Patient Information

Your Questions, Answered

  • Anaesthesia is the loss of sensation of the body for surgery through the administration of special medication. There are two broad types of anaesthesia that Dr Ho administers, depending on the type of surgery and the individual patient’s needs.

    • General anaesthesia renders you unconscious for the duration of your procedure. Patients are given medications through an intravenous cannula (‘drip’) and/or a breathing tube. You will require placement of this breathing tube shortly after you are put to sleep.

    • Regional anaesthesia is the loss of sensation of part of your body (usually the arms or legs). This is achieved by administering a local anaesthetic drug (via a tiny needle) around the nerve supplying that body part. You can be awake and completely comfortable with this kind of anaesthesia.

    Dr Ho can use either type of anaesthesia or a combination of both, to provide safe and comfortable anaesthesia for your procedure.

  • Anaesthesia in Australia is very safe today and most healthy people don’t have any problems with it. However, nothing is risk-free.

    Anaesthesia carries 2 types of risks. Firstly, there are common risks which usually have no permanent effects on your body:

    • Nausea and vomiting: up to 1 in 5 people may experience this, but the rate is decreasing due to improved anaesthetic techniques.

    • Sore throat: This can be due to the breathing tube and usually settles within 2 days

    • Bruising: due to the intravenous cannula and nerve blocks, and this usually settles within 2 days.

    Secondly, there are very rare but serious risks (such as severe allergy, heart attack, stroke or even death) which can have a lasting impact on your body:

    • Damage to teeth: if you need general anaesthesia, Dr Ho has to carefully inserting a breathing tube to help you breathe. Insertion of this tube has the potential to cause damage to teeth.

    • Aspiration: this is where stomach contents are brought back up into the throat and then inhaled into the lungs. This is a risk during a general anaesthetic and can lead to serious lung damage. This is the reason that Dr Ho places great importance on adequately fasting prior to your procedure. You MUST declare if you are on GLP-1 agonist medications (as stricter fasting instructions are required).

    • Allergy: It is possible to have an adverse reaction to an anaesthetic drug or other materials in the operating theatre, even without a prior history of allergies. It is vital that you inform me of any known allergies to medications or rubber/latex products.

    • Awareness: Being conscious of the things going on around you whilst anaesthetised is exceedingly rare. It is generally associated with ‘high risk cases’ where lower medication doses are used (when the use of normal doses could be life-threatening to the patient). In these cases, Dr Ho uses a special ‘awareness’ monitor which minimises this risk.

    • Life-threatening events (heart attacks, strokes) related to anaesthesia are rare and can usually be managed appropriately in the hospital setting. Death is extremely rare.

    In general, the risk of complications is more closely related to the type of procedure you are undergoing, and your general physical health, than to the anaesthesia itself. Patients with heart, or lung disease who have previously had a stroke, are diabetic, or smokers are in a higher risk category.

    Dr Ho is always available to outline these risks to you over the phone in greater detail, should you want to discuss them.

  • An anaesthetist is a fully qualified medical doctor who has spent at least three general training years in the public hospital system before completing a further five years of specialty training in anaesthesia.

    The anaesthetist’s role encompasses all aspects of medicine related to care of patients before, during and after surgery. This includes:

    • pain management,

    • resuscitation, and

    • the management of medical emergencies.

    Surgery puts significant stress on the body, and without modern anaesthesia the majority of these procedures would not be possible.

    Additionally, anaesthetists are often the primary care providers in resuscitating critically ill patients, and in providing pain relief for women in labour.

    The training to become a Specialist Anaesthetist is equal in length to that of other specialists, including Surgeons. Anaesthetists must continue to update their skills by regularly attending professional development sessions.

  • Await contact from my practice rooms

    Dr Ho’s practice staff will SMS or email you shortly after you are booked for your procedure. Alternatively, if you would like to contact me beforehand, please call my practice on (02) 8999 3317 or email admin@northshoreanaesthetics.com.au

    Staff will provide you with personalised instructions, an online pre-anaesthesia assessment form, and information regarding the anaesthetic fee.

    Fill out the online pre-anaesthesia questionnaire

    Please do this promptly as directed by the office, as Dr Ho requires this information to formulate your specific anaesthetic plan.

  • On your pre-anaesthetic survey, you have the option to request a pre-operative phone call from Dr Ho. Otherwise, he will review your responses and then email you ideally 3-7 days day before your operation to finalise his assessment and provide specific instructions.

  • Dr Ho will not know the exact time of the operation at the time of your pre-operative phone call. Generally, the hospital will call you the afternoon prior to your booked surgery with a confirmed time of arrival. This tends to be at least 90 minutes prior to your surgery start time.

    Please arrive promptly as the admission paperwork and pre-operative transfer to the operating theatres takes a long time.

  • Please see the following section for more details.

    In summary, please do not take:

    • water for 2 hours

    • breastmilk for 4 hours (for babies)

    • everything else for 6 hours

    prior to your time of arrival at hospital.

  • In addition to the checklist provided by the hospital, Dr Ho will require you to bring:

    • Any specialist letters of correspondence (especially cardiologists or respiratory doctors) from the last year;

    • Your regular prescription medications, in case this is needed in the postoperative phase;

    • Any insulin medication (for people with diabetes);

    • Your CPAP machine (if you have obstructive sleep apnoea); and

    • Your denture container (as these will generally be removed for general anaesthesia).

  • Dr Ho will meet you in the pre-operative area for further assessment before we move into the operating theatre. There, he will insert an intravenous cannula (‘drip’) in your arm to give you fluids and any necessary medications. His team will attach monitors (for blood pressure, ECG and oxygen) and administer oxygen through a comfortable mask. Dr Ho will then administer the appropriate anaesthetic. He will be present throughout your anaesthesia to monitor your vitals and administer any necessary medication.

    At the end of the operation, Dr Ho will remove the breathing tube (if you had a general anaesthetic) and then wake you up. He will then transport you to a recovery area where he and his team will monitor and facilitate your recovery.

  • Your surgeon or Dr Ho will always endeavour to contact your next of kin on the completion of your operation. We do this to:

    • Give them an update and peace of mind; and

    • Let them know an approximate time when you may be either picked up (for day surgery), or visited on the ward (for inpatient surgery).

  • Prior to your surgery

    • Hydrate yourself well with water the day prior to your procedure (unless you are given medical instructions to do otherwise);

    • Continue gentle exercise such as walking or swimming;

    • Stop smoking as soon as possible (ideally at least 6 weeks prior to your treatment);

    • Reduce alcohol consumption. Please refrain from alcohol for 24 hours prior to your procedure.

    On the day of surgery

    • Fasting: please strictly follow the hospital’s instructions on fasting. If your stomach is not empty during surgery, there is a significant risk of stomach contents entering into your lungs, which can be fatal.

    • If your operation is in the morning, you must not have anything to eat after 12 midnight (ensuring a 6-hour fast). You may drink water up to 2 hours prior to the time you have been asked to attend the hospital.

    • If your operation is in the afternoon, please have a light breakfast (e.g. toast or muesli and milk) prior to 7.00 am (ensuring a 6 hour fast). Do not eat or drink anything after this time except for water, which you may continue to drink up to 2 hours prior to the time you have been asked to attend the hospital.

    • Sometimes your procedure will have specific fasting instructions given by your surgeon (e.g. colonoscopy). These instructions take priority over Dr Ho’s general fasting instructions.

    • Medications: Please bring all medications to hospital. You should take all your regular medications up to and including the day of your surgery (with a small sip of water). If you are on diabetes, weight-loss, or blood thinning medications, please contact Dr Ho for specific advice - these medications may be exceptions to the above instructions.

  • While pain is a common concern after surgery, there are very good methods of minimising pain. This includes the use of drugs (intravenous medication, tablets), procedures (nerve blocks), and/or non-drug methods. Most patients have their pain well-controlled following surgery.

    Dr Ho’s job is to ensure that your recovery following surgery is as comfortable as possible. He will provide a tailored strategy for you to manage any postoperative discomfort you may experience. An essential component of this strategy is patient education, so please read the following outline prior to your operation.

    Types of pain relief

    1. Regular simple oral analgesics: usually paracetamol and an anti-inflammatory (ibuprofen, diclofenac or celecoxib). Taken regularly for a set period of time post-operatively.

    2. Regular prescribed analgesics: strong prescribed sustained-release medications such as tramadol, Targin, tapentadol and morphine. These may be prescribed regularly for a set period of time post-operatively.

    3. ‘Breakthrough’ prescribed analgesics: strong prescribed immediate-release medications such as tramadol, Targin, tapentadol and morphine. These are prescribed to be taken at your ‘when required’ for pain.

    Patients can underestimate the effect of simple analgesics on their pain relief. It is essential to take regular simple analgesics for your pain relief, before taking stronger prescription medication. Even if stronger medication is required, this should be taken in addition to regular simple analgesic medication.

    > Paracetamol and anti-inflammatories have (in the vast majority of cases) been shown to be effective in relieving pain. They have minimal side-effects, and reduce the dose of additional opioid pain-medication required.

    4.Additional types of pain relief (only for inpatient stays):

    The following methods of pain relief are appropriate for the hospital-setting only, and used in conjunction with regular simple analgesics.

    • Patient Controlled Analgesia

    • Spinal (Intrathecal) morphine

    • Epidural analgesia

    • Peripheral nerve catheters: similar to a peripheral nerve block, except that a small plastic tube (catheter) is placed next to the nerve to allow ongoing nerve block for up to 4 days.

  • Immediately after surgery

    • You will feel drowsy for a short period (usually < 1 hour) after you wake up. Most people wake up comfortable, but side effects can infrequently occur. It is important that you let Dr Ho or your recovery nurse know about these, as most are treatable and/or temporary. These include: pain, sore throat, nausea, dizziness or itchiness.

    • Most people will experience some discomfort from their surgery. Unfortunately, medication cannot completely remove surgical pain, but they can usually effectively control it. Dr Ho will ensure you are comfortable when you wake up.

    Going home

    • Most patients are able to go home on the same day of surgery. Please ensure you have someone to accompany you home. For at least 24 hours after coming out of anaesthesia, do not:

      • drive a car;

      • make important decisions;

      • use any dangerous equipment or tools;

      • sign any legal documents; or

      • drink alcohol.

    • Dr Ho will discuss a plan to manage your pain from home. This will usually consist of some over-the-counter medications. Should you need stronger medications, he will provide a prescription for you.

Procedure-specific information

  • As a father of six, Dr Ho understands the anxiety you and your child may feel in the lead up to surgery. He takes great satisfaction in providing you both with a safe and satisfying experience.

    How can I manage my child’s anxiety?

    Children are generally calm if their parents are calm. Dr Ho places importance on parental education, as an effective way to manage their child’s anxiety. He recommends that you are honest with your child about their surgery and anaesthesia. This will involve explaining what you know to them (at an age-appropriate level) at least a few days ahead.

    The following information should assist.

    What can my child and I expect?

    Before Surgery:

    After you are checked into the hospital, Dr Ho will meet you and your child in the preoperative ward to outline and confirm the anaesthesia plan. Your child may become anxious and uncooperative. Dr Ho and his nursing staff are experienced in settling your child, and we ask for your trust.

    You have the option of being present with your child at the start of anaesthesia. There is no hard and fast rule. Dr Ho recommends that you do whatever makes your child feel more comfortable.

    Going to sleep:

    Dr Ho generally initiates anaesthesia in younger children (< 10 years) with anaesthetic gas, delivered through a clear mask which covers their nose and mouth. This is not painful, and he uses techniques to gain your child’s cooperation.

    In older children (>12 years), he usually initiate anaesthesia with an intravenous injection. A local anaesthetic cream may be applied to their hands, allowing painless insertion of an intravenous cannula (‘drip’) to commence their anaesthesia.

    You may stay with your child until they are asleep. However, once this occurs, you must leave quickly, as the deepening of anaesthesia requires greater vigilance. As your child is drifting off to sleep, they may display normal signs of anaesthesia which include: combative behaviour, shaking of limbs, rolling of their eyes, and snoring. Please do not be alarmed. It is important you remain calm during this period as Dr Ho’s attention is completely on your child and their safety.

    After Surgery:

    When surgery is complete, Dr Ho will bring your child to the recovery area, where they will gradually wake up in the care of specially trained nurses. Most children wake up comfortably, but some may be distressed, usually due to disorientation.

    Children may experience some side-effects from the surgery which include:

    • nausea and vomiting;

    • sore throat;

    • bruising; and

    • pain.

    Dr Ho and his nursing team will treat any of these side-effects, and only discharge your child from recovery when they are comfortable. Parents are generally not allowed in the recovery area, but we may occasionally call for you if we think this will help settle your child.

    How do I prepare my child for surgery?

    1. Communication: Dr Ho suggests explaining to your child what they can expect (from the information above) in age-appropriate language. He is very happy to assist with this over the phone during his pre-operative assessment call.

    2. Fasting: please strictly follow the hospital’s instructions on fasting. If you do not hear otherwise, please following these guidelines before the procedure:

    • No eating or drinking for 6 hours

    • No breastmilk for 4 hours

    • No clear fluids (water, apple juice) for 2 hours prior

    • Please note: Sometimes your procedure will have specific fasting instructions given by your child’s surgeon (e.g. colonoscopy). Those instructions take priority over Dr Ho’s general fasting instructions listed above.

    Medications: Please bring all your child’s medications to hospital. Your child should take all their regular medications up to and including the day of your surgery (with a small sip of water). If they are on diabetes or blood thinning medications, please contact Dr Ho for specific advice, as these medications may be exceptions to the above instructions.

  • What is sedation?

    Sedation is otherwise known as ‘twilight anaesthesia’. You are rendered very sleepy and unaware of your surroundings, while still maintaining the capacity to breathe on your own, move and (sometimes) obey commands. The vast majority of people have no recollection of the procedure.

    Sedation is different from general anaesthesia, where I administer greater quantities of anaesthetic medication in order to render you completely unconscious.

    Dr Ho uses sedation for:

    • Specific surgical procedures – gastroscopy, colonoscopy, closed reduction of broken bones, and examination under anaesthesia.

    • To supplement regional anaesthesia techniques – spinals, epidurals and peripheral nerve blocks.

    Why should I have sedation?

    • Less side-effects: as you receive a lower quantity of anaesthetic, you will experience less nausea, vomiting and post-operative sedation. This helps you recover quicker.

    • Avoiding general anaesthesia: sedation reduces the effects of anaesthesia on your heart, lungs and brain, which may confer safety benefits for some patients.

    • Specific procedures may require you to be conscious in order to give feedback to your surgeon during your procedure.

    How is a sedation performed?

    Dr Ho will apply standard monitoring, and oxygen therapy via a mask prior to your sedation. Dr Ho administers the sedation intravenously, through an IV cannula (‘drip’) that he places in your hand or forearm.

    Are there complications?

    Generally, complications are rare with sedation. A minority of patients have dream-like recollections of the experience, and can recall features of the operating room or verbal conversations, however these are not distressing.

    Will I recover quickly?

    Most patients are able to go home on the same day of surgery. Please ensure you have someone to accompany you home. For at least 24 hours after sedation, do not:

    • drive a car;

    • make important decisions;

    • use any dangerous equipment or tools;

    • sign any legal documents; or

    • drink alcohol.

  • What is a spinal?

    A ‘spinal’ is an injection of local anaesthetic in the lower back into the spinal fluid space, where the nerves supplying the legs and lower abdomen run. This causes complete weakness and numbness to the part of your body being operated on for the next 2-4 hours.

    Why should I have an spinal?

    • Better pain control: drugs can be injected into the spinal space which provide excellent pain relief, with minimal side effects when compared to oral or intravenous pain relief.

    • Safety: many operations of the lower abdomen and legs can be performed purely under spinal (with sedation if required). This avoids exposure of your lungs and brain to the anaesthetic, which has clear safety benefits for certain patients.

    How is a spinal done?

    Dr Ho will position you sitting up over the side of your bed with your back flexed. He will clean your skin, and inject local anaesthetic to numb the skin around the spinal area. While you keep very still, and using a special needle, he will find the spinal fluid space and administer local anaesthetic. This usually takes 2-5 minutes for full effect. If anything bothers you while the spinal is being done it is important to let Dr Ho know.

    Will the spinal work?

    Spinal blocks work very well. They have a high success rate (>95%). Dr Ho will always test your spinal and ensure you are comfortable. If it is not working well, another spinal may be performed or he may decide to give you another form of anaesthesia.

    A common misconception regarding spinals is that you have to be awake during surgery. In addition to your spinal, Dr Ho can provide you with sedation, which renders most people sleepy and unaware of their surroundings during the surgery.

    Are there any side effects or complications from spinals?

    The side effects include:

    • Decrease in blood pressure easily treated with medications.

    • Weakness of the legs which means you will have to remain in bed.

    • Inability to use your bladder which will necessitate a urinary catheter.

    • Itchiness.

    Complications can be classified as follows:

    • Minor: < 1% risk of severe headache lasting several days.

    • Major: Extremely rare but serious risks which occur < 1:50,000 cases.

      • Permanent nerve damage due to abscess (infection) or haematoma (collection of blood).

      • Severe allergy to the spinal medication.

  • What is an epidural?

    An epidural is an injection of local anaesthetic in the lower back into a space where nerves supplying the legs, uterus and abdomen run. This causes numbness to the part of your body experiencing contractions (for labour), and/or the part being operated on. A tiny catheter (tubing) is fed into this space to allow controlled pain relief for up to 4 days.

    Why should I have an epidural?

    • Better pain control: an epidural is the best form of pain relief available for labour contractions and pain associated with surgery. When working well (>95%), patients experience a sensation of ‘pressure’ without any pain.

    • Less side effects: you will have less chance of being itchy, nauseated, sleepy or having trouble going to the bathroom.

    • Anaesthesia for surgery: a stronger local anaesthetic can be administered through the epidural catheter to provide anaesthesia for surgery of the abdomen, pelvis and/or lower limbs. This avoids the need for general anaesthesia. For example, an epidural used for labour, can also be safely used to provide anaesthesia for a caesarean section, if required

    How is an epidural done?

    Dr Ho positions you sitting up over the side of your bed with your back flexed. He cleans your skin, and injects local anaesthetic to numb the skin around the epidural area. While you keep still, and using a special needle, I place the catheter in the epidural space. Dr Ho administers several doses of the local anaesthetic to safely achieve pain relief. This usually takes 10-20 minutes for full effect.

    The catheter remains in place for the duration of your labour and/or surgery, and its effects last for several hours after the catheter is removed. It is important to let Dr Ho know if anything bothers you while the epidural is placed.

    Will the epidural work?

    Epidural blocks work very well. They have a high success rate (>90%). Dr Ho will always test your epidural and ensure you are satisfied. If it is not working well, another epidural may be performed or we may decide to give you another form of pain relief. Either way, he will ensure you are safe and comfortable.

    Are there any side effects or complications from epidurals?

    The side effects include: a decrease in blood pressure (which is easily treated with medications); weakness of the legs which means you will have to remain in bed during its use; inability to use your bladder which will necessitate a urinary catheter; shivering; and itchiness.

    Complications can be classified as follows:

    • Minor: 1% risk of dural puncture headache, which may necessitate another procedure to treat this.

    • Major: Extremely rare but serious risks which occur < 1:50,000 cases.

      • ‘Spinal block’ which may cause a loss in consciousness, drop in blood pressure and the need for a ventilator to assist with breathing.

      • Permanent nerve damage due to abscess (infection) or haematoma (collection of blood).

    An effective labour epidural does not have any adverse effects on your baby.

  • Epidurals for labour pain

    Management of labour pain is an important part of your birthing plan. Your obstetrician and midwife will have discussed many forms of pain relief during your antenatal care.

    Even though your birth plan may not include epidural pain relief, it is important to know about epidurals before labour, as you may not manage with other forms of pain relief and therefore may consider having an epidural once you are in labour.

    As an anaesthetist, Dr Ho is asked by your midwife and /or obstetrician to perform the epidural for your pain relief. This is his gold standard technique for management of labour pain. Additionally, epidurals are also used in the management of specific obstetric problems such as high blood pressure and instrumental (Ventouse/vacuum-assisted or forceps) delivery. For more detailed information on the procedure, please see the patient information section on Epidurals.

    Patient Controlled Epidural Analgesia (PCEA)

    Most hospitals that Dr Ho services utilise PCEA for the ongoing management of labour pain following placement of the epidural. This machine is connected to your epidural catheter. It delivers a regular amount of medication (prescribed by me) through into your epidural every hour to maintain your pain relief. Additional medication is also injected when you push a button (which is connected to the machine). Thus, you can control your pain management instead of ringing for your midwife.

    • How often should I press the button? When your contractions begin to become uncomfortable. Administration at this time is much more effective than pushing the button when the pain becomes ‘unbearable’.

    • Can I overdose? No. Dr Ho ensures safety by programming a lockout time between each successful delivery of pain relief. This ensures that the medication has time to work before a further dose is given.

    • Who can push the button? As you are the only person who can feels the pain, only you can push the button. It is dangerous for your family members to push the button for you.

    • How long will I have the PCA? Your epidural will continue until you are fully dilated and ready to deliver your baby. At this point, your midwife may ‘turn down’ your epidural medication to allow you to coordinate your pushing with your contractions.

  • Types of anaesthesia for Caesarean Section (C-section)

    In general, Dr Ho provides four types of anaesthesia for Caesarean section:

    • Spinal Anaesthesia: He provides a single dose of local anaesthetic into a space just deep to the epidural space (called the subarachnoid space). This allows delivery of a smaller amount of drug to achieve surgical anaesthesia for the C- section. No catheter is placed in the back. Please see the patient information section on Spinals.

    • Epidural Anaesthesia: this is used in women whom already have an effective epidural catheter inserted for labour pain. Dr Ho provides a ‘top-up’ dose of a stronger medication to achieve surgical anaesthesia for the Caesarean section. Please see the patient information section on Epidurals.

    • Combined Spinal/Epidural Anaesthesia: Dr Ho provides a single injection into the spinal space (spinal anaesthetic), before immediately placing an epidural catheter into the epidural space.

      • He performs this in situations where there is risk of the spinal anaesthetic ‘wearing off’ prior to your Caesarean section being completed (high-risk operations, multiple births etc). This option is rare, and performed in consultation with your obstetrician.

    • General Anaesthesia (GA): Dr Ho very rarely performs a general anaesthetic for a C-section. This is only performed in a very time-critical emergency, where the placement of a spinal is not possible.

    Standard obstetric practice has a strong preference for spinal/epidural techniques over general anaesthesia, for the following reasons:

    • In most patients, these regional techniques are considered safer. They avoid inherent general anaesthetic risks to the mother (e.g. aspiration of gastric contents into the lungs), and the baby does not receive any anaesthetic medication and is therefore more alert on delivery.

    • The mother is awake to enjoy the special occasion.

    • Her partner can join her in the operating room for the delivery.

    Ensuring block effectiveness

    A common anxiety is whether you will feel pain during the C-section with a spinal/epidural block. Dr Ho always tests the block before allowing your surgeon/obstetrician to commence. He may do this in several ways:

    • Asking you to raise your legs off the bed. Your legs should feel very heavy, your movement significantly weaker than normal, or even non-existent.

    • Asking you to detect the coldness of ice on your skin. The area of surgery (abdomen) up to your breasts is usually numb to the cold feeling of the ice. Temperature nerve fibres also transmit pain, so loss of this sensation is indicative of successful anaesthesia for surgery.

    ‘Feeling’ during surgery

    Both spinal and epidural anaesthesia numb the lower half of your body to pain. However, the nerve supplying the sensations of pressure and stretching are often not blocked. Your uterus is also indirectly connected by abdominal connective tissue to the upper-half of your body. Therefore, you will experience a sensation of pressure and/or pulling by the surgeon as the delivery of your baby nears. This is expected, normal and not an indication of ineffective anaesthesia.

    That being said, Dr Ho will be next to you the whole time to listen to any concerns voiced, and manage any discomfort felt.

  • What are nerve blocks?

    A nerve block sends local anaesthetic through a small needle to a spot near the nerves. This causes numbness and weakness to the part of your body being operated on.

    Why should I have a nerve block?

    In some cases, the nerve block is all that’s required to keep you completely comfortable, and you do not need general anaesthesia.
    So why should you have it?

    • Safety: If you have many medical problems, or have side effects from general anaesthesia, having a block may be safer for you.

    • Improved pain control: you will need less pain medicine.

    • Less side effects: you will have less chance of being itchy, sick to your stomach, sleepy or having trouble going to the bathroom.

    • Recovery: You are likely to go home sooner.

    How is a nerve block done?

    Dr Ho will clean your skin, and inject local anaesthetic to numb the skin around the block area. Then he will administer a medicine to help you relax. Using a special needle and an ultrasound machine which gives a picture of the nerves, blood vessels and muscle, he can accurately find the nerves. Dr Ho then gives you the local anaesthetic that ‘freezes’ the nerves that go to the area where you are having surgery. The numbness and weakness lasts between 8-24 hours. It is important to let him know if anything bothers you while the block is being done.

    Will the nerve block work?

    Nerve blocks work very well. They have a high success rate (95%). Dr Ho always tests the block to see that the nerve block is working before the surgery starts. If it is not working well, another nerve block may be performed or we may decide to give you a general anaesthetic (put you to sleep). Either way, he will ensure you are safe and comfortable. A common misconception regarding nerve blocks is that you have to be awake during surgery.

    In addition to your block, Dr Ho can provide you with sedation, which renders people sleepy and unaware of their surroundings during the surgery.

    Are there any side effects or complications from nerve blocks?

    Side effects or problems linked to nerve blocks are rare.

    • Nerve damage: < 1% of patients may have a prickly feeling or numbness in the area blocked. This can last 3-4 weeks. Very rarely (< 0.2%) you may still have weakness in the blocked area after this time.

    • Adverse reactions: < 0.1% of patients may have an adverse reaction to the local anaesthetic drug. This can be treated. Please let Dr Ho know if you have previously had a bad reaction to a local anaesthetic.

    • Specific complications: depending of the type of block, other complications may include damage to structures including the lung, blood vessels and muscle. This is exceedingly rare as he visualises these structures on ultrasound.

  • What is a PCA?

    A PCA is a machine which delivers a set amount of strong pain-relieving (opioid) medication into your intravenous drip, when you push a button. Thus, you can control your pain management instead of needing to ring for a nurse.

    The drug and dose delivered when you push the button is prescribed by me. It is delivered immediately and it works very quickly.

    How often should I press the button?

    Press the button whenever you have pain. If your pain is poorly controlled, you will not want to move about and this increases the chance of problems resulting from your operation. You should push your button until you feel comfortable enough to cough and move around as much as you are allowed to.

    Before undertaking an activity such as getting out of bed, or having physiotherapy, Dr Ho suggests you prepare by using the button in advance.

    Who can push the button?

    As you are the only person who can feels the pain, only you can push the button. It is dangerous for your family or other visitors to push the button for you.

    Can I overdose?

    No. Dr Ho ensures safety by programming a lockout time between each successful delivery of pain relief. This ensures that the medication has time to work before a further dose is given.

    What are the side effects?

    The medication can cause:

    • Drowsiness. If you feel too drowsy, do not press the button.

    • Nausea and vomiting

    • Constipation

    • Itch

    • Difficulty passing urine

    These side effects can usually be treated if your nurse is informed promptly.

    How long will I have the PCA?

    Usually between 1-3 days, at the discretion of myself and your surgeon.

    After removing the PCA, your pain management is converted to oral medication.

  • Nerve blocks

    Dental surgery (tooth extraction) is generally associated with moderate post-operative pain. As such, Dr Ho recommends a nerve block in addition to the general anaesthetic you receive, as it will provide:

    • Better pain control: you will not need any strong pain medicine.

    • Less side effects: you will have less risk of being itchy, nauseous, sleepy or having trouble going to the bathroom.

    The nerve block is performed by either Dr Ho, or your dental surgeon while you are under general anaesthesia. As such, there is no discomfort associated with this. However, you will wake up with the lower part of your face numb and pain-free.

    Your nerve block will last 6-18 hours. He will provide an instruction sheet with a tailored plan on how to manage your pain when the nerve block wears off.

    Post-operative pain relief

    Prior to your surgery, please ensure you have an ample supply of paracetamol and ibuprofen (or an equivalent anti-inflammatory). Used together, these are very effective in managing pain and inflammation associated with dental surgery.

    Dr Ho will request you to take these regularly for at least 3 days after your procedure.

    • Paracetamol is taken 4 times per day (approximately every 6 hours)

    • Ibuprofen is taken 3 times per day (approximately every 8 hours). He may sometimes request you not to take this if you have certain medical conditions.

    Dr Ho may provide a prescription for a stronger pain killer, in case this is required in addition to the paracetamol and ibuprofen.

  • Sinus Surgery

    • Recovery: You will wake up in the recovery room usually with some packing in the nose to prevent early post-operative bleeding. Your nose may feel blocked, and some blood and crusted mucous around the area is normal.

    • Pain: Most patient wake up in minimal pain due to local anaesthetic placed in the nose during your surgery. However, this will wear off several hours after your surgery. For this reason, Dr Ho starts all patients on regular paracetamol every 6 hours +/- regular ibuprofen every 8 hours (depending on your type of surgery).

    • He will also provide a prescription for stronger pain relief tablets, should you need them in addition to your regular paracetamol +/- ibuprofen.

    Tonsil Surgery

    • Recovery: You will wake up in the recovery room, initially with a numb throat due to local anaesthetic placed around the surgical site. Nausea and mild vomiting may occur due to a combination of the pain medication and palate irritation, but this can be treated readily with medications by your recovery nurse.

    • Pain: Post-tonsillectomy pain management is notoriously challenging. Setting patient expectations and following the below plan is essential to a good recovery.

      Initially, due to the anaesthetic medications, pain is well controlled. However, the throat pain will intensify several hours after your surgery, once this wears off. Moderate to severe throat pain can be expected for the first 7-10 days, often worst at day 5-7 postoperative. Pain usually improves markedly in the second postoperative week, and most patients are pain free after 2 weeks. It is essential that you actively eat and drink normally during this time, using the prescribed pain medications to do so.

      Dr Ho starts all his patients on regular paracetamol every 6 hours + regular anti-inflammatory (usually celecoxib every 12 hours) + regular long-acting opioid medication (usually tapentadol slow-release for the first week). 

    • He will also provide a prescription for additional strong pain-medication which can be taken as required (usually tapentadol immediate-release + lidocaine mouth gargles + prednisolone steroid medication). 

    Ear Surgery

    • From an anaesthetic point of view, recovery from ear surgery is usually rapid and unremarkable. These operations are usually not associated with significant pain, and the operative site is easily made numb with a local anaesthetic injection given during your operation.

    • Patients getting ear surgery are at slightly higher risk of postoperative nausea and vomiting. It is important you let myself or your recovery nurse know early, so that we can treat this with appropriate medication.

  • Urethroplasty

    Spinal

    A urethroplasty is a major operation associated with moderate pain at the operative site. As such, Dr Ho recommends a spinal anaesthetic technique in addition to the general anaesthetic you receive.

    This spinal anaesthetic in a single injection of local anaesthetic and morphine, which provides the following advantages, for up to 24 hours:

    • Better pain control: you will need less pain medicine for the first 24 hours after your procedure (the most painful period).

    • Less side effects: you will have less chance of being itchy, nauseous, or sleepy when you wake up.

    • More rapid recovery: having your pain controlled will facilitate mobility, nutrition and rehabilitation from your urethroplasty. The spinal injection avoids the routine use of a PCA (see the PCA information section) and the associated intravenous lines and machines which impair your postoperative mobility. Please see the patient information section on Spinals for more information.

    Recovery

    You will wake up in the recovery unit, usually pain-free (if you received a spinal anaesthetic).

    If you had a buccal graft, you may have some discomfort inside your mouth (not covered by the spinal) which is well-controlled by medication.

    You will also have a catheter in your bladder, which remains there for several weeks, as per your urologist. You will be on ‘bed rest’ for the first day after your procedure, after which you will be encouraged to mobilise to prepare for your discharge from hospital.

    When your spinal anaesthetic wears off after 24 hours, you will be given a personalised postoperative pain-relief plan.

  • Sedation

    Unless you are a young child, gastroscopies and colonoscopies are generally performed under sedation. Please see the patient information section on Sedation for more information.

    Preparation

    Please ensure you accurately follow your surgeon’s fasting instructions. This may vary from my usual anaesthetic fasting instructions, especially if bowel preparation is required. Bowel preparation is a crucial part of endoscopy, to ensure optimal conditions for diagnosis and/or treatment of your bowel condition.

  • Nerve block

    Eye surgery is usually performed as a day procedure under nerve block. The advantages of this are:

    • Safety: If you have many medical problems, or have side effects from general anaesthesia, having a block may be safer for you.

    • Better pain control: you will not need any strong pain medicine post-operatively.

    • Less side effects: you will have less risk of becoming itchy, nauseous, sleepy or having trouble going to the bathroom.

    • You will go home sooner.

    The block is performed under light sedation in the anaesthetic bay immediately prior to your surgery. After administering your eye drop medication, Dr Ho cleans your eye with antiseptic, and gently inject local anaesthetic to the side of your eye. Most patient do not remember any discomfort associated with this injection. After 5-10 minutes, your eye and eyelid will be weak and numb, and you will not be able to see out of this eye. You will then be transferred into the operating theatre for your surgery.

    We always test the block prior to commencing surgery to ensure your comfort and safety. If discomfort is felt, a 2nd injection may be given to supplement the initial nerve block.

    On completion of your surgery, you will be transferred to recovery with a protective dressing over your eye. Your nerve block will last 4-8 hours. Dr Ho will provide an instruction sheet with a tailored plan on how to manage your pain when the nerve block wears off.

    Please see the patient information section on Peripheral nerve blocks for further information.

    Being ‘Awake’ During Surgery

    A common misconception regarding nerve blocks is that you have to be awake during surgery. This is not a good reason to refuse to have a nerve block. In addition to your block, he can provide you with sedation, which renders you sleepy and unaware of their surroundings during the surgery.

    For eye surgery, you will be lying flat with a sterile drape covering your eye, and some of your face. Dr Ho provides oxygen underneath this drape to ensure your comfort.

    He will be with you throughout your surgery to address any concerns you may have.

  • Nerve block

    Hand surgery is usually performed as a day procedure under nerve block. The advantages of this are:

    • Safety: If you have many medical problems, or have side effects from general anaesthesia, having a block may be safer for you.

    • Better pain control: you will need less pain medicine.

    • Less side effects: you will have less chance of being itchy, nauseous, sleepy or having trouble going to the bathroom.

    • You will go home sooner.

    This is performed under light sedation in the anaesthetic bay immediately prior to your surgery. Dr Ho uses an ultrasound machine to locate the nerves in your upper arm that supply your hand and gently inject local anaesthetic around these nerves.

    After 5-10 minutes, your forearm and hand will be weak and numb, and you will be transferred into the operating theatre for your surgery.

    He always tests the block prior to commencing surgery to ensure your comfort and safety. If discomfort is felt, a 2nd injection may be given to supplement the initial nerve block.

    On completion of your surgery, your arm will be in a sling to provide protection while you have no feeling. Your nerve block will generally last 8-24 hours. Dr Ho will provide an instruction sheet with a tailored plan on how to manage your pain when the nerve block wears off.

    Please see the patient information section on Peripheral nerve blocks for further information.

    Being ‘Awake’ During Surgery

    A common misconception regarding nerve blocks is that you have to be awake during surgery. This is not a good reason to refuse to have a nerve block. In addition to your block, he can provide you with sedation, which renders you sleepy and unaware of their surroundings during the surgery.

    For hand surgery, you will be lying flat with a sterile drape covering the arm being operated on.

    Dr Ho will be with you throughout your surgery to address any concerns you may have.

    Post-operative pain relief

    Prior to your surgery, please ensure you have ample supply of paracetamol and ibuprofen. Used together, these are very effective in managing pain and inflammation associated with hand surgery.

    He will request you to take these regularly for at least 3 days after your procedure.

    • Paracetamol is taken 4 times per day (approximately every 6 hours)

    • Ibuprofen is taken 3 times per day (approximately every 8 hours). Dr Ho may sometimes request you not to take this if you have certain medical conditions.

    He may provide a prescription for a stronger pain killer, in case this is required in addition to the paracetamol and ibuprofen.

  • Nerve block

    Shoulder surgery (rotator cuff surgery, shoulder replacement) is generally associated with significant post-operative pain. As such, Dr Ho recommends a nerve block in addition to the general anaesthetic you receive as it will provide:

    • Better pain control: you will need less pain medicine.

    • Less side effects: you will have less chance of being itchy, nauseous, sleepy or having trouble going to the bathroom.

    This is performed under light sedation immediately prior to your general anaesthetic, in order to minimise the procedural risk. He uses an ultrasound machine to locate the nerves in your neck supplying your shoulder and gently inject local anaesthetic around these nerves.

    You will wake from your surgery with a numb shoulder, forearm and hand which will last between 8 and 24 hours. Your arm will be in a sling to provide protection while you have no feeling. He will also provide an instruction sheet with a tailored plan on how to manage your pain when the nerve block wears off.

    Please see the patient information section on Peripheral nerve blocks for further information.

    Blood pressure monitoring

    Shoulder surgery, according to the surgeon’s discretion, may be performed in the ‘upright chair position’. As this position is associated with potentially dangerous drops in your blood pressure, Dr Ho will usually place a small ‘arterial monitor’ in your wrist for the duration of your surgery to allow closer monitoring. This is usually placed after you go to sleep. It causes minimal discomfort, and is usually removed in the recovery area shortly after you wake up.

  • Open chest and abdominal operations (as opposed to keyhole surgery) are associated with significant levels of post-operative pain. As such, Dr Ho recommends a regional anaesthesia technique in addition to the general anaesthetic you receive as it will provide:

    • Better pain control: you will need less pain medicine.

    • Less side effects: you will have less chance of being itchy, nauseous, sleepy or having trouble going to the bathroom.

    • More rapid recovery: having your pain controlled will facilitate mobility, nutrition and rehabilitation from major chest and abdominal operations.

    Nerve block techniques

    These include TAP (transversus abdominus plane) and PECS (Pectoral and Serratus) blocks, which can safely be performed after you are put to sleep. You may wake up with a tiny plastic ‘catheter’ which can infuse local anaesthetic in the nerve block regions for up to 4 days following your operation.

    Please see the patient information section on Peripheral nerve blocks for more detailed information.

    Epidurals – please see the patient information section on Epidurals.

    Patient controlled analgesia (PCA) machines – please see the patient information section on PCAs.

  • Major breast operations (such as mastectomy) are associated with significant levels of post-operative pain. As such, Dr Ho recommends a regional anaesthesia technique in addition to the general anaesthetic you receive as it will provide:

    • Better pain control: you will need less pain medicine.

    • Less side effects: you will have less chance of being itchy, nauseous, sleepy or having trouble going to the bathroom.

    • More rapid recovery: having your pain controlled will facilitate mobility, nutrition and rehabilitation from major chest and abdominal operations.

    Chest Wall Blocks

    For major breast surgery, Dr Ho performs PECS (Pectoral and Serratus) blocks, usually as a single ultrasound-guided injection after you are put to sleep. Most patients wake up to minimal or no discomfort. This lasts for 8-16 hours, after which I prescribe appropriate oral medication to control your pain.

    Please see the patient information section on Peripheral nerve blocks for more detailed information.

Dr Matthew Ho, anaesthesiologist, supporting a patient in a hospital operating theatre during a medical endoscopy, with monitors displaying internal images of a patient's gastrointestinal tract.

Your anaesthetic fees

Dr Matthew Ho understands that costs for medical treatment are a source of anxiety for many patients. As such, Dr Ho is transparent in providing a fee estimate and obtaining your financial consent prior to your procedure.

If you are an ‘emergency’ booking, this is not always possible.


  • Private Health Insurance Funds differ in the coverage and rebates they each provide. The rebate will usually not cover the full cost of your surgery, requiring you to pay a ‘gap’ or ‘out of pocket expense’.

    The factors contributing to your out of pocket fee are:

    • Operation type and duration

    • Complexity of anaesthesia

    • Your specific medical conditions

    • Anaesthesia performed for emergency surgery, out of hours, or requiring callback from home

    • Medicare rebate for your procedure

    • Your private health insurance status

    If your health fund allows ‘co-payments’ to be charged, this generally reduces ‘out of pocket’ costs for patients and simplifies account payments.

  • Assuming your surgery is elective, my office will contact you prior to your procedure to provide a fee estimate. We will also provide you with an online link which asks for your consent, followed by instructions for prepayment.

    Please contact us on (02) 8999 3317 should you have any questions.

    You can also request an anaesthetic quote here.

  • The Australian Medical Association (AMA) publishes a range of suggested fees for services. The fees that Dr Matthew Ho charges are generally less than the suggested AMA rates. There is usually a gap (out of pocket expense) between the health fund rebate and the total fee for each procedure.

    For elective surgery, Dr Ho requests payment prior to the admission date. There are three different types of invoice:

    1. Co-payment or ‘known-gap’ funds (e.g. Medibank Private, HCF, BUPA, AHM, Teacher's Health, CBHS, Peoplecare, Westfund).

    Dr Ho has agreements with most health funds, which allow co-payments to be charged.

    The co-payment is the portion of the account which is not covered by either Medicare or your Health Fund. This ‘out of pocket’ or ‘gap’ amount is paid prior to your surgery.

    Having a ‘known gap’ fund is beneficial for your anaesthetic fee for 2 reasons:

    • In general, your rebate is higher and your anaesthetic gap fee lower;

    • Dr Ho will settle the rebate portion of your account directly with the insurer, thus avoiding the need for you to ‘chase’ your rebate.

      1. Total fee (e.g. overseas insured)

    This invoice is for the full anaesthetic fee, which you pay to my rooms prior to your surgery. After your procedure, we will send you an itemised receipt. You will then be able to claim your rebate from your health fund.

    1. Medicare + Uninsured (Medicare but no private health insurance)

    This invoice is for the full anaesthetic fee, which you pay to my rooms prior to your surgery.

    After your procedure, Dr Ho’s rooms will send you an itemised receipt. You will then be able to claim your rebate from Medicare.

  • Prepayment can be made via credit card, BPay, or bank transfer. Instructions will be provided through the weblink, on the invoice, or over the phone.

    For emergency surgery situations, where prepayment is not required, your account will be due 14 days after your surgery, using the same payment methods.