The Anaesthetic Department provides anaesthetic services for all orthopaedic surgical procedures being carried out in the hospital, the techniques used being general, regional and a combination of both.
Pre Assessment Clinic
The hospital has a well-established Nurse-led Pre-Operative Assessment Clinic which is also staffed by a Consultant Anaesthetist. There is a regular medical outpatient Clinic conducted by a Consultant Physician, who is available to provide medical advice to the Anaesthetic Department. Consultant Anaesthetists also carry out pre-operative assessment of children undergoing scoliosis surgery, making sure that they are suitable for treatment at the Royal Orthopaedic Hospital.
Operating Theatres and Staffing
All of the ten operating theatres are either new or recently upgraded. All operating theatres have modern anaesthetic machines and experienced operating department personnel. There are three ultrasound machines used for regional anaesthesia and vascular access, along with other state-of-the-art pieces of supplementary equipment.
In addition to general anaesthesia, the following techniques are widely used in the perioperative period:
- One lung ventilation
- Total intravenous anaesthesia
- Cell salvage (cell salvage is a process that collects blood from an operating site. This blood is then processed in a cell salvage machine and given back to the patient)
- Epidurals (Thoracic, Lumbar and Caudal)
- Spinal anaesthetic
- Inter-pleural catheters (within the tissue of the chest wall)
- Continuous lumbar plexus infusion
- Brachial plexus blocks
- Intravenous regional anaesthesia
Recovery Area and High Dependency Unit
The hospital has a well-equipped recovery area with a dedicated recovery staff, who work in close liaison with the Acute Pain Team and the High Dependency Unit.
The newly constructed High Dependency Unit (HDU) has 12 beds where all major orthopaedic cases are recovered for the first 24 hours. The HDU is equipped with invasive monitoring equipment and non-invasive ventilatory support, however, elective post-operative ventilation is not carried out.
Any patient who requires post-operative ventilation is transferred to the parent unit from where the patient was referred. Careful assessment of cases reduces this to a minimum. On a number of occasions the spinal surgeons carry out surgery in other hospitals if the condition of the patient demands elective post-operative ventilation. For this the anaesthetist and theatre team may travel with the surgical team.
Acute Pain Service
The hospital has an Acute Pain Service. Ward rounds are carried out daily and audit of the activity is recorded. The hospital has well-established protocols for management of acute pain. A teaching programme to educate the nursing and medical staff regarding management of pain is fully operational.
Chronic Pain Management Service
The hospital has a well-established Pain Management Service run by a Consultant Anaesthetist with input from his multi-disciplinary team comprising a Psychologist, nurses, Physiotherapists and Occupational Therapist. The Team not only manages chronic pain, but is also involved in active rehabilitation and functional restoration of chronic pain sufferers.