Can I opted out of General Anaesthetic?

One other thing I should add in response to your examples of deaths, and articles - it is very easy to find an article on a botched case, simply because it makes the news. However, if there was some way of documenting on this topic every anaesthetic that goes as planned, it would probably bring the entire patient.info down with the volume of traffic.

There are things worse than death.........

BTW How do you guys train?

Do you ever pick a member of the class to be put under?

Or ask the Public volunteer?

Mike

To become a fully trained anaesthetist, there's the 5-6 years of medical school, followed by a further two years training as a general junior doctor (Foundation Doctor) before becoming eligible for entry into anaesthesia. Once in, it's a minimum of 7 years, although most do more than that mostly through extra clinical fellowship years to get extra experience in sub-specialist areas. In addition there are two sets of post-graduate exams that need to be completed before progression at various stages, which are fairly universally considered to be one of the most difficult post-graduate exams sat by medical professionals (anaesthetists require a complete understanding of every body system, the pharmacology and chemistry of most drug groups, including knowledge on the molecular composition of anaesthetic drugs, manufacturing etc and physics, especially relating to pressure laws, flows, electrical circuitry, mass spectrometry and energy absorbtion spectra amongst other more general medical things).

On the job training is undertaken under direct supervision from an experienced consultant who's gone through all of the above. Initially, observation, before progressing to doing "simple" anaesthetics, again under direct supervision (so they can step in if it's not going to plan). Anaesthesia is fairly unique amongst most medical fields in that you get one to one supervision for most of the entire 7 years of training. In addition, there are seperate modules for intensive care training (intensive/critical care units are run by anaesthetists). An anesthetist will anaesthetise thousands of patients before completing their training.

In addition, an anaesthetic, whether general or regional, is not given without the presence of a trained assistant, the ODP (operating department practitioner). Their role is to support the anaesthetist in giving in anaesthetic, and at least in this country, their presence is mandatory.

A general anaesthetic, although very safe these days, comes with a multitude of serious risks that are minimised by the presence of highly trained individuals. Due to the risks, we would never unnecessarily put someone through a general anaesthetic, so no, volunteers are not "put under" purely for training, for those reasons.

At last some one in the know putting a lot of sense back into this issue I myself recently had bilateral cataract surgery done with GA a choice of the consultant although not taken easily by the attending anesthatist if it came to the crunch I could have had local but I made it through both times my reply to them was I signed the consent form I realised the risks if any and agreed to put my keeping in their hands.

 

Isn’t it interesting how some people wish to stop discussion and debate when perhaps their own professional preferences and judgments get challenged.  A patient has a perfect right to object to general anaesthesia and my own personal experience is that they often effectively bullied into it:  i.e. they won’t get the operation they need if they object because the surgeon refuses to do it this way.  On the NHS, the surgeon is taxpayer funded and so his salary is guaranteed and, quite frankly, the patient can like it lump it regarding choice of anaesthesia.  My own personal situation related to a slipped disc and a micro-discectomy operation.  I initially objected to the general anaesthesia because it really doesn’t have to be done this way.  The state-subsidised surgeon wouldn’t budge.  It was his preference, not mine.  Anyway, I later found out that the micro-discectomy operation really wasn’t that micro at all because it left a long scar down the bottom of your back and cut into and stripped away muscle to get at the disc, so it was very painful and required a long recovery period.  A few private surgeons in the country performed this operation endoscopically but that’s another story.

However long an anaesthetist may have to train, that does not mean that they should be able to ride roughshod over patient choice.  They might not always know best.  Explaining to a patient why something just physically cannot be done a certain way is one thing, but, again, my own personal experience of the NHS is that its employees rarely spend time giving this sort of detail and that there may well be a different approach to a procedure but that they either don’t know about it (unlikely) or, quite honestly, can’t be bothered.  You can see this with, for example, hip operations.  They can be done in a minimally invasive way and under regional anaesthesia.  Instead of being advised about this and being given the choice, when my partner’s father felt and cracked his hip, they just did it the old-fashioned way and, apart from the unnecessary extra scarring, the G.A. has basically turned the old boy into a cabbage.  He drove a car beforehand, now he just sits and veges in the living room, never going out.  I don’t suspect that the surgeons will think about the wife who has to pick up the pieces afterwards when they go home of an evening.  I, too, spent many years training for my profession but I still regard it as something as an article of faith to go through a case beforehand with the client and obtain their preferences and instructions as much as I can before proceeding. 

I would like to know why “Mouse Nightshir” says that certain medications, e.g. blood thinners, suggests the use of general anaesthesia.  I have not heard about that before.  Also, why do you need a general anaesthetic for diagnostic scans?  I fully agree that it is too dangerous to allow dentists to give anaesthetics.  I myself have heard of far too many incidents regarding that practice.    

Finally, let us not forget the fact that when a patient is put under a general anaesthetic, that they become totally unconscious.  I swear that this is the truth when I say that I once knew a nurse who just laughed and wouldn’t comment any further when someone else suggested that, in those days (c.20 years ago), some of the hospital theatre staff would be pulling up drapes and pointing and laughing at the patients’ private parts before the surgeons came in.  Personally, I don’t find that sort of thing very funny.  I find it abusive behaviour deserving of criminal sanction.  Just as well, I suppose, that the patients concerned never found out about it. 

 

Rights we all have but few realise that. However, when it comes to medicine I can 'see' some of those pictures and descriptions in the days before we had anaesthetics. Every medical procedure needs discussion between patient and those medics responsible for that patient. Many of us respond in quite different ways to any procedure, so it is in everyone's interest to have an open discussion.

My wife has had a bad reaction to anaesthesia. However, it is not being given anaesthetics that is the problem, just which one or what type. From her first experience we know now to ensure the anaesthetist understands and will act accordingly. We back that up by ensuring the surgeon will also ensure the 'right' type and dose is administered. An operation for a full hip replacement last year was without incident, so good in fact that it must have aided early recovery.

That last point is one that I have and always will stress with the medics. They want a good result; they dread complications; hospital beds need to be released asap; overall nobody wants yet another bad story to leak out. But none of the medics are like gods. Just as all of us are different individuals so too our bodies, our thoughts (positive/negative), personal matters impacting medics on any given day and more are part of a mix that cannot be fully controlled. There is a lack of general education about every aspect here from which many could benefit.