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Anaesthesia Factsheet 1

Anaesthesia involves using drugs to block pain signals during medical procedures so patients don't feel pain. For those with ankylosing spondylitis (AS), anaesthesia may present difficulties due to limited mobility and bone changes in the spine. It is important for anaesthetists to be aware of a patient's AS well in advance to plan accordingly. Seeing an anaesthetist before surgery allows them to assess the severity of AS, airway involvement, discuss risks and options, and create an anaesthesia plan tailored to the patient's needs.

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32 views3 pages

Anaesthesia Factsheet 1

Anaesthesia involves using drugs to block pain signals during medical procedures so patients don't feel pain. For those with ankylosing spondylitis (AS), anaesthesia may present difficulties due to limited mobility and bone changes in the spine. It is important for anaesthetists to be aware of a patient's AS well in advance to plan accordingly. Seeing an anaesthetist before surgery allows them to assess the severity of AS, airway involvement, discuss risks and options, and create an anaesthesia plan tailored to the patient's needs.

Uploaded by

thet
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Anaesthesia and Ankylosing

Spondylitis
What is anaesthesia?

Anaesthesia means ‘loss of sensation’. Anaesthetics are used for pain relief during tests or
surgical operations so that you do not feel pain, touch, pressure and temperature.

How do anaesthetics work?

They work by blocking pain signals that pass along your nerves to your brain. Your nerves
are bundles of fibres that use chemical and electrical signals to pass information around your
body. If you cut your finger, the pain signal travels from your finger to your brain through your
nerves. When the signal reaches your brain, you realise that your finger hurts.

General anaesthetics will send you off to sleep and will prevent your brain from recognising
painful messages. On the other hand, local anaesthetics stop the nerve signals reaching
your brain, allowing procedures to be carried out without you feeling pain, although some
patients may feel pressure or tugging during surgery. When it wears off, the signals will work
again and your feelings will come back.

Types of anaesthesia

There are several different types. Most do not make you unconscious, but they stop you
feeling pain in a particular area of your body.

 Local anaesthetic - used for minor procedures and tests to numb the nerves in the
area where the procedure is taking place. You stay conscious but do not feel any
pain. 

 Regional anaesthetic – is used for larger or deeper operations where the nerves are
harder to reach. The 2 most common types of regional anaesthesia are spinal and
epidurals. Both are injected into your back but in different compartments. The choice
between spinal and epidural is determined by the type and length of surgery. Local
anaesthetic is injected near the nerves in order to numb a larger area, but you remain
conscious. A supplemental sedative can be given.
 General anaesthetic - used for more extensive operations when you need to be
unconscious. It stops your brain recognising any signals from your nerves so that you
cannot feel anything. 

 Sedation - for minor painful or unpleasant procedures. Sedation makes you feel
sleepy and relaxes you both physically and mentally.   

Anaesthetists

Anaesthetists are medically qualified doctors specialising in looking after you before, during
and after your operation. Your anaesthetist will make sure that you are safe throughout the
surgery, and that you wake up comfortably. They may also help with any pain relief that you
need afterwards.

Before your procedure, they will discuss with you what anaesthetic methods are appropriate,
plus any risks or side effects. You should raise any queries that you have with them.

Potential difficulties with anaesthesia in ankylosing spondylitis (AS)

Most people with AS will have no problems with anaesthesia, but there are some for whom
difficulties may arise and it is important to be aware of this in advance of any planned
surgery.

General anaesthetic

When surgery requires a general anaesthetic, the anaesthetist usually needs to pass a
flexible tube down through your windpipe as part of the procedure. This helps with breathing
control during anaesthesia and helps protect the lungs from inhaling the stomach contents. It
is called endotracheal intubation.

Anaesthetists are trained to use different types of equipment to help overcome any
problems. All surgical theatres in the UK have a “difficult intubation trolley” with additional
devices to assist with intubation.

The development of a fibre optic laryngoscope now allows anaesthetists to see the upper
part of the voice box and pass a flexible tube into the windpipe in people with restricted
mouth opening or neck movement. The use of topical anaesthetic and sedatives mean you
should experience minimal discomfort. This technique is called “awake intubation” as you
are given a general anaesthetic soon after the tube has been inserted.
Epidural / spinal anaesthetic

If you need lower body surgery, it is worth considering either an epidural or spinal
anaesthesia. However, the anaesthetist needs to know if you have any weakness or loss of
sensation in the lower limbs. Where there are changes to the spine due to new bone
formation from AS (known as bamboo spine), epidural or spinal anaesthesia may not be
possible due to bony obstruction preventing the needle reaching either the spinal or epidural
space.

Importance of having an anaesthetic assessment in advance of surgery

It is vitally important that your anaesthetist is made aware that you have AS in advance
of surgery in order to allow them perform an assessment and formulate a plan for
anaesthesia. This may involve pre-arranging that specific equipment, for example a fibre
optic laryngoscope, will be available in the operating theatre.

Seeing your anaesthetist in advance will also provide an opportunity to establish a


relationship between you and your anaesthetist. This can help reduce any anxiety you
may feel and will allow your anaesthetist to:

 Determine the severity of your AS


 Assess your airway involvement
 Request specific investigations in advance
 Discuss potential risks with you
 Discuss different anaesthetic options with you
 Answer any questions you may have
 Formulate an anaesthetic and postoperative care plan

How soon should I speak to my anaesthetist about AS before my operation?

A number of different health professionals will be involved before your surgery. You will
have a surgical consultation and then once a date for your surgery has been agreed,
either your surgeon or preoperative nurse will contact your anaesthetist to arrange an
anaesthetic assessment.

If your surgeon does not suggest arranging an anaesthetic consultation for you then it
would be perfectly reasonable for you to request one.

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