Preparing for Surgery

Introduction:

Surgery can be an overwhelming experience. It is important to go into your surgery feeling secure and confident. This guide will help you to understand what to expect.

Understand the procedure:

Talk to your doctor. Learn what to expect before, during and after surgery. Ask about the process of being admitted to the hospital or outpatient center, the type of anesthesia you might need, the length of stay in the hospital or outpatient center, rehabilitation and pain management. The more you know, the better you will be able to face the challenges of going through and recovering from a procedure. Don't ever hesitate to ask questions, voice concerns or speak up when you do not understand.

Assemble your personal and medical information:

Before your surgery, many people will be asking about your insurance coverage, medical history and legal arrangements. You may feel that you are answering the same questions over and over again, but this redundancy is necessary to meet quality assurance and medical insurance guidelines. If you have everything written down, you can reduce your frustration and speed the process. Be sure to include the following information:
• A designated family member or friend as your primary contact to receive information from the doctor and disseminate it to other family members and friends.
• A list of all the doctors you currently see and your reasons for seeing them. Provide names, addresses and phone numbers.
• A list of medical conditions and all previous operations.
• A list of all the medications you currently take on a regular basis. Copy the name of the medication, the dosage and the frequency (daily, twice a day, etc.) from the prescription bottle. Don't forget to include vitamins, herbal preparations, and mineral supplements or other over-the-counter medications you take regularly. Your doctor may advise you to stop taking certain medications or supplements a week or two before your surgery.
• A list of any allergies or adverse reactions you've had to drugs or anesthesia in the past. Provide the name of the drug, why you were taking it, a description of your reaction and when this happened.
• Any dietary restrictions or other health problems you have, such as diabetes, asthma, HIV or hepatitis.
• A list of your insurance coverage, including the name of the insurance company, the plan or group number and contact information.
• Information about any legal arrangements you've made, such as a living will or durable power of attorney. Bring a copy of the documents with you to the hospital or outpatient center.

Get in shape for surgery:

The physical preparations you make can affect both the outcome of the surgery and your recovery time. Most of these suggestions are common sense, although some may surprise you. • If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery. • If you drink, don't have any alcohol for at least 48 hours before surgery. • If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can have an impact on your surgery. • Eat well. If you are overweight, your doctor may recommend a weight loss program, depending on the procedure you are having and when. • Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to strengthen your upper body will help you cope with crutches or a walker after surgery. Isometric exercises can help maintain the strength of your leg muscles. Also ask about the exercises that will be prescribed after surgery. If you familiarize yourself with these postoperative exercises and practice them now, they will be easier to perform after the surgery.

Plan ahead for your homecoming:

Recovering from surgery takes time. The type of procedure you are having will determine the length of your recovery. But you can take steps now that will help make your recovery easier and faster. Planning ahead is the key to minimizing stress and optimizing your outcome.
• Arrange for someone to take you to and bring you home from your surgery. Depending on the procedure, you may need someone to stay with you for a few days after the procedure.
• Set up a "recovery center" where you will spend most of your time. Things like the phone, television remote control, radio, facial tissues, wastebasket, pitcher and glass, reading materials and medications should all be within reach.

Depending on the type of surgery, you may require certain medical equipment and aids to help you with basic daily living functions during the various stages of your recovery.. Work with your doctor and insurance company to arrange for these items to be available and in your home when you return from having your surgery. Some of these items include:

Wheelchair
Walker
Cane
Shower Seat
Grab Bars
Hospital Bed
Bedside commode
Bedside table

Medical preparations:

Several health care professionals will be involved in your surgery. As an active participant in health care decisions, you should ensure that each professional has the information necessary for proper decision-making.

• Your primary care physician or an internist will conduct a general medical evaluation a week or two before surgery. This examination will assess your health and your risk for anesthesia. The results of this examination should be forwarded to your surgeon, along with a surgical clearance.
• If you will be donating your own blood for the surgery, donation times should be scheduled at least one week apart, beginning about six weeks and ending approximately five days before your surgery. During this time, you should be especially careful to eat properly and take a daily iron supplement. This is usually done for joint replacement surgery.
• Shortly before your scheduled surgery, you will probably have an examination to review the procedure and answer any last-minute questions.
• You may need to have several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray.
• Advise your doctor of any medical conditions you have and of all the medications you are taking and any surgical implants you have. You may need to stop taking certain medications or your surgeon may recommend substitute medications until your surgery.
• Discontinue taking any pain relievers that contain aspirin for at least a week or two prior to surgery, as aspirin thins the blood and promotes bleeding.
• If you are also planning dental work such as extractions or periodontal treatments, schedule them well in advance of your surgery. Do not schedule any dental work, including routine cleanings, for several weeks after your surgery.
• Notify your doctor if you come down with a fever, a cold or any other illness in the week before the surgery.

What types of Anesthesia are available:

Decisions regarding anesthesia are tailored to the personal needs of the patient and the type of procedure you are having. There are five main types:

• General Anesthesia provides loss of consciousness, where you are put entirely to sleep.
• IV Sedation provides light sleep. In this case, you are usually not aware of the procedure nor do you remember it.
• Regional Anesthesia involves the injection of a local anesthetic to provide numbness, loss of pain or loss of sensation to a large region of the body. Regional anesthetic techniques include spinal blocks, epidural blocks and arm and leg blocks. Medications and sedation can be given to make you drowsy and blur your memory.
• Monitored Anesthesia Care consists of local anesthetic injections as well as constant monitoring by an Anesthesiologist.
• Local Anesthesia, which provides numbness to a small area, may be injected by the surgeon.

Are there side effects:

The Anesthesiologist will discuss the risks and benefits associated with the different anesthetic options, as well as any complications or side effects that can occur with each type of anesthetic. Nausea or vomiting may be related to anesthesia or the type of surgical procedure. Although less of a problem today because of improved anesthetic agents and techniques, these side effects continue to occur for some patients. Medications to treat nausea and vomiting will be given if needed. The amount of discomfort the patient experiences will depend on several factors, especially the type of surgery. The doctors and nurses can relieve pain with medications. Discomfort should be tolerable, but do not expect to be totally pain free

Last minute preparation:

The 24 hours before your surgery will be busy. Use this checklist to make sure you don't forget anything.
• Take a shower or bath the night before your surgery. This will help reduce the risk of infection.
• Do not shave the area of the surgery. If this is necessary, the OR staff will take care of it.
• Do not wear any make-up, lipstick or nail polish.
• Do not eat or drink anything after midnight the night before surgery.
• Do bring a bag of essentials. Some of the items you should include are:
A pair of comfortable, sturdy bedroom slippers with non-skid soles.
A knee-length robe or gown if in-patient.
Copies of your insurance cards, advance medical directives and medical history
A list of medications you regularly take. In most cases, you will be instructed to take any regular medication the morning of the surgery with just a few sips of water.
Personal care items such as a hair brush, denture case, eyeglass case, contact lens case; leave your cash, credit cards and jewelry at home
Loose-fitting clothes and comfortable shoes to wear home
If you haven't asked others for help yet, do so now. Have someone check in with you daily. You'll recover more quickly if you have help instead of straining and trying to do it all yourself.

What to expect the day of your surgery:

Surgery can be a scary thing. The more you know about what to expect, the easier the process will be.

Once you arrive at the hospital or out-patient center you will be required to fill out and sign registration forms. At this time you will present your insurance card and be given a band to wear on your wrist that identifies who you are and who your surgeon is.

Once you are registered, you will be escorted to the pre-surgical area where you will change into a hospital gown. At this time you will meet the various staff members who will be caring for you before, during and after you procedure. At this time, your vital signs will be checked and monitored, any other preparations will be made and an IV line will be established where fluids, anesthesia, and medications can be administered.

Once this is done, the anesthesiologist will meet with you briefly to discuss your health history, the type of procedure you are having and the type of anesthesia you will be receiving. It is at this time you can discuss any anxiety or fears you have and the anesthesiologist can address them for you. Often, at this time the anesthesiologist will give you some pre-medication to help you relax before the start of the procedure.

You are then taken to the operating room where the anesthesia is administered and the procedure is performed.

After surgery, you will be taken to the recovery room. Once you “react” and awaken from the anesthesia, the recovery room staff will check your vital signs and work to make you as comfortable as possible. At this time, your surgeon will usually come and speak to you about how the procedure went, the expected outcome as well as the expected recovery period. The surgeon will also give you any instructions on what to do over the next few days. You will also be given pain medication if necessary.

The surgeon will then speak to your family members, explaining what was done, the result and expected outcome and asnwer any questions they may have.

If you are in-patient at the hospital, you will be sent to your room once you are stable. If you are an out-patient, the recovery staff will help you to dress and make sure you are mobile. You will be given discharge instructions, prescriptions for pain medication and your doctor’s phone number in case you have any problems. In most cases, the surgeon will see you in the office within a few days of having the procedure.

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.