Pre Operative preparation

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Pre-Operative assessment

The preoperative assessment usually happens a week or a couple of weeks before the day of the surgery. The assessment involves visiting the hospital for blood tests, MRSA screening, ECG, and chest x-rays. The investigations are tailored for each patient and done to assess the fitness of the patient before the surgery. In patients with major medical problems, the nurses might refer the patients to an anaesthetist for assessment or to other speciality consultants to get a second opinion for the fitness for surgery. During the pre-assessment, the patients will be given clear instructions regarding:

  1. Fasting guidelines (whether you need to stop eating and drinking in the hours before surgery).
  2. Regarding the medications that need to be stopped (anticoagulants) and the medications that need to be brought to the hospital on the day of surgery.
  3. The things that need to be brought to the hospital.
  4. Whether you need to stay in the hospital overnight and if so for how long.

 

Fasting guidelines

The practice of fasting preoperatively is to allow time for gastric emptying to happen thereby reducing the risk of aspiration pneumonitis at the induction of anaesthesia. A minimum of 6 hour preoperative fasting time is recommended for food, solids, and milk (chewing gum and sweets are also considered as solid food). Intake of water up to 2 hours before the surgery is safe however it is better to check with the anaesthetist and surgeons on the day of surgery. If you have a morning operation, you will not be able to eat anything after 3 am. You will be able to drink only water until 6 am. If you have an afternoon operation, you may have a light breakfast of tea and toast before 8 am. You can also drink only water until 11 am the day of your operation.
The fasting guidelines can be different for patients with diabetes. Usually the patients with diabetes, who are on medications, are admitted the previous night or early in the morning in the hospital and started on sliding scale insulin.

 

Hygiene

It is advisable to remove all body piercings. In upper limb surgery the rings, bracelets, nail polish, artificial nails etc must be removed before the surgery. This can help to reduce unwanted bacteria which could cause infection. The rings in the fingers can cut down the circulation to the finger after surgery because of swelling.

 

Coming to Hospital

It is important not to forget to bring in all the tablets (medications) you are taking or use including drops, inhalers, injections and skin creams in their original packages. You will be advised which medications you can and cannot take before your operation.
Also remember to bring toiletries, clothing (to get dressed daily), slippers (with a full back and which are not too tight) or shoes, the walking aids, and even your glasses, hearing aid and teeth.
Change in health status before surgery:
Please contact the Pre-assessment Nurse or hospital if you develop any of the following before your operation.

  • Colds, Flu Symptoms or Chest Infection
  • Coughs, Sore Throat or Ear Ache
  • Problems passing Urine (burning, unpleasant smell)
  • Any broken skin, insect bites, red inflamed spots, infected hair follicles, blisters or leg ulcers or any other suspicious skin lesions
  • Any urgent dental work
  • Started antibiotics for any reason
  • any change to your general health since your Pre- assessment visit

This may prevent your surgery being cancelled on the day of your operation.

 

On the day of surgery

A member of your doctor’s team will review your consent for the surgery, mark your limb and answer any further questions about your operation. The Anaesthetist will assess you and discuss with you the post-operative pain controlling system they think will best suit you.
Following the operation, you will be transferred to the recovery room and then to the ward. You will have the intravenous line still in your arm, an oxygen mask on and may also have an anaesthetic catheter, PCAS or ‘pain buster’ pump line for pain control. To prevent blood clots Intermittent Calf Compression or anti-embolism stockings may be on your legs. You will also be given medication or injections to reduce the risk of blood clots, if needed. You will also receive intravenous antibiotics to help prevent infection.

Once you are back on the ward, the nursing staff will help make you feel comfortable. They will change your oxygen from a mask to nasal cannula (oxygen into the nose), and can help you sit up once you are feeling well enough. You can eat and drink when you are able, and it is important to drink extra fluids while you are on the ward. You will also be encouraged to get out of bed and begin mobilising as soon as possible. The Physiotherapy and Nursing Staff will help with this, unless there is a medical reason for you not to get up (dizziness, low blood pressure, etc.).

The treating surgeon will explain to you about the procedure and give you instructions that need to be followed post-operatively.

 
For further information, please visit:

  1. Pre-operative tests:
    https://www.nice.org.uk/guidance/ng45/resources/routine-preoperative-tests-for-elective-surgery-1837454508997
  2. General information:
    https://patient.info/doctor/pre-operative-assessment-examination-and-tests
    https://www.nhs.uk/Conditions/surgery/Pages/preparing-for-surgery.aspx
  3. Can I use my mobile phone?
    https://www.nhs.uk/chq/Pages/2146.aspx

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