Anaesthetics

A local anaesthetic numbs a small part of the body. It is used when the nerves can be easily reached by drops, sprays, ointments or injections. You stay conscious, but free from pain. Common examples of surgery under local anaesthetic are having teeth removed and some common operations on the eye.

Regional anaesthesia is when local anaesthetic drugs are injected near to a bundle of nerves which carry signals from a larger area of the body to the brain.

The most common regional anaesthetics (or blocks) are spinal and epidural anaesthetics. These can be used for operations on the lower body, such as a caesarean section or hip replacement. You stay conscious but free from pain. However, sedative (sleepy-making) drugs can also be given to ensure you are calm and relaxed during the operation.

General anaesthesia is a state of controlled unconsciousness during which you feel nothing. Some operations can only be done with a general anaesthetic. Anaesthetic drugs are injected into a vein, or anaesthetic gases are breathed into the lungs. They stop the brain recognising messages coming from the nerves in the body. As the anaesthetic drugs wear off, consciousness will return.

These three types of anaesthetic can be used on their own or with another type to give the best and safest anaesthetic for each patient.

Sedation involves using small amounts of anaesthetic drugs to produce a ‘sleep-like’ state. It makes you physically and mentally relaxed, but not unconscious. Many people having a local or regional anaesthetic do not want to be awake for surgery. They choose to have sedation as well. If you have sedation, you may remember little or nothing about the operation or procedure. However, sedation does not guarantee that you will have no memory of the operation. Only a general anaesthetic can do that. For more information, click here.

Anaesthetic techniques are often combined. For example, a regional anaesthetic may be given for pain relief afterwards, and a general anaesthetic makes sure you remember nothing.

This section should help you understand a little bit more about the potential risks, but it is important to discuss any particular worries you have with your anaesthetist.

Anaesthetic techniques and equipment have greatly improved over the last 60 years, as has the training and safety equipment to protect you. If you are in good health, modern anaesthetics are really very safe. However, all procedures have some risks.

Click here to view leaflets that look at the main risks of anaesthetics.

Balancing Risk

Having surgery involves balancing risk – this means trying to balance the positives of having the operation against the risks and deciding on whether you want to go ahead. Please click here if you are interested in reading more about how we look at risk and what the numbers really mean.

This website includes text taken from the Royal College of Anaesthetists’ (RCoA) website www.rcoa.ac.uk but the RCoA has not reviewed this as a whole.

Anaesthetists are all doctors who have completed a full medical training. They then choose to complete further training over nine years to become fully trained consultant anaesthetists. Anaesthetists are the largest group of hospital based doctors. There is a wide range of sub-specialties which make up the overall specialty of anaesthesia.

You will meet anaesthetists working in many different areas of the hospital.

• Operating theatres All anaesthetists work in the operating theatres. Some may specialise in particular types of surgery, such as vascular, paediatrics or eye anaesthesia.
• Intensive care medicine These anaesthetists work on an intensive care unit. They look after critically ill patients suffering from a wide range of serious illness such as severe breathing problems, kidney failure or life-threatening infections. They also look after patients who have had major surgery or after major trauma before they are well enough to be nursed on a specialist ward.
• Obstetric anaesthesia Anaesthetists work on the labour ward providing pain relief and anaesthetics for childbirth. They also work alongside obstetric doctors in the assessment and care of women with complex medical problems during  pregnancies, or who develop complications  during pregnancy.
• Pain specialists These anaesthetists care for patients suffering long term pain. Patients are referred to pain relief clinics where a full pain assessment is made. This may be followed by injections, specialised use of pain relief medicines and/or psychological techniques and support. The quality of life for patients with long term pain can be greatly improved.
• Emergency care and resuscitation Anaesthetists work closely with Emergency Department (ED) doctors to look after the sickest patients as they arrive in the hospital.

Medical students study for five years in both a university and a hospital. They then graduate as doctors with the basic medical degree. All doctors then have a further two years of Foundation Stage training in a range of different specialities. This gives a wide basic training and allows them to find out the areas of work they are interested in. Doctors who wish to train in anaesthesia apply to go on a training programme which lasts seven more years to become a consultant.

At first, a new anaesthetist works with a consultant anaesthetist by their side all the time. As the trainee passes competency assessments and gains experience, the level of supervision is very gradually reduced.

Anaesthetists need to complete all the required  standards set by the Royal College of Anaesthetists. They also need to pass a difficult two-part exam called the Fellowship of the Royal College of Anaesthetists (FRCA). Trainees need to pass these before they can continue with the last stage of their training.

The standards of training in the UK are very high. The Royal College of Anaesthetists has a duty to set and monitor standards of training. Hospitals which do not provide a high enough level of training to these standards will no longer be allowed to train anaesthetists.

Anaesthetists in training (junior doctors)

CT1/2 – Core training year 1 and 2
These are the early basic training years in anaesthetics.

ST 3/4/5/6/7 – Specialty training years 3-7 of training
The number is the training year which they are in. This training covers all the specialist training these doctors need to become consultants.

Senior anaesthetists

Senior anaesthetists are no longer in training and usually work on their own or supervise a trainee.

Consultant anaesthetists
A consultant has completed all the training requirements in anaesthesia to allow them to be on the GMC specialist register. They work without any senior supervision but must all continue education in anaesthesia each year. They usually specialise in a particular area of anaesthesia. Some may lead teams in different areas of the hospital, such as intensive care and pain medicine.

SAS doctor
This group of anaesthetists have different levels of experience and may be called either Staff Grade, Fellow, Associate Specialist or Specialty Doctor. For various reasons, these anaesthetists have made a choice not to complete all the higher specialty areas of training, or may be pursuing other interests (such as teaching or research) before continuing their training.

Depending on their skills and experience, these doctors may work alone, but can ask for advice or assistance if required.

Other titles you may see

Locum anaesthetist
These can be anaesthetists of any grade that are temporarily working to cover a position.

Anaesthetic Associates (AA)
They are trained healthcare professionals who are qualified to give anaesthetics under the supervision of a consultant anaesthetist. This role is new to the UK, but is more common in northern Europe and the United States. The AA will be a health professional or a university graduate who has a specific training programme which leads to a Postgraduate Diploma in Anaesthetic Practice.

All grades of anaesthetists are appraised each year to best ensure they meet the standards of practice required in the UK. They also use this appraisal to decide what extra courses or training they need to attend to keep them up to date in all the areas that they work in or to learn new skills. This process is overseen by the General Medical Council.

The maternity unit manages over 4000 deliveries per year and comprises 33 single delivery rooms and three-four bedded bays. There are two obstetric operating theatres and two high-dependency rooms for mothers developing complications during pregnancy or childbirth.

Anaesthetists provide a 24 hour service including a range of anaesthetic options for caesarean section, a 24 hour epidural service and joint management with the obstetricians of women with severe pregnancy complications.

Each week a Consultant Anaesthetist holds a clinic for mothers who require additional anaesthetic assessment prior to delivery.

The Maternity Unit is located on the 2nd floor at the end of east wing.

To access information and videos about pain relief and anaesthesia, please go to www.LabourPains.com

Introduction | The Royal College of Anaesthetists

Information for children, parents and carers | The Royal College of Anaesthetists

See inside Russells Hall Hospital

Patient FAQs | The Royal College of Anaesthetists

A to Z of medical terms (glossary)