MEN'S HEALTH MATTERS:Different anaesthetics are used depending on the surgery being performed
Q I am going to have an operation on my right hip, and my doctor spoke to me about spinal anaesthetic. What is the difference between a general and a spinal anaesthetic?
A A general anaesthetic is where you are kept unconscious and pain-free during an operation using a combination of drugs. Most commonly these drugs are injected into a vein and you fall asleep after about 15 seconds. A breathing tube will then be placed in your windpipe and you will be kept asleep for the duration of your operation by a combination of oxygen, air and anaesthetic gases delivered by a mechanical ventilator.
Once the operation is over, the anaesthetic gases are stopped and as you wake up the tube is removed to allow you to breathe normally again. Traditionally this is what patients expect when they have an operation and it is very safe. Minor common side effects are drowsiness, nausea and vomiting, and occasional confusion, which can be more pronounced in the elderly. There tends to be a higher incidence of post-operative complications in patients with chronic lung disease, heavy smokers and obese patients. This group of patients may be better off having a regional blockade if the surgical site is amenable to this type of anaesthetic.
An alternative to a general anaesthetic is regional anaesthesia, and these are mostly given as spinal blocks. This type of anaesthetic is especially suitable for patients having surgery on parts of the body below the umbilicus (belly button). Operations on the prostate gland, hip operations, leg operations, hernias, Caesarean section and even hysterectomy are very suitable for spinal anaesthesia.
Using a very fine needle, a small amount of anaesthetic drug is injected into the fluid surrounding the spinal cord and effectively this blocks all pain signals reaching your brain below that level for more than two hours. It also affects movement, so your legs will not move until it wears off.
The potential benefits of spinal anaesthesia are better pain relief and less nausea in the immediate post-operative period and a quicker return to eating and drinking.
A spinal anaesthetic allows the area that is being operated on to be isolated from the upper body, and patients can remain awake - although many are given light sedation and effectively have little recall. Most anaesthetists would consider this type of anaesthetic preferable to a general anaesthetic in the elderly, obese patients or patients with repiratory disease. Although side effects are not common, some patients may experience a bad headache a few days after the procedure, which generally resolves within a few days.
During both these operations, you will have a doctor who specialises in anaesthesia looking after you. You will be monitored and your safety is the responsibility of the consultant anaesthetist who is looking after you.
Q I am 73 years of age and had treatment for prostate cancer four years ago. My recent PSA blood test has increased a little. Is there any cause for concern?
A You have not mentioned which treatment you had - whether it was surgery, radiation therapy or another treatment. Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland and its level can be measured by a simple blood test, which can be done in most laboratories. Because PSA is produced by the prostate (and prostate cancer) you should discuss rising PSA test levels with your doctor.
An elevated PSA is simply a warning signal that further tests may need to be done. Doctors consider a number of factors before recommending further treatment, as additional treatment based on a single PSA test result is often not recommended. Rather, a rising trend in PSA test results over a period of time combined with other findings, may lead to a recommendation for further treatment. There is no standard practice as the disease varies considerably between men. As a guide, further treatment may be considered in men who have had a radical prostatectomy (removal of the prostate gland) where the PSA level does not fall to undetectable levels following surgery, or a detectable PSA (> 0.3 ng/ml) that increases on two or more subsequent measurements after having undetectable levels. For men who have had other initial therapy, such as radiation therapy and/or hormonal therapy, further treatment may be considered when PSA levels have risen three consecutive times at least three months apart after having reached a very low level.
These are only guidelines as prostate cancer is complex and many variables need to be considered in each case.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Carl Fagan, consultant anaesthetist, St James's Hospital, Dublin