The Surgeon’s rooms will liaise with us directly, and give us your details. We will then make contact, usually by text message, otherwise by phone, asking permission to send you some preoperative information. This may include a link to a preoperative health screening questionnaire, and information about any anaesthetic charges that will occur. The substantial majority of patients will not have a “gap” charge associated with their anaesthetic.
The Preoperative Process
I have been forwarded a health questionnaire – do I need to complete it?
If we have forwarded you a health questionnaire, we believe it is in your best interests to complete it – every person is unique, and requires a unique anaesthetic. The information contained in the questionnaire allows your anaesthetist to tailor an anaesthetic specific to you. It also allows them to review and manage any medications you are taking, and liaise with your other specialists.
Please note that in some cases (for example, with minor procedures, or if your surgeon has forwarded us the relevant information already), we may not need to forward you a health questionnaire.
I’m providing highly confidential medical information – is it safe?
Your medical information is stored on a local server (not overseas), and is protected using 256 bit SSL encryption (the highest standard possible). Your personal information is never shared or traded with any third party.
What do I do with my medications?
If you have filled out a health questionnaire, your medication list should be forwarded through to the anaesthetist, and you will be contacted prior to surgery.
As a general rule you should take your usual morning medications with a sip of water on the morning of the operation. It is very important that if you are taking either blood thinning drugs, or diabetic medications, that you have clear instructions on when to stop and restart them. The surgeon or proceduralist will often provide this advice – if you are unclear about your instructions, please contact us.
Dietary supplements (especially fish oil or krill oil, ginger, ginseng, and gingko biloba) should be stopped 2 weeks prior to surgery.
Do I need to fast before my anaesthetic?
Yes, and this is in order to reduce the risk of regurgitation (bringing up of stomach contents) with the potential for aspiration (the passage of those contents into the lungs). As a general rule, food should be stopped at least 6 hours before a procedure, and water at least 2 hours before. Some patients have particular fasting concerns, and these will be addressed by your anaesthetist. We ask that you inform us if you have a gastric band in place, or if you have ever had issues with regurgitation, or aspiration, relating to a previous anaesthetic.
The following fasting guidelines are recommended by ANZCA (the Australian and New Zealand College of Anaesthetists)
- For adults having an elective procedure, limited non-fatty solid food may be taken up to six hours prior to anaesthesia. In most circumstances, patients are encouraged to drink clear fluids for up to two hours prior to anaesthesia. Clear fluids are water, pulp-free fruit juice, clear cordial, black tea and coffee. Cloudy or milk-based drinks or alcohol are not to be taken.
- For children over six months of age having an elective procedure, breast milk or formula and limited solid food may be given up to six hours prior to anaesthesia, breast milk up to four hours and clear fluids (no more than 3ml/kg/hr) are encouraged up to one hour prior to anaesthesia.
- For infants under six months of age having an elective procedure, formula may be given up to four hours, breast milk up to three hours and clear fluids (no more than 3ml/kg/hr) up to one hour prior to anaesthesia.
- Prescribed medications may be taken with a sip of water less than two hours prior to anaesthesia unless otherwise directed
(for example oral hypoglycaemics and anticoagulants).
I am a smoker
We ask that you cease smoking as soon as possible before surgery. This will provide a number of benefits to you, particularly in terms of your respiratory function, and will improve wound healing after surgery.
Please let us know if you have smoked on the day of surgery.
For more information, please refer to the following website:
https://healthywa.wa.gov.au/Articles/F_I/Gettting-ready-to-quit-smoking
or speak to your General Practitioner
I am Diabetic
It is important that you let us know if you have diabetes. Medications may need to be ceased or modified coming up to your surgery. It is vitally important, if you are taking insulin, that you have clear instructions on your regimen around the time of surgery.
Sleep apnoea
Please let us know if you have been diagnosed with sleep apnoea, and if you use any adjuncts such as a CPAP machine or mandibular splint. They should be brought with you to hospital.
I have a cold. What should I do?
Please let us know if you have any symptoms of cold or flu as soon as possible. Aside from the possibility of COVID-19 (which will need to excluded), there could be issues proceeding with your surgery.
I have a laparoscopic gastric band
It is important that you let us know if you have a gastric band, and how much fluid is in it (if you know). The band may need to be deflated (which may require a separate appointment prior to surgery), or usual fasting times may need to be altered.
I have a pacemaker
Please bring the wallet card that was given to you after your pacemaker insertion – this gives us valuable information about your device, and how we need to manage it during surgery. Alternatively, you can email us a copy of the card.
When will I meet my anaesthetist?
Whilst some of your contact with the anaesthetist will take place online, you will of course meet your anaesthetist before your operation to discuss your anaesthetic and to perform a relevant examination. This may occur in Doctor’s consulting rooms, or in the hospital on the day of surgery. Once all relevant information has been reviewed, the anaesthetic options (general, sedation, regional) will be discussed, and an anaesthetic specific to you designed. Your postoperative pain management will also be discussed, as this is managed by the anaesthetist.
What are the risks associated with anaesthesia?
Australia is one of the very safest places in the world to have an anaesthetic, and severe morbidity or mortality from anaesthesia is extremely rare. The following is by no means an exhaustive list, and any specific concerns about your upcoming anaesthetic should be discussed with your anaesthetist.
The common risks of anaesthesia include, in no particular order:
- Nausea and vomiting (which can be treated – if this has been an issue in the past, please tell your anaesthetist)
- Bruising at the site of injection
- Shivering following anaesthesia
- Sore throat (this is usually mild, and resolves in minutes to hours)
- Uncommon risks include:
- Lip or tongue injury
- Damage to the teeth or dental work
- Corneal abrasions (a scratch to the eye)
Very rare risks include:
- Damage to the peripheral nerves that persists after surgery
- Severe allergy to a drug (anaphylaxis)
- Heart attack or stroke
Information about Procedures
Epidural Anaesthesia for Labour and Childbirth
Epidural anaesthesia is one of the pain relief options for a woman in labour. The process involves:
- A discussion with your anaesthetist about epidural anaesthesia, and it’s complications. Information is often provided as part of your pregnancy information, and Hospitals often have antenatal information courses, where an Anaesthetist will be available to answer questions. We encourage our patients to inform themselves as much as possible, and ask us questions.
- Insertion of a cannula, or intravenous drip
- The mother will then be asked to either lie on her side, or sit on the edge of the back
- An area of the lower back is then cleaned with antiseptic solution, and a drape applied to it
- A small amount of local anaesthetic is injected into the skin of the lower back
- A needle is inserted into the epidural space in the back via a hollow needle. This requires that you remain very still during insertion
- The catheter is then taped to the back, and drugs can be injected into the catheter, either by hand or via a machine.
The drug takes several minutes to take full effect, and is initially perceived as shorter contractions. You will still be able to push during contractions.
Further information can be found here.
Anaesthesia for Caesarean Section
There are a number of different modes of anaesthesia for Caesarean section, and they include:
Spinal anaesthesia: where a single dose of anaesthetic is injected into the fluid surrounding the spinal cord. This results in rapid loss of sensation below the level of the belly button
Epidural anaesthesia: a slim, pliable plastic tube is inserted into the back and drug can be administered through it. The advantage of an epidural is that drug can be repeatedly added to it (it can be “topped up”) during labour.
Combined spinal-epidural anaesthesia: this is a combination of the above techniques. It combines the rapid onset of a spinal anaesthetic with the longer duration of an epidural.
The above techniques all allow the mother to stay awake while her baby is being delivered.
General Anaesthesia
This is usually reserved for emergency procedures, or in circumstances where epidural or spinal anaesthesia is not appropriate. The mother will not be able to be awake when the baby is being delivered, and a partner or support person will not be able to present in the delivery theatre.
Further information can be found here.
Anaesthesia for Bariatric Surgery
This can take several forms. The most common procedures are laparoscopic gastric band surgery, sleeve gastrectomy, and gastric bypass.
Laparoscopic gastric band surgery involves placement of an adjustable band around the top of the stomach. This band can be inflated with fluid, and makes a person feel fuller after less food.
Sleeve gastrectomy involves resecting (removing) approximately 80% of the volume of the stomach, leaving a stomach approximately the size of a banana. This is typically done laparoscopically, which involves (as with banding), placing tubes through the skin of the abdomen.
Gastric bypass can involve different techniques, but in essence means that the surgeon creates a small pouch in the upper part of the stomach, and connects this to the intestine, literally bypassing much of the stomach.
Each of the techniques has a place, and there is no one best solution for every patient. You should discuss carefully the risks and benefits of each type of weight loss surgery with your surgeon before proceeding.
You should have clear fasting and medication instructions for the day of surgery. In general, you should abstain from solid food and Optifast for at least 6 hours prior to your procedure, and clear fluids (water, lemonade, pulp free juices) for at least 2 hours prior to surgery.
You may have a premedication prescribed.
Following surgery, you will receive painkilling medication, anti-nausea medication, and injections placed under the skin to reduce the risk of deep vein thrombosis.
Further information can be found here.
Anaesthesia for Joint Replacement Surgery
The majority of joint replacement surgery is for the hips and knees (although other joints can be replaced). This is major surgery, and must be discussed with your anaesthetist.
- Joint replacement can involve a combination any or all of the anaesthetic modalities, including:
- Spinal anaesthesia
- Epidural anaesthesia
- Peripheral nerve blocks
- General Anaesthesia
Further information can be found here.
Anaesthesia for Eye Surgery
It is important that you have clear preoperative instructions regarding your medications, particularly any blood thinning drugs. It may be possible for you to keep taking these through the perioperative period.
There are different types of anaesthesia that you may be offered for your eye surgery, and these range from Local anaesthesia (in the form of eye drops), regional anaesthesia (or an eye block, where local anaesthesia is injected around the eye once you have been sedated), or general anaesthesia.
It is important that you follow fasting instructions
Further information can be found here.
Anaesthesia for Children
When you arrive at the hospital your child will be admitted, which involves going through their medical history, recording vital signs, and weighing them. Your anaesthetist will make a plan for your child’s anaesthetic, and this may include premedication. If appropriate, you will be able to accompany your child to theatre (only one parent may accompany the child). Your child may have either gas (volatile anaesthetic) or intravenous medication to go off to sleep, and this will be discussed with you prior to surgery. The anaesthetist stay with your child the entire time they are in theatre, and then delivers them to the recovery room.
Further information can be found here.
Information about Fees and Billing
Why is there an Anaesthetic Fee?
We always strive to keep our patients informed leading up to, and after, their anaesthetic.
We are often asked about charges, and this can be a confusing area for patients, as there are many different components of your care which potentially carry a charge.
The Private system is fundamentally different to the Public Hospital system.
In a Public Hospital, all staff are contracted to the Hospital, and are generally salaried (but occasionally paid per case or hourly). There is no charge to a patient.
In the Private system, anaesthetists are not employed by the Hospital – instead, they are accredited to work at a particular hospital, and charge a fee for the service they perform. The anaesthetic fee is separate to the surgical fee, and to other hospital charges (e.g. room charge, pathology, etc). The exception to this is when you have been offered a surgical package, with a defined upfront cost.
How is the Anaesthetic Fee determined?
The anaesthetic fee is related to the Medical Benefits Schedule, and is measured in values called “units”. There are 3 basic components to an anaesthetic fee
- The pre-anaesthetic consultation
- The nature of the surgery being performed
- The time taken for the anaesthetic
There are also a number of other items that can be included in the anaesthetic, and they are generally related to increasing anaesthetic complexity.
A complete list of anaesthetic item numbers can be found on the Medicare Website.
When you undergo a surgery requiring an anaesthetic, Medicare and your Health Fund will each rebate a portion of the anaesthetic fee per unit – in the majority of cases the whole anaesthetic fee is covered by these two contributions, and you will be left with nothing extra to pay. In some situations though, Medicare and your Health Fund may not cover the entire fee, and there is a shortfall. This is the “gap”. The “gap” will vary by the procedure, how long it goes for, and by what your particular Health Fund will rebate.
How does an Anaesthetist decide their fees?
Anaesthetists charge what they feel is an appropriate fee, and this will differ between anaesthetists. It is impossible to give a “one size fits all” answer, as each separate anaesthetist has different arrangements with Health Funds (no gap providers, capped out-of-pocket arrangements etc).
If there are any out-of-pocket expenses relating to the anaesthetic service, we will contact you to advise.
What will my fee be? Will I have a gap to pay?
Whilst we cannot give a one-size-fits-all answer for every patient (and by inference, every anaesthetist), we have attempted to make things as transparent as possible.
There are many procedures that our anaesthetists “opt in” for – that is, they accept the reimbursement offered by the Health Fund and Medicare, and there is no gap to pay. The information provided to you by your surgeon or proceduralist will normally confirm when this is the case. If there is a gap to pay, we inform you at the earliest possible opportunity. We will provide you with an estimate, which clearly explains the fee, and your likely rebate.
If you are unsure of your anaesthetic fee, and would like an estimate, please click here, and we will get back to you as soon as possible.