Fearful, anxious, uneasy, and emotional. These are all terms many patients use to describe their thoughts and feelings toward an upcoming surgery in the operating room. The entire process of finding out you have a medical or health issue and require surgery can be daunting. The fear of the unknown and having your life in the hands of another individual is arguably one of the scariest situations. However, preparing yourself and knowing what to expect about an upcoming scheduled surgery can help alleviate those apprehensive thoughts.
Scheduling a Date and Preparing
Depending on urgency and availability, a surgeon will have his scheduling team find an appropriate date for your surgery. Once your surgery date is scheduled, the hospital staff will call you, typically the day before, to inform you of the exact time to arrive. To prepare, your surgeon will set a general "to-do list" to be completed before surgery, which may vary depending on each patient. Your surgical team, including your surgeon and anesthesia providers, will evaluate if you have any other medical or health issues and if you take any prescribed medications. This is because these risk factors can affect the surgical team's process in ensuring your safety during and after surgery.
For example, suppose you have a chronic disease such as Chronic Obstructive Pulmonary Disease, Cardiovascular Disease, or Type 2 Diabetes Mellitus. In that case, you are at an increased risk of complications during surgery and may require additional workups. These workups could include a detailed pre-surgical physical exam, medication review or dosage change, taking your vital signs, reviewing related health history, a head-to-toe exam, and additional testing like an EKG, urine tests, blood tests, or an X-ray. All testing would be performed to determine the extent of your health and if any interventions or precautions need to be taken before or during surgery for your safety.
While awaiting further testing or your surgical date, you can act to remain as healthy as possible by eating a healthy, well-balanced diet, resting to avoid overexertion or other potential injuries, refraining from smoking and alcohol, and following the doctors' orders regarding continuing or ceasing any current medication you may be prescribed.
Day before Surgery
Once your surgical time is determined, a nurse will call you typically the day before and inform you when to arrive, typically 1.5 to 2 hours before your scheduled surgery time. Additionally, the nurse will notify you when to stop eating and drinking the night before and if you need to bring anything to the hospital. You may also ask any questions you have at this time. If you have any particular equipment you use at home daily, such as a cane, walker, or CPAP machine, you may bring that with you. Additionally, disclose information regarding any medication allergies, metal implants, and medications you take to aid in your specialized surgical plan. You may bring any personal items you feel comfortable having during your stay, such as a book, tablet, or game, to occupy your mind. You should also arrange transportation from the hospital, especially if it is a same-day surgery, in which case you cannot drive home yourself.
Preoperative
Arrival time preoperatively is early because you will go through a preoperative workup before being wheeled back into the operating room. This ensures your vital signs are stable, your height and weight are checked, you're changed into a surgical gown, an intravenous line can be accessed in the operating room, and the surgical and anesthesia team can visit you before surgery. The surgeon and anesthesiologist will obtain signed consent stating you understand your surgery, the risks and complications, any life-saving procedure mechanisms necessary for an emergency, your agreement or disapproval of blood products should they be needed, and that you agree to the entire plan.
The preoperative area is where you will remain with your support person or persons until the surgical team retrieves you, typically the nurse anesthetist and operating room nurse. This team ensures that all boxes are checked off and completed before entering the operating room.
Intraoperative
Once you have arrived in the operating room, the rest of the surgical team will perform their specified role to ensure your surgery is completed smoothly and safely. You will move onto the operating room table and begin to breathe in oxygen through a mask while medications to drift you off to sleep are injected through your intravenous catheter. The nurse anesthetist inserts an intubation tube in your airway to keep you breathing during your procedure. The surgical team will apply warm blankets for comfort, apply a sequential compression device around your calves to aid in preventing blood clots, position you appropriately for your specific surgery, and apply a surgical prep to the incision site to prevent infection. A timeout, or surgical pause, is performed to ensure every team member understands the surgery, site, and patient, and any other important information relevant to the surgery is stated and agreed upon. Your surgeon now may begin surgery while the nurse anesthetist monitors your vitals and adjusts your medications accordingly to keep you asleep and comfortable throughout your procedure. The circulating nurse ensures the surgeon and surgical technologist, who hands the surgeon all the sterile surgical tools, have everything they need for the surgery. A code cart which is stocked with a defibrillator and emergency lifesaving medications, is always directly outside of the operating room should an emergency occur. Rest assured that every individual of the surgical team is certified and prepared to assist in life saving measures during your surgical procedure should that be necessary.
Postoperative
Once your surgery is completed, the surgical team will transport you to recovery. Depending on the severity of the surgery or the postoperative state you are in, that could be the Post Anesthesia Care Unit (PACU) or the Intensive Care Unit (ICU). Nurses in both recovery areas typically provide one-on-one care due to the critical state of a person awakening from anesthesia. PACU and ICU nurses monitor frequent vital signs, blood sugar checks, alertness, pain levels, etc. If necessary, recovery nurses will page surgeons or anesthesia regarding any questions or changes in condition postoperatively.
In conclusion, having a surgical procedure can spark feelings of anxiousness, but preparing and knowing what to expect during the process can help ease your mind. Your surgical team assesses every aspect of your individualized health and case to ensure all bases are covered, and a specialized plan is made for you. Safety and preparedness are the number one concerns of your surgical team.
McKenzie Stabile, BSN, RN
Sources:
https://nurseslabs.com/intraoperative-phase/ Assessed and Endorsed by the MedReport Medical Review Board