No matter how trustworthy your catcher is, there is a moment of intense anxiety as you let yourself fall backwards. It’s a fear of the unknown.

Before any surgery that needs a general anaesthetic you will meet with one of the pre- assessment nurses who work closely with the anaesthetic doctor and will discuss in detail your medical history, medications, allergies and any concerns that you may have.

On the day of the procedure the anaesthetic doctor is present throughout the whole procedure from induction of anaesthesia, being reassuring, monitoring your blood pressure, heart rate, oxygen levels, administering medications, until you’re transferred into the recovery room where you will wake up with the recovery nurse.

Your doctor aims to ensure that you’re receiving enough anaesthetic to be unconscious and pain free but not so much to avoid serious side effects like dropping in blood pressure, reduced breathing and other complications. They have the experience, skills and equipment and know how to react in case of any problem.

Anaesthesia represents a pharmacologically unique situation, during which patients are exposed to multiple substances including anaesthetics, analgesics, antibiotics, antiseptics, blood products, among many others which can produce immediate hypersensitivity reactions or anaphylaxis. Yes, you can be allergic to anaesthetic agents, even if you never had an allergy to anything before. Anaphylactic reaction to anaesthetic agents is fortunately rare, ranging from 1 in 10000 to 25000 cases. The most likely drug to trigger a reaction is a muscle relaxant. Modern muscle relaxants are less likely to do so, than previously used drugs. It is important to note that allergies to drugs are not passed on in families.

Often the phrase ‘allergy to anaesthesia’ is used to describe a side effect from the anaesthetic, such as nausea, vomiting, agitation, double vision, sore muscles, etc. These are not allergies, some of the common side effects of anaesthesia or surgery. Anaesthesia and anxiety are temporary. The surgery you have scheduled is to help you feel better. View your surgery as unlocking a positive future with a better quality of life.

Have a question for the professionals you’d like answered? Get in touch with sarah.gill@image.ie with the subject headline ‘Ask The Doctor’.

This article was originally published in December 2022.