Pre Anaesthetic Questionnaire

Please describe the surgery if you do not know the exact name e.g. left shoulder repair, bladder surgery.

Can you climb 1 flight of stairs or walk on flat ground for half hour without shortness of breath?

Please list your medications
e.g. Panadol osteo 375mg 3 times a day, Metformin 500mg twice a day
click (+) to add more medications

There are risks associated with ANAESTHESIA & SURGERY. These risks are however so low that, almost always, the benefits of undergoing the anaesthesia, surgery or procedure far outweigh these risks.

OCCASIONAL EVENTS: Nausea, Vomiting, Pain & Discomfort, Muscle Ache, Blurred Vision, Sore Throat, Headaches, minor Respiratory Problems/Infection, Bruising and Bleeding.

VERY UNCOMMON EVENTS: Dental Damage, Temporary Loss of Voice or Hoarseness, Vocal Cord Injury, Loss of Sensation, and minor Allergic Reactions.

EXTREMELY UNCOMMON EVENTS: Aspiration of Gastric Contents into Lungs, Severe Infections, Jaundice/Hepatitis, Awareness during General Anaesthesia, Eye Damage, Nerve Injury, Blood Clots.

RARE EVENTS: Heart Attack, Brain Damage, other serious threats to general health, or at worst, Death.

Regarding Spinal or Epidural Anaesthesia: Low Blood Pressure, Incomplete Block, Itching, The “Shakes”, Backache, Headache (sometimes severe), Bleeding, Infection (including Abscess) or extremely Rarely, Permanent Nerve Damage or Paralysis may occur.

Regarding Nerve Blocks: Incomplete block, Bleeding, Infection, Damage to surrounding structure, Temporary nerve damage or extremely rarely, Permanent nerve damage.

On the day of surgery, your anaesthetist will answer any questions you may have about these risks and will discuss risks specific to you.