Dr Steven Cook – Anaesthetist.
As an anaesthetist I am the specialist doctor who manages your medical conditions to ensure you have a safe anaesthetic and post-surgery recovery. I liaise with your surgeon and other medical practitioners to ensure you are fit for your operation.
It is very satisfying when a patient is well prepared for surgery and recovers well. The opposite is also true when a patient hasn’t prepared well. Smoking up to the day of surgery, poor physical fitness and sub-optimal management of chronic medical conditions makes my chances of keeping you safe less certain. Frequently I would see the complications of long term health problems such as diabetes, obstructive sleep apnoea or obesity result in complications such as chest infections, wound infections and slow recovery. I don’t like seeing this, and I’m pretty sure you don’t either.
However, the good news is that you as a patient can make a significant difference in the success of your surgery by ensuring you are in optimal health and your medical conditions are reviewed and treated appropriately. Strong evidence exists that being in optimised health prior to anaesthesia decreases the risk of post operative complications by up to 30%. Optimal preparation allows a more rapid return to normal function and a decreased length of hospital admission.
Your General Practitioner can assist by regular review and management of medical conditions, often in liaison with appropriate medical specialists and other health providers. Examples of this include optimisation of cardiovascular, respiratory and endocrine conditions such as diabetes prior to surgery. Ceasing smoking 4 weeks prior to surgery and ensuring emphysema or asthma are well managed can decrease post operative respiratory complications by up to 41%. Hypertension, cardiac failure and pacemakers may require review prior to surgery and diabetic management should be discussed with your doctors. Patients with a known history of significant anaemia may need to be tested 6 weeks prior to surgery for consideration for iron supplementation.
Physical fitness and nutrition are increasingly being recognised as important factors in the success of surgery. These factors can be discussed and planned in advance of your operation with your General Practitioner, surgeon or an allied health practitioner such as a dietitian or exercise physiologist.
Elderly and frail patients are particularly at risk of complications after major surgery and potentially benefit the most from pre-surgery health optimisation. This is generally best done in a multi-disciplinary team with assessment of suitability of surgery, pre-surgical conditioning and planning for post-operative care requirements such as rehabilitation or intensive care support. By doing this before surgery, together we obtain the best chances of a successful outcome, even when you have some health concerns.
As a patient you have a major influence on the success of your surgery. Work with your doctors to optimise your health and decrease the risks of complications. A first step is visiting your General Practitioner 6 weeks prior to surgery to review your health conditions and medications, ceasing smoking and starting some moderate daily exercise.
In this way we can get your surgery and anaesthetic right first time, every time.
Dr Steven Cook is a specialist anaesthetist in public and private practice in Brisbane. He has an interest in trauma, orthopaedics, military medicine and Perioperative care.