ENT surgery begins not with anaesthesia, but with a conversation

An anaesthesiologist’s task is not merely to “put a patient to sleep” before surgery. They assess the patient’s overall health, select the most appropriate type of anaesthesia, monitor vital signs throughout the operation, and care for the patient’s well-being afterward. Our clinic’s anaesthesiologist and intensive care specialist, Dr Ieva Kārkliņa-Kravale, explains why speaking with the anaesthesiologist before ENT surgery is just as important as speaking with the ENT surgeon, how a patient should prepare for anaesthesia, and what parents need to know when their child is having surgery.

An anaesthesiologist does more than “put you to sleep”

Contrary to the widespread misconception that anaesthesia is a nursing profession, an anaesthesiologist is a doctor. Their responsibility begins before surgery, when the most suitable type of anaesthesia is chosen, and continues after the surgeon has finished and the patient has awakened. The anaesthesiologist provides general anaesthesia or sedation during an operation or procedure, monitors vital signs and safe awakening, observes the patient after surgery, and manages pain relief.

An ENT doctor focuses specifically on the nose, ears, or throat, whereas the anaesthesiologist is interested in everything: medical history, coexisting conditions, medicines, previous experience of anaesthesia, allergies, every organ system, and daily habits, because anaesthesia affects the entire body. This conversation before planned surgery is extremely important. Meeting the patient is especially valuable when the operation is for a child, for whom unfamiliar people and surroundings can cause additional anxiety. Meeting the anaesthesiologist helps establish a connection and familiarity, reducing fear and worry about the upcoming operation, at least to some extent.

There is no such thing as unsafe anaesthesia!

In their daily work, anaesthesiologists hear many fears: that patients will be unable to fall asleep, will wake during surgery, or, conversely, will not wake after anaesthesia; that anaesthesia will be unsafe or have long-term consequences. Parents whose children are having surgery are particularly concerned about long-term effects. It must be acknowledged that there are still no absolute conclusions about potential adverse effects of paediatric anaesthesia on a child’s central nervous system. Although research continues, no link between anaesthesia and a child’s learning difficulties or developmental problems has been proven so far.

Every patient should understand that there is no unsafe anaesthesia, only simpler and more complex cases. Anaesthesiologists manage every process as safely as possible. Anaesthesia would be unsafe if an anaesthesiologist and anaesthesia nurse administered it and then left the patient unmonitored for the entire operation, but this does not happen: a member of the anaesthesia team always remains and monitors the patient.

The anaesthesiologist is present throughout the operation or procedure:

• ensuring that the patient remains still and feels no pain;
• monitoring heart function;
• controlling blood pressure;
• monitoring oxygen saturation;
• monitoring breathing and, when necessary, mechanical ventilation;
• adjusting anaesthesia to the patient’s condition;
• ensuring safe awakening after surgery.

Why is it important for patients to be honest about their habits?

Before any operation, including ENT surgery, the patient will undergo examinations prescribed by the doctor. No special preparation is required for the conversation with the anaesthesiologist, because the doctor will guide it and ask focused questions to obtain the necessary information.

The most important thing is to answer these questions honestly. The anaesthesiologist’s office is not the place to feel embarrassed or pretend. The specialist does not ask questions to shame or judge anyone, but to provide conditions that protect the patient’s life and health during surgery. Anaesthesiologists do not enjoy asking whether someone smokes or regularly drinks alcohol, but they need this information. Anaesthesia can be expected to affect a person who regularly drinks alcohol differently from someone who does not drink at all. Sensitive information remains between doctor and patient, but the doctor must know it.

Patients should answer honestly and without embarrassment about:

• chronic conditions;
• medicines being taken;
• dietary supplements, if used;
• allergies;
• smoking;
• alcohol or other substance use;
• previous experience of anaesthesia;
• complications during previous operations.

Why must you not eat or drink before anaesthesia?

One requirement doctors will repeat several times before planned surgery is the period during which the patient must not eat or drink. This rule must be followed strictly. If the stomach is full when anaesthesia is administered, its contents can enter the airways when the body relaxes and cause serious complications.

Patients sometimes think that a little juice or coffee with milk on the morning of surgery cannot matter. But juice with pulp, milk, and infant formula are not clear liquids; they are food. If the patient has eaten or drunk anything before anaesthesia, the doctor must be told, because the anaesthesia plan may change and in some cases the operation may have to be postponed.

When are anaesthesia and surgery likely to be postponed?

If a patient is acutely ill or a chronic condition has worsened, it may be safer to postpone planned surgery until the patient feels better. Surgery is likely to be postponed if the patient has:

• a pronounced cough or other signs of acute illness;
• a raised body temperature;
• an exacerbation of bronchial asthma;
• certain heart rhythm disorders;
• markedly elevated glucose levels in diabetes;
• alcohol intoxication;
• insufficient preparation, for example when required preoperative examinations have not been completed.

Anaesthesia for a child: trust is the most important thing

Planned surgery for a child often causes great anxiety for parents. Children sense both their parents’ calmness and their worry, so the parents’ trust in the specialist and sense of safety also determine how the child feels. Parents should speak to the child calmly and honestly about the upcoming operation. It is important for the child to meet the anaesthesiologist beforehand. The doctor will show the young patient the anaesthesia mask, let them touch it and try it on, and explain that the child will have a very important task so the operation can take place. This avoids frightening surprises and strengthens the child’s confidence as an important participant in the operation.

The rest of the preparation is relatively simple. Children without chronic health problems do not need preoperative examinations as detailed as those for adults; blood tests prescribed by the doctor are sufficient. Like adults, children must not eat for at least six hours, but after the operation they have certainly earned an ice cream for their courage! During recovery from ENT surgery, it is genuinely useful because it helps reduce local swelling and gives the young patient a positive experience.

Anaesthesia is not only the moment when the patient falls asleep. It is a process that begins with a conversation before surgery and continues into the postoperative period. Patients should know that the anaesthesiologist will remain alongside them throughout, safeguard them, continuously monitor how their body is functioning, and adjust anaesthesia to the particular situation and individual. The anaesthesiologist, anaesthesia nurse, surgeon, patient and, when the patient is a child, their parents all work as one team.