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The provision of sedation and anaesthesia for patients undergoing various procedures outside the operating theatre. Examples of this include different endoscopic procedures, interventional radiology and dental surgery (this list is not exclusive).

The anaesthetist's major role lies in providing anaesthesia during surgery, but this role is ever widening. For example anaesthetists are leading the development of preoperative assessment of surgical patients and the quantification of risk. They are leading the development of acute pain teams for the relief of post-operative pain, and providing anaesthesia and pain relief in obstetric units.

Anaesthetists often lead the clinical management of intensive care units alongside other specialties, and work closely with Emergency Physicians to treat emergency patients. They provide care for patients in chronic pain clinics, provide anaesthesia in psychiatric units for patients receiving ECT, as well as the provision of sedation and anaesthesia for patients undergoing interventional radiology and radio-therapy.

The anaesthetist's major role lies in providing anaesthesia during surgery, but this role is ever widening. For example anaesthetists are leading the development of preoperative assessment of surgical patients and the quantification of risk. They are leading the development of acute pain teams for the relief of post-operative pain, and providing anaesthesia and pain relief in obstetric units.

Anaesthetists often lead the clinical management of intensive care units alongside other specialties, and work closely with Emergency Physicians to treat emergency patients. They provide care for patients in chronic pain clinics, provide anaesthesia in psychiatric units for patients receiving ECT, as well as the provision of sedation and anaesthesia for patients undergoing interventional radiology and radio-therapy.

The anaesthetist's major role lies in providing anaesthesia during surgery, but this role is ever widening. For example anaesthetists are leading the development of preoperative assessment of surgical patients and the quantification of risk. They are leading the development of acute pain teams for the relief of post-operative pain, and providing anaesthesia and pain relief in obstetric units.

Anaesthetists often lead the clinical management of intensive care units alongside other specialties, and work closely with Emergency Physicians to treat emergency patients. They provide care for patients in chronic pain clinics, provide anaesthesia in psychiatric units for patients receiving ECT, as well as the provision of sedation and anaesthesia for patients undergoing interventional radiology and radio-therapy.

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Lifestyle changes

There are many changes you can make to reduce the risks of surgery. Even small changes can make a big difference.

Exercise

Your heart and lungs have to work harder after an operation to help the body to heal. If you are already active, they will be used to this. While you are waiting for your operation, try and increase your activity levels.

Brisk walking, swimming, cycling, gardening or playing with your children are all helpful. Try to do any activity which makes you feel out of breath at least three times per week, but always check with your doctor first what type of exercise is most appropriate for you. Activities that improve your strength and balance will also be useful for your recovery.

Who can help me?

• Your GP surgery may be able to refer you to an exercise scheme at your local gym. Some people find a personal trainer helpful.
• Depending on where you live you may have access to NHS ‘healthtrainers’ who can help motivate you and offer advice. There are also a number of mobile apps to help you set goals and track your progress, such as ‘Active 10 walking tracker’ and ‘Couch to 5K’.
• Try joining a free council or community walking group or environmental volunteering scheme in your local area such as ‘Walks on Prescription’. As well as giving you encouragement and support to start walking and exercising, they are enjoyable and will boost your mood. Ask your GP surgery what is available in your area.
• If you have back or joint pain you will often see a physiotherapist before seeing a consultant. You may be more limited than others, but ask your physiotherapist for exercises that you can do.

These are only some ideas and there will be many health and fitness programmes that you can
explore in your local area.

Diet

Your body needs to repair itself after surgery – eating a healthy diet before and after your surgery
can really help.

There are many changes you can make to reduce the risks of surgery. Even small changes can make a big difference.

Weight

If you are overweight, losing weight can help reduce the stress on your heart and lungs. In addition it can help to:

• lower your blood pressure
• improve your blood sugar level
• reduce pain in your joints
• reduce your risk of blood clots after surgery
• reduce your risk of wound infections after surgery
• allow you to exercise more easily.

Who can help me?

Your GP surgery should be able to give you some advice and information on healthy eating, any local weight loss schemes and exercise opportunities in your area. Some councils also have schemes that can support you so it is also worth looking at your local council website or contacting them. NHS Choices can offer useful help.

You may find it helpful to join a weight loss class. In some areas NHS health trainers may be available to help you.

It has been shown that people who improve their lifestyle in the run up to surgery are much more likely to keep up these changes after surgery. This can have a really positive impact on their health in the long term.

Alcohol

Alcohol can have many effects on the body, but importantly it can reduce the liver’s ability to produce the building blocks necessary for healing. Make sure you are drinking within the recommended limits, or lower, to improve your body’s ability to heal after surgery.

Who can help me?

You can find useful information on how to reduce alcohol and the benefits to you on NHS Choices. Also see the Drink Aware website.

Smoking

Stopping smoking is hard, but the good news is that quitting or cutting down shortly before surgery can reduce length of stay in hospital, improve wound healing and lung function. Preparing for surgery offers a real opportunity to commit to stopping smoking.

Who can help me?

• Your GP practice will be able to offer help in reducing or stopping smoking, so ask them about the best options for you.
• There may be charities or support groups in your local area.
• Action on Smoking and Health (ASH) is a public health charity that works to reduce the harm caused by smoking. They have helpful advice on quitting.

Many medical conditions can affect recovery from surgery. It is important to make sure any known conditions are controlled as well as possible ahead of your surgery.

You can also book in for a general health check at your GP surgery if you are between 40 and 74 years old.

Diabetes

Good control of your blood sugar is really important to reduce your risk of infections after surgery. Think about your diet and weight. Talk to your diabetes nurse or team early to see if they need to make any changes to your treatment.

Blood pressure

Blood pressure should be controlled to safe levels to reduce your risk of stroke. Sometimes operations may be delayed if it is too high.

Have your blood pressure checked at your surgery well ahead of your operation – some GP surgeries have automated machines so you can pop in any time. If it is high, your GP can check your medications and make any changes needed ahead of the operation.

Anaemia (low blood count)

If you have been bleeding or have a chronic medical condition, a blood test can check whether you are anaemic. If you are, you should talk to your GP about treatment to improve your blood count before surgery.

Treating your anaemia before surgery reduces the chance of you needing a blood transfusion. It will also help your recovery and make you feel less tired after your surgery.

Heart, lung and other medical problems

If you have any other long-term medical problems, consider asking your GP or nurse for a review of your medications, especially if you think your health is not as good as it could be.

Anxiety and mental health

Most people feel some anxiety about having surgery. If the thought of going into hospital is making you very anxious or upset, it may be helpful to talk about your concerns with your GP. In some areas GPs can refer you for specific support.

Many techniques including mindfulness, relaxation and breathing exercises or yoga could help you relax before and after your surgery.

If you are taking medication for mental health problems it is important to let the nurse at the hospital know about your medication. They will usually not want you to stop this. They can help organise any particular support you need for your time in hospital or return home.

Dental health

If you have loose teeth or crowns, a visit to the dentist may reduce the risk of damage to your teeth during an operation.

Before you go home your nurse will give you written information about what to expect during your recovery and how to manage any pain you might  experience. This will also include anything to look out for and a number to call if you are worried.

The Royal College of Anaesthetists has released factsheets on some of the most common surgical operations to give more detailed information on how to prepare for different types of surgery and what to expect afterwards.

Before you go home your nurse will tell you

• any dos and don'ts
• whom to contact if worried
• what to look out for
• how to manage pain
• when to take your medication

Enhanced recovery is the name given to a programme that aims to get you back to your normal health as quickly as possible after a major operation. Hospital staff look at all the evidence of what you and they can do before, during and after your surgery to help give you the best chances for a quick and full recovery. This should get you home sooner.

The programmes will vary depending on what operation you are having and which hospital you are being treated at, but may include:

• improving your fitness levels before your operation if there is enough time
• treating any other long-term medical conditions
• reducing the time you are starved for by giving you water and carbohydrate drinks before your surgery
• giving you drugs to prevent sickness after surgery
• considering the best ways of giving pain relief during the operation
• using local anaesthetic blocks or regional anaesthetics where possible
• giving you the best pain relief afterwards to get you moving quicker
• allowing you to start drinking earlier
• reducing the time you have catheters and drips
• teaching you exercises to help you recover after your operation.

By following an enhanced recovery programme, there are usually fewer complications after surgery. There is also less chance of you needing to go back into hospital again.

Lead authors

Dr Hilary Swales, RCoA Patient Information Lead

Dr Anne-Marie Bougeard, RCoA Perioperative Medicine Fellow

Dr Ellie Walker, NIAA Health Services Research Centre (HSRC) Research Fellow 2014–2017

With contributions from

Dr David Paynton, Royal College of General Practitioners (RCGP) Clinical Lead for Commissioning

Mr Nick Markham, Royal College of Surgeons of England (RCS Eng) Council Member

Professor Ramani Moonesinghe, Director, NIAA Health Services Research Centre

Ms Elena Fabbrani, RCoA Patient Information Manager

This information has been reviewed by the RCoA Patient Information Group (which includes lay members) and by the RCoA Professional Standards Advisory Group.