Additional Links for Patient Education:

• American Society of Anesthesiologists                  
• WebMD

Pre-Admission Testing
 
You’ve met with your surgeon, gotten a second opinion if desired, and are now scheduled to have the operation. The next appointment will likely be scheduled the week before surgery for preoperative learning and possibly some testing. This is your chance to ask questions about preparing for the surgery and to discuss any special needs you might have. It is important that you are an active partner in your care and wellness.
 
A nurse or an anesthesia provider may do the pre-anesthetic interview. The goal of the interview is to identify potential risks to you before you are given anesthesia and to discuss the type of anesthetic you’ll receive.  Testing may be requested (blood tests, chest X-ray, electrocardiogram, respiratory testing) depending on your age and physical condition. In some cases, as indicated by your overall health and the type of surgery, no testing may be needed.

It’s very important to share information about your medical history. Bring a list of all medications and current dosages you’re taking. This list should include prescription and nonprescription medications as well as herbal or vitamin supplements. Be honest about any use of street drugs which can react dangerously with some anesthesia drugs. If you have a history of heart or lung trouble, your regular cardiologist or internist may be asked to give a medical recommendation regarding your health before the anesthesia is given. The goal is for your health to be at its best before you are given anesthesia.

If you take medications regularly, you should be told which medicines to take before surgery. If you are diabetic, it is usually best to avoid oral diabetes medications the morning of surgery.  If you take insulin, ask your doctor about special insulin dosing instructions.

At the end of this appointment you should feel confident about how to prepare for the day of surgery, know what to generally expect when you arrive at the facility for the procedure, and have an understanding of what physical things you will do before returning home. If you have any questions about the type of anesthesia that you will receive during surgery, feel free to address these questions during this visit, although this will also be addressed the day of surgery.  In some cases you may discuss your anesthesia and surgical preparation by a telephone call instead of a visit to the facility.


What to Expect on the Day of Surgery
 
It’s understandable to be a little anxious the day of surgery. It is important to report to your nurse any unusual or illness feelings you’re experiencing to your nurse. Remind us of any special needs such as bladder or bowel control issues or use of any assistive devices like hearing aids or dentures. If employees don’t introduce themselves, ask them to please do so. You have a right to know who’s involved in your care.

You’ll need to have a driver on the day of surgery for the trip home and should not stay alone after surgery. Transportation and personal arrangements must be made in advance, and the driver’s name and contact number or location should be given to the admitting nurse for later use. 

You must not eat or drink as per your instructions; this is for your own safety, to reduce the risk of aspirating stomach contents into your windpipe, a serious and potentially life-threatening complication. If you have been instructed to take medications the day of surgery, they may be taken with a small sip of water. You may brush your teeth and spit out any rinse water. Please leave all valuables at home. Come bathed or showered. Remove all body and piercing jewelry before to coming to the facility. Bring any inhaler you use to help with breathing.

Patients are customarily asked to arrive at the surgery center well ahead of the scheduled surgery time. Although inconvenient or annoying in some regards, it is a necessary procedure that allows for admission, paperwork, and preparation for surgery. Everyone appreciates your understanding and cooperation. As surgical suites tend to be quite cold, you may find it beneficial to dress warmer than you otherwise would.


Preoperative Holding Area
 
When you arrive to the preoperative holding area before your surgery, you will have a nurse who will be responsible for your care at all times. You’ll be asked to remove all clothing and jewelry and a hospital gown will be given to you. 

The nurse will interview you and do a nursing assessment, answer any questions and provide any teaching you will need at this time. Facility personnel should secure your belongings for safekeeping. You’ll be asked to empty your bladder if you haven’t already. An intravenous line may be started.

Sometimes an unavoidable delay occurs when a hospital emergency case is put ahead of yours or a patient before you has surgery longer than planned. It’s never easy to wait, but your understanding will always be appreciated when there’s a delay.

An anesthesia doctor or team [nurse anesthetist and doctor] will interview you and plan your care with you. You may or may not be given some intravenous sedation to relax you in the holding area. You may walk or may be taken by stretcher into the operating room. Once in the operating room your anesthetist will not leave you for any reason; you will be monitored constantly throughout the operation.

Regional Anesthesia:  The preoperative holding area is where the majority of regional anesthesia (with the exception of spinal anesthesia) is performed.  Regional anesthesia is a broad category that includes such techniques as epidural anesthesia, spinal anesthesia, and nerve blocks; all techniques involve the injection of local anesthetic ("numbing medicine") in the vicinity of large nerves, which interrupts transmission of pain messages from the body to the brain.  Regional techniques can be used for surgical anesthesia (usually in conjunction with light sedation), but are most commonly used for post-operative pain control using long-acting local anesthetics.

Epidural Anesthesia:  Commonly used for anesthesia during labor and delivery, epidural anesthesia is also used to provide post-operative pain control for certain procedures and in certain situations.  Anesthesia is achieved by injecting local anesthetic into an area outside of the spinal cord, providing pain relief/numbness at and below the level of catheter insertion.  For specific information regarding the placement of an epidural catheter, refer to the section below under obstetric anesthesia entitled "How is the epidural block performed?".  Typically an epidural catheter is left in place for one to several days so that medications can be given intermittently or continuously to provide pain relief.  As long as the catheter is in place, you will be visited daily by an anesthesiologist to verify that your pain is being adequately controlled.

Nerve Blocks:  For surgery involving the extremities, you may be given a nerve block which provides anesthesia and/or post-operative pain relief for that extremity, usually lasting 12-18 hours after surgery.  You will nearly always be given sedation prior to the procedure.  For surgery involving the arm or shoulder, you will typically receive a brachial plexus block; local anesthetic is injected around the nerves that provide sensation to the arm and shoulder as they pass through your neck, producing numbness in those areas.  For surgery on the hip or leg you may be given a femoral and/or sciatic nerve block.  With a femoral nerve block, local anesthetic is injected around the femoral nerve as it passes through the groin, producing numbness in the front of the knee and thigh.  A sciatic nerve block is performed by injecting local anesthetic around the sciatic nerve in the buttock area.  This produces numbness down the entire backside of the leg and most of the foot.  If you are having surgery on your lower leg or ankle, you may be given a popliteal block, which is similar to a sciatic nerve block except that the local anesthetic is injected around the sciatic nerve (or branches of) behind your knee.

Invasive Monitor Placement:  For certain surgical procedures, or if you suffer from certain medical conditions such as heart or lung disease, you may need to have invasive monitors placed prior to surgery.  These include arterial lines, central venous lines, and pulmonary artery catheters.  You will typically be sedated prior to placement of these monitors, which typically occurs in the preoperative holding area.

Arterial Line:  An arterial line (somewhat similar to an IV catheter) is usually placed in the wrist, where your pulse is most prominent.  Arterial lines are used to monitor blood pressure continuously rather than periodically with a blood pressure cuff, and to take blood samples in patients with lung disease.

Central Venous Line (CVL):  A CVL is a catheter which is placed in a large (central) vein, usually in the neck or the shoulder.  They are often used when there is a chance for large blood loss during the surgery, when the anesthesiologist anticipates needing to give you blood or large volumes of fluid.  They may also be used when other means of giving medications and fluids into a vein are difficult or impractical.

Pulmonary Artery Catheter (PAC):  A PAC is typically reserved for major heart or vascular surgeries, or for patients with serious heart disease.  The PAC is a small but long catheter placed through a CVL which follows the blood flow through the heart and into the pulmonary artery (the major vessel supplying blood to the lungs), where it is used to measure pressures in different parts of the heart.


What to Expect in the Operating Room
 
The physical layout varies slightly between the Baptist facilities, but once you arrive in the operating suite an overwhelming feeling may encompass you secondary to the activity and the attire of the personnel in the area. Do not be alarmed! A lot of activity will occur simultaneously to your arrival.

By now you have met the anesthesia provider and your operating room nurse who will accompany you to the operating room. As you are walked or wheeled on a stretcher to the operating room, your registered nurse will answer any questions you may have and offer reassurance. You may notice bright lights, instruments, equipment, and an environment that is so clean we call it sterile. You will notice the operating room team members putting on face masks as they enter the operating room to maintain the sterile environment. As you move from the stretcher to the operating room table, warm blankets will be provided to off set the cool temperature of the operating room.

The anesthesia provider will remain in proximity to your head and airway, monitoring your vital signs throughout the surgery. The anesthesiologist will begin giving medications through your intravenous line to relax you and make you comfortable. The surgeon will perform the surgery, with the assistance of a scrub nurse / technician while a circulating nurse oversees your entire care to ensure overall safety. With the advances in new technology many surgical procedures have become less invasive.

While you are in surgery your family will receive updates on the length or progress of your surgery. Once your surgery is complete the surgeon will go and speak to your family. The anesthesia provider will see that you awaken safely and take you on a stretcher to the postanesthesia care unit (recovery room).


What to Expect in the Postanesthesia Care Unit
 
When your surgery is over you will be observed for a period of time in an area known as the Postanesthesia Care Unit (PACU), also known as the recovery room. Your anesthesia provider will bring you to the PACU on a stretcher and give a report to your PACU registered nurse. The type of anesthesia you have received will determine your length of stay and overall post-operative course. During your stay in the PACU, the nursing staff will monitor your vital signs closely, ensuring that you are able to cough and swallow and are awake enough to sit up without being dizzy and responding appropriately. The nurse will address your needs so that you have only minimal discomfort. Once you achieve set criteria specific to your type of surgery and anesthesia you will be evaluated for discharge from this area.


Admission to a Facility
 
When overnight or extended stay is needed, after a period of observation you’ll be taken to your room from the recovery area or the PACU to your room. Your family/friend can wait in a designated waiting area where the surgeon will usually meet with them at the end of the procedure. They can join you in your room after you’re transferred there. Any personal belongings stored by hospital personnel will be brought to your room.

When you arrive in the room you should meet your new nurse and should be shown how to contact that nurse for help. You should be taught how to use any electronic equipment available to you. Appropriate diet and activity levels, available medications for you (for pain, nausea, sleeping), and any prescribed medicines like antibiotics should be explained to you.

As always, you remain a partner in your care and recovery. Ask questions when you have them and give feedback that will aid in your recovery and discharge to home.


Outpatient Surgery

When surgery is over you’ll be observed for a period of time. The type of anesthesia given and your procedure will largely determine your postoperative course. Your nurse will work with you to treat any physical concerns and to plan your discharge home. Very few people need to stay overnight when outpatient surgery is planned. Focus on returning home as you had planned.

Your activity level will be steadily increased and you’ll be offered something to drink. You may be required to urinate before discharge after some surgical procedures or after spinal anesthesia, or you may be discharged with instructions on what to do if you can’t urinate within a given time range.

You’ll be given take-home printed instructions for self-care. Instructions should include wound care, any activity restrictions, diet, a follow-up appointment plan, any signs to watch for and to report, and an emergency contact number for your doctor. Use of medication for pain control should be addressed and discussed with you.

If you will need medication you should get either the actual medication or a prescription to be filled at your pharmacy. Your nurse or pharmacist should discuss potential side effects or special dose instructions of all prescribed medications with you. Always follow the dosing instructions to prevent complications from occurring and report any unusual reactions if they should happen. If you have stopped any medications in preparation for surgery, ask your nurse or physician about resuming any medications.

You’ll need to have a driver on the day of surgery for the trip home and should not stay alone after surgery. Transportation and personal arrangements must be made in advance, and your driver’s name and contact number or location should be given to the admitting nurse for later use.


What to Expect if You Are Going Home on the Day of Surgery
 
Once you have been discharged from the PACU you will either be admitted to an inpatient bed or return to the area that will discharge you to home. Discharge from this area is at the discretion of the surgeon in conjunction with the anesthesia provider. Before leaving you will receive verbal as well as corresponding written instructions. Included in this information will be general instructions regarding diet, medications, bathing and activity restrictions, as well as those specific to your procedure. An emergency contact number for your doctor should be given to you in the event care is needed after business hours. Home readiness rather than street fitness is the goal of ambulatory surgery. This means that you are ready for discharge home for further recuperation. You should not resume normal recreational or professional activities immediately. Follow your physician’s instructions.


Pain Management
 
The management of postoperative pain should begin in the preoperative period while you are preparing yourself for surgery. Various factors must be considered such as anxiety, fear of surgery experience and anticipation of pain. A thorough history which includes your current medications, a pain assessment, and education on the use of a pain scale will provide a basis for your plan for pain management. A pain scale is a measurement tool that the staff will use to assess your comfort level. The more detailed and accurate the information, the more adequate pain relief you can expect. Depending on whether you are going home the same day, staying over night or for a few days, immediately following your surgery there are various options for pain management. These methods take into account the extent of your surgery, type of anesthesia, and past medical history. Regional anesthesia was discussed above, although in some instances this may be administered in the recovery room after surgery rather than in the holding area prior to surgery.  Other modalities for post-operative pain control include injection of local anesthetic into the surgical site (by the surgeon while in the OR), as well as oral, intramuscular, and/or intravenous pain medications. A pain management plan will be designed specific to your needs.