A nurse will see you soon after you arrive, and your surgeon and anaesthetist will also visit you before your operation. A consent for surgery and anaesthesia will need to be signed after you have had any questions about the procedure answered to your satisfaction. For most operations the surgical site will be indicated by the surgeon with a black felt pen. Before going to theatre you are asked to change into a theatre gown, which ties up at the back to make it easier to remove in theatre if necessary.

Premedication can be discussed when I see you preoperatively. This is a mild sedative in tablet form (temazepam) that can be given 1-2 hours before surgery if needed. This is less commonly given than in the past because it may delay recovery from the anaesthetic and because most patients find that the preoperative anaesthetic consultation tends to allay anxiety in any case. Many simply prefer not to give up full possession of their faculties until absolutely necessary!

You will normally be taken to theatre either in your own bed or on a trolley. Day case patients may walk to theatre with the nurse. You will be met in the theatre suite by a theatre technician (anaesthetic assistant and your anaesthetist who will go through a checking procedure, confirming your identity, the planned operation, any allergies, the time you last had food and drink, and other details. You will then be prepared for anaesthesia, either in an anaesthetic room immediately outside theatre (and transferred in while asleep) or in the operating theatre itself. In both settings the atmosphere will be quiet and calm, without any surgical instruments in view.

First, routine monitors will be put in place (blood pressure cuff, ECG dots, oxygen-sensing probe). The bed you are on may feel comfortably warm because a heated mattress is used to help prevent any fall in body temperature during surgery. I will then place an intravenous cannula (a tiny plastic tube) in the back of your hand or higher up your arm, tape this in place and give an initial dose of anaesthetic medicine (usually fentanyl, sometimes with midazolam). This causes a pleasant drowsy sensation but does not send you to sleep.

Next you will be asked to take a few breaths of oxygen from a clear, soft plastic mask. This is only to fill your lungs with oxygen (there is no anaesthetic gas or vapour in this), a routine precaution before starting the full anaesthetic. About two minutes after insertion of the cannulla, more medicine is given to send you soundly to sleep, occasionally causing a mild burning sensation in the hand or arm. After this, of course, you will have no further awareness of your surroundings until the operation is over. Most likely, you will remember only a pleasant floating sensation after receiving the initial intravenous medication, then nothing until waking up after the operation. If you are distressed about breathing oxygen from the mask before going to sleep this step can be left out, since there is no proven added risk in doing this.

I will be with you throughout the time you are asleep, ensuring that you are safe, sound asleep and as comfortable as possible when you wake up. When you wake up, you will hear me or the Recovery nurse telling that you the operation is over. You may be vaguely aware of a soft plastic tube being removed from your mouth. This is either an "endotracheal tube" or a "laryngeal mask", one of two types of tube placed as soon as you are asleep to provide a safe airway during surgery. You may still be in the operating theatre when this happens, although it is more likely that you will already have been moved to the Recovery Area. You will gradually become more aware of your surroundings over the next 10-30 minutes. You may be aware of a lightweight oxygen mask on your face and of routine blood pressure checks every few minutes. I or a trained recovery nurse will be with you throughout this time and immediately available to attend to any discomfort or concerns.

Local anaesthetic nerve blocks, spinals and epidurals

Most operations these days involve administration of some form of local anaesthetic in addition to general anaesthesia to help keep you comfortable afterward. For day case procedures (such as arthroscopy) local anaesthetic will be injected into the area of the operation after you are asleep. For in-patient operations involving the hip, knee or ankle, a local anaesthetic block of the major nerves to the operative site is usually done. This means that patients having this type of block will wake up with a numb, heavy feeling involving all or part of the leg, lasting 8 - 24 hours, after which other pain-killers are used as needed. Complications of these techniques (nerve damage, a blood clot forming in the injection site, or local anaesthetic entering the bloodstream causing fits) are very rare.

Some day case procedures are well suited to local anaesthesia with light sedation. Sedative medication (fentanyl / midazolam) is given through an intravenous cannula before the nerve block is put in. The patient then controls the level of sedation throughout the procedure by using a self-administration system that adds small doses of another sedative (propofol) into the drip. After effects are minimal and probably less than occur with general anaesthesia.

Arthroscopic operations (knee and ankle) are unfortunately not well suited to local techniques. This is because injection of local anaesthetic into the joint does not numb it enough, and because a tourniquet (a tight band on your thigh) is needed, which is also uncomfortable. Major nerve blocks and spinal and epidural anaesthesia can be used but tend to be too long-lasting, working against early mobilisation. Spinals and epidurals also have side effects and risks that most would consider inappropriate for a day case procedure.

Major hip and leg operations can also be done with the patient awake or sedated using spinal or epidural anaesthesia. These techniques involve the injection of local anaesthetic into the area where nerves leave the spinal cord in the lower back, numbing all nerves from the waist down. Spinal or epidural anaesthesia can also be combined with general anaesthesia, and for major abdominal surgery (operations on the esophagus, stomach, liver and pancreas) this is commonly used to help with postoperative pain control. I will be happy to discuss the advantages and disadvantages of these techniques in detail if you wish to consider this approach.