Here's a helpful guide to common questions our patients ask us. If you can't find an answer here please contact us, and we'll get back to you with answer
No matter what type of anaesthetic you are to receive (general, regional, local or sedation), your Anaesthetist will wish to monitor how well you are breathing and how much oxygen is getting to your blood and tissues. Generally, we do this by using a finger or toe probe that relies on measuring the colour of light that transmits through your finger tip.
Acrylic nails and nail polish, especially in the red to crimson colour range, can interfre with this reading, putting the reliability of the measurement at risk.
If possible, avoiding the deep red to crimson nail polishes, or leaving your manicure appointment until after your surgery, and arriving with your own unadorned nails will most commonly overcome the problem and allow your Anaesthetist to optimise your anaesthetic care.
Why do I have to fast from food and drink?
We ask patients to fast because of the higher risk of regurgitation and aspiration of stomach contents in to the airway and lungs. The effect on a patient's recovery, should aspiration occur, can be dramatic.
At a minimum, there may be an unplanned stay in hospital at least overnight. There can also be a prolonged period (potentially 4 to 6 weeks) of an uncomfortable cough that can be worse with exercise. A significant aspiration can result in a patient's need to receive assistance with their breathing and can include admission to High Dependency or Intensive Care Units.
Please refer to the following for additional information:
What do I fast from?
There can be specific fasting instructions for specific procedures, and patients with specific underlying conditions or at particular hospitals, which you will be informed of by your Surgeon, Anaesthetist, or the hospital prior to your procedure. However, the following are the general guidelines accepted by NAPS Anaesthetists for patients having an elective procedure, as listed on the ANZCA website.
For adults and children over the age of 2 years
For infants and children over 6 months and under 2 years
For infants under 6 months of age
Medications that are needed (you will be informed if there are medications you are to stop before surgery) can be taken as required with a sip (<30mL) of water less than 2 hours before surgery.
What is a clear fluid?
What is not clear fluid?
There is no simple answer to this question.
No Anaesthetist wishes to give an anaesthetic to a patient with an acute illness or an unstable chronic illness, especially if this involves the airway and breathing system. Even if you feel your child is improving or your GP said in the previous few days that they were alright, your Anaesthetist on the day may choose a more conservative treatment plan and postpone your child's surgery.
An otherwise healthy child will need to have no symptoms of illness for 1 to 2 weeks after a significant head cold or respiratory illness, for their risk of adverse respiratory event to return to normal. If your child suffers from an underlying respiratory illness, eg Asthma or Cystic Fibrosis, this symptom free period may increase to 4 to 6 weeks.
Significant respiratory illness would include, but not limited to, the child having a temperature, a sore throat, an ear ache, a blocked nose (which may be seen as the child is breathing with an open mouth), or a runny nose (the colour is not relevant to the illness or fitness for anaesthesia), a cough (whether dry or moist), loss of appetite, a change in their level of energy and interest in play, a desire to sleep or sit quietly with a parent and not engage in their usual activities, perhaps crying more and being less tolerant of things generally, restless sleeping, perhaps waking often and needing attention throughout the night.
Despite all this, an isolated runny nose may not have any real consequence to your child's anaesthetic. We understand infants and pre-school aged children often have runny noses for reasons that are not due to viral or bacterial infections. Teething, hay fever, or allergies, having enlarged tonsils and adenoids, being transferred from a warm bed to a cold car and in to an air conditioned hospital can all be associated with a runny nose, and may not alter their risks.
Your Anaesthetist will balance the risks of postponing your child's surgery with the risk associated with them having a compromised airway and the likelihood that this will create a medically critical situation or a prolonged period of respiratory illness or other adverse event in the recovery period.
If after reading this you are confident that your child's runny nose falls in to the significant illness or are worreid that it may, then we encourage you to speak directly with your Anaesthetist and/or Surgeon, and consider the implications to you and your family should the surgery be postponed on the day of surgery.
As doctors, we have no control over what proportion of our fees are covered or not covered by the various insurance bodies responsible for the reimbursement of money to patients.
Anaesthetists decide what our time and experience is worth, whilst we care for our patients with our surgical and procedural medical colleagues. We base this decision on the fact that we are working in a first world medical environment and that we have studied and trained for between 5 - 6 years beyond our undergraduate medical degree, to provide some of the safest and technologically advanced anaesthetic care in the world.
Any invoice is partly covered by the Medicare rebate, at a rate defined by the Federal Government in its Medical Benefits Schedule of fees. Between 2013 - 2018 there was a freeze placed on these MBS rebates and even now some services have not been released from this freeze. These Medicare rebates are currently under review, but they are often set based more on what is possible for Governments to gain Parliamentary support for rather than the real costs of medical care.
Private insurance funds then pay for an amount above this Medicare rebate as defined by their own benefit scheme, and each fund, whilst often being aligned, gives differing amounts for each item attracting a rebate. Furthermore, there are some procedures which are not included in the MBS and these may or may not be available for reimbursement by a fund. Finally, it can depend on the level of insurance a client chooese to hold, and which fund a client chooses to insure with.
Some funds keep their premiums to clients low, but then have a different lower rebate system should the doctor choose to charge above the fee that the fund has set, this will force the client to pay a larger out of pocket cost. It should be taken in to consideration that it is to the benefit of shareholders within a for-profit health insurance fund to keep outgoing payments low.
Consequently, given there is a benefit to government and insurance companies to undervalue and limit payment for the services of doctors, and more specifically, Anaesthetists, then there will be an maount of our invoices that remains uncovered and will need to be met by the patient themselves.
An Anaesthetist's fee is calculated based on the number of units (RVG units) which are calculated from:
Each Anaesthetist sets their own RVG unit price from which the total invoice is then calculated. At times, they will choose to utilise the amount that is offered by the private insurance funds (the no-gap or known gap rate) and as such the patient will have no out of pocket costs. At other times, they will have reasons where they feel it is appropriate to charge above the insurance fund fees and this will create an out of pocket cost to the patient.
It is important to remember that there are over 30 individual Anaesthetists within the NAPS cooperative, and we each decide how we will approach our billing and which cases will attract an out of pocket cost. Across the entire practice however, close to 60% of our accounts are billed so as to leave no out of pocket costs. And the majority of the others are billed within the known gap levels.
At NAPS, we take every possible step to ensure patients undergoing procedures that will attract an out of pocket cost are notified with an Informed Financial Agreement. We attempt to obtain lists from the surgeons rooms with your contact information as soon as they are placed on a list. We find that we need this information at least 72 hours before the day of surgery. Surgeons are not always aware of all of their cases on any particular list until inside that time, however we have staff dedicated to coordinating this process and attempt to send an email within 48 hours of receiving a patient's name/email address, or to post the information when no email address is provided.