The Anaesthesiologist:

1. What is an Anaesthetist or Anaesthesiologist?

An anaesthetist is a medical specialist who specialises in the administration of general and regional anaesthesia, pain management and critical care. Anaesthetists are experts in both pharmacology and resuscitation. In some countries anaesthetists are referred to as anesthesiologists.

2. How does one become an Anaesthesiologist (Narkotiseur)?

To become an anaesthetist you first study to become a medical doctor (this normally takes about 6 years). After this you practice as a general practitioner and fulfill mandatory periods such as your internship and community service. Specializing as an anaesthetist takes a minimum of four years of full time training. Anaesthetists must pass a variety of oral, written and clinical exams to qualify. They must also maintain their knowledge using continuous development points (CPD) and this is overseen by the Health Professions Council of South Africa (HPCSA).

3. Are Anaesthesiologists registered with the HPCSA?

All specialist anaesthetists are registered as medical specialists with an independent license to practice with the HPCSA.

4. Are you able to provide any type of anaesthetic?

Anaesthetists are trained in all forms of anaesthetics. Some anaesthetists train further, completing what is known as a fellowship in certain sub-specialities. These sub-specialities include cardiac surgery, obstetrics, neonatology (very small babies), pain management and critical care.

5. Is the job tiring?

Anaesthetists work long hours in a stressful field. We do, however, as an association make mandatory provision for decent amounts of rest and annual leave to keep us well rested and sharp.

6. Is the job stressful?

Anaesthesia is often described as continuous low-grade stress with bursts of high-level stress. Patients relinquish all their control to you, and the responsibility is great. Anaesthetists have to think quickly if a problem occurs under anaesthesia, as the time to correct it is often short. Major problems are uncommon and anaesthetists are trained to handle them. In many ways, anaesthetists are similar to airline pilots who continuously train to solve a problem if it occurs, even though the chance of that problem occurring is rare.

7. Do you stay in theatre while I am asleep?

Anaesthetists monitor your condition continuously and alter the anaesthetic, provide you with various drugs, and interact with the surgical team. Anaesthesia is a dynamic state for a patient to be in that requires constant correction and treatment by the anaesthetist.

8. May I request a specific anaesthetist?

As a patient, you may request a specific anaesthetist, however this is NOT always possible. Each anaesthetist has specific surgical lists on each day of the week with specific surgeons. In order to have your requested anaethetist, if not normally allocated to your theatre, they would need “swop” a theatre list with another anaesthetic colleague. This can be arranged prior to your day of surgery, but can’t be promised.

General Anaesthesia

1. What is General Anaesthesia?

There are usually three components that comprise general anaesthesia: loss of consciousness, pain relief and muscle relaxation. When you receive general anaesthesia you will lose consciousness for the duration of the procedure. Analgesia is provided while you sleep with the intention of waking you up after the procedure with minimal discomfort. Medication is also prescribed to manage any potential pain in the postoperative period.

2. How is one placed under general anaesthesia?

Children usually receive an anaesthetic gas that they breathe in and this makes them fall asleep. Going to sleep using an anaesthetic gas may take bit longer. Most children, however, will choose this method over an injection to go to sleep.

Adults are usually anaesthetised using medication that is injected in the intravenous line into a vein. These drugs work very quickly and you can expect to lose consciousness within seconds.

3. How do you wake me up?

Once the surgical procedure is completed, your anaesthetist will lower the anaesthetic drug that is maintaining your anaesthetic. Whether you breathe the gas out, or the anaesthetic medication is broken down inside your body, you usually wake up relatively quickly after this.

4. Is anaesthesia dangerous?

Modern anaesthesia has become much less unsafe than in the past. Serious incidents are rare, and usually treatable by anaesthetists who anticipate their occurrence and are trained to manage them. Healthy patients usually experience very safe anaesthesia whereas sickly patients experience more difficult anaesthesia. This is why sickly patients and the anaesthetist must form a plan before your anaesthetic to provide you with the safest options for your procedure. Your current state of health, the type of procedure you are booked for, and the expected duration of recovery all play a part in your risk profile and the preparation required by you and the anaesthetist prior to your surgery.

5. I suffer from nausea or allergies. Should I tell the anaesthetist?

It is extremely important for you to raise any of your concerns with your anaesthetist during your pre-operative consultation. Most anaesthetists will cover all the important parts during the consultation but please voice your concerns you may with your doctor. Patients often think that they have to suffer from symptoms after a general anaesthetic, but in reality we have several very effective modalities to treat patients who experience anaesthetic-related complications e.g. nausea, anxiety.

6. Why may I not eat prior to my operation?

If your stomach is full of food, the food may run up your oesophagus (food pipe) as you go to sleep and enter your lungs. This can be fatal. For this reason, all patients are required to not eat for at least 6 hours prior to the anaesthetic, to ensure an empty stomach. Clear fluids (water, apple juice) are allowed up to 2 hours prior to surgery, especially in small children and the elderly, but you should check with your surgeon or anaesthetist prior to consuming such fluids. Chewing gum produces gastric acid in the stomach, and for this reason you should avoid doing this for 6 hours prior to your surgery.

7. When may I drive?

As the drugs administered to you affect your judgment and balance, you are requested not to drive for 24 hours after your last anaesthetic.

8. When may I start to work again?

This is a topic for you to discuss with your surgeon since it depends on your surgery and expected recovery.

9. I am afraid of being in pain.

Please voice your concerns to your anaesthetist prior to your procedure so that we may offer you various options to ensure comfort after your operation. We endeavour to manage pain effectively in order to avoid the complications related to poorly managed pain.

Regional Anaesthesia

1. What is Regional Anaesthesia?

In anaesthesia we have the ability to inject local anaesthetic drugs that transiently block a nerve or a group of nerves. This renders a certain area of the body the inability to feel pain and temporary paralyzes the muscles supplied by the specific nerves being blocked.

2. When will I be given a pain block?

A block is usually given if significant surgery or post-operative pain is expected in an area. Nerve blocks may provide excellent pain relief after surgery. This may reduce the need for stronger forms of intravenous and oral pain relief and thereby reduce the chance of side-effects from these medications. Occasionally a pain block is given as the sole choice of anaesthetic instead of general anaesthesia.

3. How long will a pain block last for?

This depends on the site of the block and the local aneasthetic used. Some blocks may last for only a few hours, and others for up to 24-36 hours. In certain circumstances, we leave a small catheter in the area for local anaesthesia to trickle into the region. In such a case the block will last until we remove the catheter. Once the block wears off, the pain that returns is usually of a milder intensity and can be managed with prescribed analgesics.

4. Are there any risks to a pain block?

Pain blocks have risks, however most are rare. For this reason you will be required to sign written consent prior to the administration of a block. The risks of a block depends on the specific site and block being performed and includes:

  • the block not working properly, requiring other interventions or general anaesthesia
  • a very long acting block
  • infection of the area
  • bleeding in the area (haematoma)
  • nerve damage (which can be temporary or permanent)
  • paralysis
  • headache
  • a pneumothorax or ‘popped lung’

convulsions, cardiac arrest and death if the drug enters a vein (this is exceedingly rare)

5. Must I have a pain block?

The decision as to whether to have a block for your procedure is your choice. Discuss the pros and the cons with your anaesthetist and try to reach a beneficial outcome together. It is very difficult to conceptualise risk since it means very little until it happens to you personally.

6. Will my medical aid pay for a pain block?

It is very likely that a medical aid will pay for a block. However, in the unusual case that they refuse, the cost of the block must be settled by you personally.



1. What can I expect if my procedure is under sedation?

In the vast majority of cases you will receive conscious to deep sedation. This means that you will be sedated deeply, but not on the level of general anaesthesia. The goal of sedation is to make you comfortable during the procedure with a a quick recovery. If a patient is very ill or elderly, the anaesthetist may opt for a full general anaesthetic or very light sedation. Sedation requires that the patient be relatively healthy. If your endoscopy is part of a large and concurrent procedure e.g. your gall bladder removal, you will be given general anaesthesia from the beginning.

2. How can I prepare for my procedure done under sedation?

You should remember to not eat any food for 6 hours or drink any clear fluids for 2 hours prior to the procedure. If you are scheduled to have a colonoscopy your surgeon will organise for you to drink “bowel prep”. This fluid cleans out your system very efficiently so that your colon can be well visualized.

3. Will I remember the procedure?

It is important to understand that unlike a general anaesthetic, sedation doesn’t guarantee unconsciousness or complete amnesia (loss of all memory). However, your anaesthetist is with you constantly to facilitate your comfort during the procedure. Most patients do not recall the procedure, and are surprised to wake up and find that the procedure has already been completed.

4. Why do I need sedation?

Without sedation the procedure might be very uncomfortable and even painful. Sedation may also improve the quality of the examination as the surgeon or proceduralist is not constantly worried about your discomfort and safety during the procedure.

5. May I go home after a sedation?

Whereas most patients are able to go home the same day after a short period of recovery, hospital discharge remains at the discretion of your treating team. If you are discharged the same day it is imperative that you do not drive for 24 hours after the procedure.

6. Will I be in pain after the procedure?

Pain after the procedure is uncommon but a minority of patients experience mild abdominal cramping or nausea. In this case, please inform the hospital staff so that we may prescribe treatment for you.

7. Why is there a hospital co-payment for my endoscopy?

This is most likely a condition of your medical aid plan, and should be followed up with them.

8. Why is the anaesthetic fee the same if my procedure only required sedation?

Many anaesthetists consider sedation to require more skill than general anaesthesia, as we must keep the patient on a plane between general anaesthesia and being awake. Conscious sedation shares the same risks as general anaesthesia and requires the same care from your anaesthetist. It is also important to remember that in general your bill pays for the presence of an anaesthetist, and not only the difficulty of the anaesthetic.