10 Things your Anaesthesiologist Asks You At Your First Meeting

16 October is World Anaesthesia Day.

This year marks 171 years since the first successful documented anaesthesia was performed for a surgery. And yet, even today, not many know what to expect when they are redirected by their doctor to meet an anaesthesiologist.

Some know I make you unconscious, some come fearful for their lives because they have heard scary tales, some... well, there are a lot of weird and whacky 'somes' to fill the list. One thing that amuses patients during their first meeting are the 'seemingly unrelated questions' we ask. 

With that in mind, I decided I would try to break it down to you so that your eyebrows don't pop up should you ever have to go meet your anaesthesiologist. 

So what are the 10 things your anaesthesiologist asks you at your first meeting?

1. What happened to you? 

The history of your present illness matters for co-relating to other diseases as well as deciding our course of anaesthesia.

2. Tell me about your past operations and medical history. 

When asking about past operations, we also ask about the type of anaesthesia given and whether there were any complications so that we can be better prepared. 

Your medical history can relate to past admissions, diagnoses for disorders like hypertension, diabetes etc which will again be important when we need to choose the drugs best suited to you and the type of anaesthesia.

3. Are you on any medication? 

Very important that you know and tell us the medicines you are / were on. Surprisingly common even with the educated class, patients are blissfully unaware of the diseases they take medicines for. 

It is always better to have the drug name (not brand name) and dosage written down in a paper safely stored in your wallet/purse beforehand, I advice. This matters because it isn't enough to say you are on medicines for (say) hypertension - different ones act differently and interact with other drugs we may give during anaesthesia. We also need to determine which drugs to stop and which to continue hours before surgery.

4. Do you have allergies? 

If you have had an allergic reaction to any food or drug in the past, please note the name. People who have allergic reactions often develop it to common drugs (eg: penicillins) and so there is a high risk the same drug may be given to you again unless you inform your doctor. 

If you cannot recall the name, at least tell the doctor what the drug was given to you for (pain, cold, an antibiotic) and the severity of the reaction (from skin rashes to difficulty in breathing)

5. The last time you had food or water. 

A question asked when the surgery is posted for the same day, this often draws stern eyebrows from the patient. Trust me, I am not trying to live vicariously by hearing descriptions of your awesome curries or desserts (okay, maybe 'I' personally am but my colleagues aren't!) 

This matters because we need to determine the duration before safe anaesthesia is provided to you without the risk of you vomiting or worse, having that same food and drink enter your lungs. The latter scenario is horribly dangerous and can be fatal. 

So - and I cannot stress this enough - be honest with us. Do not conceal from us because you may go in for a minor surgery of your thumb and end up dead by choosing not to tell us you had food an hour before the surgery. 

We have safety guidelines which differentiates even between clear and opaque drinks - so yes, you may wonder why we are asking you whether the juice was lime or pineapple.

6. Any Substance abuse? 

Alcoholic drinks, cigarettes and recreational drugs; tell us the duration and when you last had them. Some of our drugs behave differently in long standing users because of the effect the latter has had on your lungs, liver, kidneys or even heart.

7. Do you have any implants? 

Whether it be removable dentures or metallic implants, please remember to tell us. Many have suffered and died because they forgot (or we forgot to ask also, I agree). Metallic implants are an absolute NO-NO before entering MRI suites. Please never forget that. Similarly, if you have removable dentures, be prepared to hear us ask you to remove them on the day of the surgery.

8. How many flights of stairs can you climb? 

Patients who are clutching their abdomen in pain sometimes snarl when I ask them this but trust me, I am not mocking your pain. This is a primary way of estimating your heart and lung functions. It is a pre-cursor to the detailed physical examination that comes later.

9. Any recent cough, cold or flu 

Some patients get annoyed when we postpone elective surgeries to allow colds and chest infections to heal, wondering why a runny nose matters for a surgery on the feet. I agree that such surgeries may, more often than not, be done under spinal surgeries and so not involve your nose but you need to understand - we value your safety above all else. And for us, for any surgery, we always need to consider the possibility that a case done under spinal anaesthesia (SA) can become one under general anaesthesia (GA), involving your airway, at anytime due to various factors during the surgery. And if we play with your airway while it is sensitive, there is a high possibility of a bad to even deadly outcome when your airway responds adversely to our manipulations.

10. Please open your mouth

Another 'why the heck is this doctor asking me this' question! 

When you see me beginning my physical examination, you expect me to use my stethoscope and check your heart and lungs. What leaves patients quizzical is when I ask them to open their mouth as wide as possible. Again, you wonder what relation your mouth has to the surgery on your foot. 

Source: Anaesthesia Key

We go back to the fact mentioned a point earlier - any case can require GA. And we need to assess your airway to determine the possibility that we may struggle to 'secure your airway safely' once we take your breath and consciousness away. This means observing the possibility of a small mouth, less space within it to maneuver our airway securing devices, restriction of neck movements, distance between various parts of your mouth and neck etc. 

There is so much more to that first meeting - the physical examination, the blood investigations, X-rays and ECGs, assessing the risks and possibly asking for further specific tests or seeking consultations with fellow specialists if we are worried about specific organs.
At the end of all this, your anaesthesiologist will give you the thumbs up while also letting you know the risks of your surgery and anaesthesia so you may consent willingly as well as the possibilities (SA, GA) available to you and what he/she recommends.

I hope you have a wonderful day and yes, while it means I and my colleagues cannot upgrade the old Honda Brio for a snazzy new Mercedes Benz, I sincerely wish you and your loved ones never have to meet me or my peers during your life in a professional capacity.

Now don't forget to thank your anaesthesiologist friends for all they do to keep you safe!

Got some doubts or an experience to share? Type them in the comment section below.

Want to know more about anaesthesia?

I have written articles on:

1. The Magical Origins of Anaesthesia (Featured in Huffington Post)

2. Can you really be pain-free and play games while undergoing surgery? Why, yes.

3. Poll: Tell me About Your Experience Under Anaesthesia

4. How Anaesthesia Defeated Religious Beliefs to Change the World for Women

5. What I learned watching anaesthesiologists with differing views treat patients

6. What we can learn from Dr Horace Wells' untimely failure

Public Awareness About Anaesthesia: 

What is General Anaesthesia?
What are the Various Types of Anaesthesia?

10 Things Your Anaesthesiologist asks You at Your First Meeting

Misconceptions About Spinal Anaesthesia
Facts About Labour Analgesia