Dr Ben Lincoln

Anaesthesia can take on many forms including:

• local anaesthesia – numbing a small part of your body
• regional anaesthesia – numbing a larger region of your body e.g. arm, leg, lower body
• conscious sedation – sleepy but not fully unconscious (“twilight”)
• deep sedation – deeply asleep but breathing for oneself
• general anaesthesia – fully unconscious and often requiring assistance with breathing

Sometimes a combination of these will be used. The decision is based on what is safe, the surgery you are having, and your preferences.

An anaesthetist is a doctor who has specialised in anaesthesia after finishing a university medical degree. Overall it takes at least 13 years of training and many examinations to become a specialist anaesthetist. As part of their training they become experts in pain management, resuscitation, care of the critically ill patient as well as other specialist areas such as obstetrics and paediatrics.

Without anaesthesia many procedures would not be able to be performed and many advances in surgery could not have occurred. To achieve the situation where the surgeon can perform your procedure your anaesthetist uses several different medications. These medications, while being necessary, can have significant impacts on your body. A specialist anaesthetist has extensive knowledge of these medications and how they interact with your body. It is because of this extensive knowledge that complications from anaesthesia are rare. When complications do occur your anaesthetist has the skills and knowledge to manage these.

Ultimately, your well-being during and immediately following surgery is the responsibility of your anaesthetist. 

Further information regarding anaesthesia and the role of anaesthetists can be found at the Australian and New Zealand College of Anaesthetists website. www.anzca.edu.au/patients 

You will meet Dr Lincoln before your operation to discuss your anaesthetic and to perform a relevant examination. This usual occurs in the hospital on the day of surgery. Important information that will be asked includes:

• Previous operations and whether there were any problems with anaesthesia.
• Serious complications experienced by family (blood relatives) during anaesthesia.
• Abnormal reactions to medications and any allergies.
• Medical problems or any recent illnesses.
• List any medications that you are taking including herbal medications.
• If you suffer from acid reflux or heartburn.
• If you are taking any weight loss medications and timing of last dose.
• Loose teeth, capped teeth, dentures, veneers or bonding.

Sometimes it is easier to bring a list of this information if that would suit you. Otherwise, Dr Lincoln will be happy to simply discuss on the day.

Fasting is important for safe anaesthesia. This is to prevent stomach contents from entering your airways causing lung damage while you are unconscious during anaesthesia. This applies for all procedures requiring sedation or general anaesthesia. 

Patients must be fasted for at least 6 hours prior to their anaesthetic. That means no food, no lollies and no chewing gum. Milk should also not be consumed for 6 hours prior to your anaesthetic. Dr Lincoln is happy for you to have water up until 2 hours before your operation (250ml/hr up until 1 hour prior to your admission time is fine). It is also okay to have black tea or coffee up until 2 hours prior to your surgery.

There are a few exceptions to this rule. The most important exceptions are patients taking some weight loss and diabetes medications e.g. ozempic, mounjaro, wegovy. It is important that you contact Dr Lincoln as soon as you are booked for surgery if you take these medications.

Excessive fasting is not only uncomfortable for patients but can also have negative effects both during your operation and recovery afterwards.

Unfortunately, patients sometimes get mixed messages from surgeons and the hospitals but if you are unsure please contact Dr Lincoln.

In most instances, take your normal prescribed medications with a sip of water regardless of whether you are fasting. This is particularly important for those patients taking heart medications and blood pressure medications.

If you are a diabetic and you the instructions from the hospital or the surgeon are unclear please feel free to contact Dr Lincoln. Some newer diabetic medications (e.g. jardiance, jardiamet, ozempic) require specific instructions and you should contact Dr Lincoln as soon as your procedure is booked.

Some new weight loss drugs (e.g. ozempic, mounjaro, wegovy) require specific instructions. Please contact Dr Lincoln as soon as you are booked for surgery.

Sometimes surgeons will ask you to stop aspirin and other blood thinning medications (eg. Xarelto, Pradaxa, Iscover, Plavix, Co-plavix, warfarin). However, it is sometimes important to continue these medications or substitute with another medication. This is especially important if you have had procedures on your heart previously (e.g. stents, artificial heart valves). If you have any questions please contact Dr Lincoln. In some instances he will need to discuss your situation with your cardiologist.

Again if you are unsure regarding any of your medications please feel free to contact Dr Lincoln.

Dr Lincoln has spent many years of training to make sure that you are safe during surgery. The training and standards set by the Australian and New Zealand College of Anaesthetists has made anaesthesia here in Australia as safe if not safer than anywhere in the world. Unfortunately despite world-best care complications can still occur but they are very rare.

As already mentioned there is no place safer than in Australia to have an anaesthetic. However, even with world-best care complications and side effects still occur. It is Dr Lincoln’s responsibility to reduce the risk of complications and also minimise the severity and side effects.

• Nausea and vomiting – one of the most common and unpleasant complications following anaesthesia. Dr Lincoln can tailor your anaesthetic to minimise this risk. If you have been sick after previous anaesthetics or if you are prone to motion sickness it is important you let him know prior to your procedure.
• Pain – Dr Lincoln will try to make sure that you wake after your operation as comfortable as possible. However, people vary greatly with their pain relief requirements and pain control techniques may need to be adjusted. If you wake with pain in recovery, you will be given extra pain relief quickly.
• Sore Throat and Hoarseness – during some anaesthetics a breathing tube will be placed once you are asleep to ensure you breathe well. This may cause a small amount of throat discomfort and/or hoarseness of your voice which may last for a few days and is rarely persistent.
• Skin bruising – commonly there may be bruises at the site of an intravenous drip or other injections.
• Dental damage – occasionally teeth may get damaged during an anaesthetic. If you have loose teeth, crowns or bridgework please tell Dr Lincoln. 
• Nerve injury – placing your body in special positions is sometimes required for your procedure and there is a small risk this can damage nerves. Your surgeon and Dr Lincoln will minimise this risk by making sure these areas are well padded and that nerves are not stretched.
• Eye injury – anaesthetists take a lot of care to protect your eyes during your anaesthetic. Unfortunately when patients are waking up from an anaesthetic patients can inadvertently scratch the surface of their eye. Damage is usually mild and should improve over several days. Some procedures have a very small risk of sight damage and Dr Lincoln will discuss this complication if you are having a procedure that increases your risk. 
• Allergic drug reactions – although uncommon, every time you are exposed to new medications there is a small chance that you may have a reaction. This risk is the same with anaesthetic medications. These reactions can vary from a rash to more serious breathing and blood pressure problems. If you have one of these reactions your anaesthetist is trained to manage this situation.
• Breathing problems – breathing problems are more common in people with pre-existing asthma or other medical problems such as emphysema or obstructive sleep apnoea. Another serious complication called aspiration can occur if stomach contents get into the lungs and damage them. This is more likely with emergency surgery or when inadequate fasting has occurred prior to your operation. 
• Heart attacks – heart related emergencies are rare during anaesthesia. However, patients especially at risk are those with pre-existing heart disease, diabetes or high blood pressure. It is important you inform Dr Lincoln if you have been having chest pain, palpitations or shortness of breath that has not been investigated by your doctor.
• Strokes – strokes are very uncommon in patients that are healthy prior to surgery. At risk patients are those with a previous history of strokes, heart disease, diabetes and high blood pressure. Please inform Dr Lincoln if you have any symptoms that may suggest a small stroke that has not been investigated by your doctor (e.g. fainting, seizures, temporary loss of vision, difficulty or slurred speech, temporary weakness of any part of your body)
• Death – death due to anaesthetic complications is extremely rare. For a fit and well patient the risk is approximately 1 in 100 000. For older patients with multiple medical conditions the risk can be significantly higher but is still rare. 

Please see the attached document for a comprehensive list of risks and their likelihood of occurring

While sedation anaesthesia covers a broad spectrum of “sleepiness” that ranges from awake but relaxed to deep sleep and amnesia. The choice will be largely determined by the procedure you are undergoing. The risks differ on level of sedation but there are several important risks:

• Aspiration – aspiration is the regurgitation of stomach contents into the mouth that can then enter the lungs. Risk is minimised by following the fasting instructions provided to you. If you aspirate gastric acid (always present in stomach even after fasting) you may wake from your procedure with a sore throat and cough. The cough may persist for several days and you may be required to stay longer in hospital but most patients recovery is otherwise uneventful.
• Awareness – with conscious sedation (“twilight”) some patients may recall some of the procedure but remain cooperative and relaxed. Most patients cannot differentiate deep sedation from a general anaesthetic (i.e. do not recall any of the procedure). Importantly regardless of the amount of sedation patients rarely experience any discomfort.
• Allergy and drug side effects – the drugs used for sedation are very common and rarely cause serious allergic reactions. Because lower doses are used the side effects (e.g. nausea, constipation, excessive drowsiness) are also reduced.

Nerve blocks (numbing a region of your body e.g. arm, leg), spinal blocks or epidurals (e.g. numb the lower half of your body) are sometimes used as part of the anaesthetic. While these procedures are very safe, rare complications such as nerve damage due to the needle, bleeding or infection can occur. The numbness and weakness is usually temporary but may be permanent in extremely rare cases.

Anaesthesia may impair your judgement and decision making skills for the first 24 hours. Therefore it is important that for the first 24 hours after your procedure you:

• Do not drive
• Do not operate machinery
• Do not do any cooking
• Do not sign any legal documents or make important decisions
• Do not drink alcohol

If you are booked for day surgery, a responsible adult should take you home and stay with you for the first night. You should also have a reliable mode of transport to get back to the hospital if required and not be further than 30 minutes from the nearest hospital. If any of these requirements are not met you may not be suitable for day surgery and please discuss with your surgeon or Dr Lincoln about staying in hospital overnight.

Dr Lincoln will play a very important role in managing your pain relief following surgery. Adequate pain control is desirable as it will improve your recovery after surgery and will help prevent complications. Dr Lincoln will discuss the options with you before your operation. There are many ways that pain can be controlled. Usually a combination of several methods of pain relief will be used. 

You will receive an account from Dr Lincoln that is separate from your hospital, pharmacy, and other medical/doctors bills. 

Your account is calculated in accordance with the structure recommended by both the Australian Society of Anaesthetists (ASA) and the Australian Medical Association (AMA). Generally this means that there is a “gap” for you to pay (difference in the amount your anaesthetist charges and the amount your fund will refund you). 

This gap varies depending on the complexity of the anaesthesia and operation, the duration of anaesthesia and operation, your previous medical conditions, and your after surgery care. 

When Medicare was first introduced, the Medicare Benefit and the AMA Fee were on a par with each other which meant patients rarely had a gap to pay. However, over time the Medicare Benefit has remained relatively static and has not kept pace with increases in CPI, inflation, and average weekly earnings.

Each anaesthetist individually determines their own fees. In most instances you will only be expected to pay the gap amount and generally your invoice will be sent to your fund immediately following your surgery. However, due to differences between private health insurers sometimes alternate methods of payment may be recommended. All uninsured patients and those undergoing cosmetic procedures will be expected to pay the full anaesthetic fee prior to their procedure. 

Your account can be paid by cheque, cash, credit card, EFTPOS or money order and then rebates claimed from Medicare and your private fund (if applicable). Credit Card payments can be made over the phone.

Please contact Axxon Anaesthesia with any questions regarding billing or to pay invoices. Contact details for Axxon Anaesthesia can be found at http://www.axxon.com.au