This piece was written by one of our contributors; consultant anaesthetist – Anna Williams.
Let’s face it, for many of us, the thought of being induced into an artificial sleep to facilitate an operation fills us with fear and dread. Whether it is for a planned, elective operation, or something more urgent, or lifesaving, it is anxiety inducing for almost everyone. The fear of the unknown, putting your trust into the theatre teams, is not an endeavour to underestimate. However, did you know there are lifestyle changes you can make to improve your perioperative course and recovery from your anaesthetic and surgery faster?
There is increasing amounts of evidence demonstrating that improved preoperative fitness has a direct correlation with postoperative recovery, so let’s take a run through of what you can do to be an active participant in your recovery (1).
The long-term health effects are well known and documented, but what about the short-term effects? What happens if you go for “one last one before my operation”, it “helps to keep me calm”?
The stimulant effects of nicotine and the increased amounts of carboxyhaemoglobin caused by the cigarette’s carbon monoxide has a negative effect on the blood supply and demand to your heart, and can increase the risk of you having abnormal heart rhythms whilst you are under anaesthetic (2).
Smoking causes a narrowing of the diameter of your small airways in your lungs. This is one of your body’s reflexes to prevent you from inhaling any foreign particles that shouldn’t be there. Smoking on the morning of surgery is associated with giving you overly sensitive airway reflexes leading to an increased risk of adverse events around the time of your anaesthetic and surgery such as coughing and an anaesthetic complication called laryngospasm. You may also produce an increased quantity of thicker mucus than normal which can be difficult to clear due to underlying damage following smoking. This in turn causes sputum retention and increases the risk of you developing a post-operative pneumonia. (2)
There is lots of good evidence demonstrating that smoking can have poorer outcomes on your wound healing at the site of the surgery, with an increased risk of wound site infections. In fact, if you break a bone, even if you don’t need an operation on it, there is still a risk of delayed fracture healing if you are a smoker.
A study looking at the perioperative complications associated with smoking revealed that the age range at greatest risk were the 16-39 year olds, perhaps a surprising result given the likelihood that they were smoking for the shortest duration. (3)
E-cigarettes or ‘vaping’ is a trend that has increased in recent years, and is often used as an alternative to regular cigarettes or as an aid to quit smoking. These devices still contain nicotine, and although do not contain or produce tar or carbon monoxide, they do contain other substances such as heavy metals and other organic and inorganic compounds that we do not fully know yet their potential harm (4). You can read more about e-cigarettes and vaping in this piece on our educational hub.
Quitting smoking before surgery ultimately leads to fewer potential postoperative complications, and the longer you manage to abstain from, the greater the benefit to your recovery. Why don’t you speak to your GP, pharmacist or the staff in the pre-assessment clinic to help with smoking cessation techniques?
Weight – over or underweight
Perhaps one of the biggest factors in perioperative anaesthesia and post-operative recovery is related to your weight.
There are very specific risks and postoperative complications related to excessive weight. Actively losing weight prior to your operation date and anaesthetic can help to reduce the stress and potential complications related to your heart and lungs (1).
As well as those specific heart and lung risks, including lowering your blood pressure, it can have an effect more body wide. Depending on your surgery and any other risk factors you will be assessed for the risk of you developing blood clots postoperatively. If you are overweight there is a greater risk of you developing DVTs or blood clots in your lungs.
Losing weight may also reduce any pain in your joints or back and allow you to find it easier to get up and about, engage with physiotherapists or start exercising after the operation. Even if you do not have a diagnosis of diabetes, losing weight will help to stabilise your blood sugars, at a time when your body is undergoing physiological stress.
Being underweight or malnourished comes with its own set of problems and is a risk factor for worse postoperative outcomes that include infection complications, poor wound healing and can lengthen your stay in hospital and increase your risk of readmission (3). Although nutrition status is screened preoperatively, if you feel that this is an area you need help with, it is always worth a conversation with your GP or Hospital Consultant who will have access to dieticians and nutritionists before your operation date, if time allows.
Did you know that alcohol is the most commonly consumed recreational drug in the UK?
Ten percent of the adult population drink on five or more days a week. Is this you? Alarmingly, according to the 2017 figures from the Office of National Statistics, 1.6 million adults in the UK may have some degree of alcohol dependence. But can alcohol have an affect on your anaesthetic and postoperative recovery? (5) Unsurprisingly it can, whether you’ve had a heavy weekend binge or have a more chronic dependency, there are implications – many of which are potentially reversible with preoperative abstinence.
Alcohol has multi-system effects on your body, but it can interfere with your liver’s ability to undertake its normal functions and can impair your body’s ability to heal due to its immunosuppression effects and an exaggerated surgical stress response. This suboptimal performance has what we can call a ‘dose-response’ relationship – increased postoperative complications with increased consumption (i.e. the more you drink, the higher your risk of complications) Post-operative infections – including wound infections, cardiorespiratory complications and bleeding problems can all be attributed to alcohol intake (3).
For many people undergoing an operation, this is a large physiological burden to your body. It is unlikely you would undertake a 10km run without some training beforehand! This same theory can be used for surgery. Combining strength and aerobic exercises are equally important as both muscle strength and fitness decline in the postoperative period (3.) Try to do any exercise that makes you out of breath three times a week, this will help your heart and lungs cope with the anaesthetic and surgical stress.
There are many diagnosed medical conditions that can affect your perioperative pathway, many of these can be optimised before your operation date. Make an appointment with your GP or Practice Nurse to make sure these are controlled as well as possible before your surgery date.
Don’t forget though, all the theatre staff and teams are there to look after you. Just because it may feel like an alien environment for you, for us it is our norm!
(1) Preparing for Surgery, Fitter Better Sooner, Royal College of Anaesthetists, 2018.
(2) Carrick MA, Robson JM, Thomas C, 2019. Smoking and Anaesthesia. BJA Educ. 19.
(3) Banugo P. Prehabilitation. BJA Education. 2017;17(12):401–5.
(4) NHS. NHS Smokefree [Internet]. Available from: https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes
(5) Blincoe T, Chambler D. Alcohol and Anaesthesia. British Journal of Hospital Medicine. 2019;80(8).