Surgical Services

• You may not eat or drink anything after midnight before surgery. This includes water, candy, chewing gum, mints and chewing tobacco. This information is important for your safety. If you do not follow instructions about not eating or drinking before your surgery, your surgery may be delayed or even cancelled.
• You may brush your teeth and rinse your mouth with a small sip of water, but do not swallow any of it.
• If you have been told to take medicine the day of surgery, take them with just a small sip of water.
• Stop smoking for at least twenty-four (24) hours before surgery.
• Do not drink alcohol for at least twenty-four (24) hours before surgery.
• Bathe or shower the night before surgery and day of surgery with an antibacterial soap as instructed by your preoperative nurse.
• It is important to remove your nail polish so that the doctors and nurses can see your true color during the surgery and in the Post Anesthesia Care Unit. The color of the skin and nail beds is an important sign of blood circulation.
• Wear loose-fitting clothes that are easy to put on and will fit over bulky bandages or surgical dressings. Do not wear jewelry, including wedding rings and body piercing (including tongue piercing), or bring money or valuables with you. Rings may be cut off, if unable to remove to lower the risk of problems such as swelling during surgery.
• No hairspray or hairpins should be worn.
• You may be asked to remove your glasses, contacts, hearing aids and dentures. Please bring your eyewear case, your hearing aid case and/or a denture cup.
• If you have a C-Pap or Bi-Pap machine, you should bring it the day of surgery.
• Bring items such as your inhaler if you have asthma or a cane if you use one, to have ready if you will need them after surgery.
• Patients returning home following their surgery must be driven home by a responsible adult. You may be asked to provide the driver’s name and phone number. If you do not have a driver home, your surgery will be cancelled.

What can I expect the day of surgery?

It is normal to be nervous as the day of your surgery gets closer. It is important that you understand the procedures involved in your stay to make your recovery safe and as speedy as possible. Please keep in mind that the surgical treatment of each person is different. Although you may be having the same operation as someone else, the way you will need to prepare and the things that will need to be done before, during, and after surgery may be special for you. On the day of surgery, you will meet with the team involved in your surgery. This may include your surgeon, anesthesiologist, nurse anesthetist, preop holding nurse and operating room nurse.

If I did not receive a pre-anesthetic interview or testing, what important things do I need to pay attention to or bring on the day of surgery?

• Bring a list of all the medicines you are taking, the reason you are taking it, the dose you take and how often you take it. Include prescriptions, over-the-counter medicines, and herbal remedies (visit www.asahq.org for additional information on herbal remedies), recreational drugs, tobacco, and alcohol. The American Society of Anesthesiologists (ASA) recommends that everyone stop herbal medicines at least two (2) to three (3) weeks before your surgery to avoid the possibility of unwanted interactions and side effects. This information will help your anesthesia provider to select the best drugs for you to avoid the unwanted drug interactions. It is important that you also bring a list of any known food or drugs to which you are allergic.
• You will be asked to give a detailed health history and family history. This will include any problems with anesthesia and allergies.

What do I need to do to prepare for my Pre-anesthetic interview and tests?

You’ve met with your surgeon, may have gotten a second opinion and are now scheduled to have your operation. Before having surgery, patients are asked to provide some general health information, including any allergies, current medications and medical history. Some patients may have a phone call as their pre-operative interview. Other patients may need to come into the hospital for their pre-anesthetic interview and testing. Whether you get a phone call or come in for your visit this is your chance to ask questions about preparing for the surgery and to talk about any special needs you might have. When trying to contact you to schedule an appointment, the nurse may not leave any phone messages or instructions, if you are not available. This is meant to protect your privacy.

Why is it important that I am interviewed?

A nurse or an anesthesia provider may do the pre-operative 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 will receive. An anesthesia assessment will be completed. It is important that you give very specific information about your health history and family history including any difficulties with anesthesia and allergies.

What kind of testing can I expect?

Testing may be ordered [blood testing, chest x-ray, electrocardiogram, respiratory testing, pregnancy testing for women of child-bearing age] depending on your age, physical condition, and/or procedure. In some cases there will be no testing required depending on your overall health and type of surgery.

Sometimes, in order to be safe with the stress of surgery and anesthesia, the need to see another specialist, such as a cardiologist, or internist may be required before surgery.

Can I continue taking all of my medicines before surgery?

You will be asked for a list of all medications you are taking, why you are taking the medication, their doses and times scheduled to be taken. Include prescriptions, over-the-counter medicines and herbal remedies (visit www.asahq.org for additional information on herbal remedies), recreational drugs, tobacco, and alcohol. The American Society of Anesthesiologists (ASA) recommends that all patients stop these herbal medications at least two (2) to three (3) weeks prior to surgery to avoid the possibility of interactions and complications. This information will help your anesthesia provider select the appropriate drugs and avoid drug interactions. It is important that you also bring a list of any known food or drugs to which you are allergic.

What do I need to know about my history of smoking; will this cause problems for my surgery?

Cigarette smoking is a risk factor for many postoperative problems. Smoking may slow the healing of surgical wounds and bones. While it may take several months to achieve maximum benefits of being a nonsmoker, even a brief period of not smoking at all before surgery can help you (visit www.smokefree.gov for more information.)

What documents should I bring, if any?

You will be asked if you have Advance Directives, also known as a “Living Will” or a “Power of Attorney for Health Care”. In a “Living Will” advance directive, you give direction to your health care providers about your future treatment choices, should you be unable to express your wishes. In a “Power of Attorney for Health Care” you direct another individual to speak on your behalf should you be unable to express your wishes. Advance directives are not required. But if you have one, you should bring it to your appointment.

What should I do the morning of my surgery?

You may not eat or drink anything after midnight before surgery. This includes water, candy, chewing gum, mints and chewing tobacco. This information is important for your safety. If you do not follow instructions about not eating or drinking before your surgery, your surgery may be delayed or even cancelled. You will be informed about which medicines to take the day of surgery, any equipment and/or supplies [such as a C-PAP for sleep apnea or inhalers for asthma] to bring with you, and any other special needs.

As a patient, it is important that you communicate openly with your health care team, participate in your treatment choices, and promote your own safety by being well informed and actively involved in your care.

You should feel sure about how to prepare for the day of surgery, know what to expect when you arrive at the facility for the procedure, and have an understanding of what physical things you will do before returning home at the end of this appointment.

What is the plan for my managing my pain?

If you’re scheduled for surgery, it’s natural to have concerns or even fears about the potential for pain following the procedure. Although some pain is likely, you should not have to endure severe pain after any surgery. Your doctors and nurses consider effective pain management a key part of your surgery. Well-controlled pain can speed your healing and lead to fewer complications.

What does effective pain treatment mean?

Effective treatment of pain will help you heal faster and enable you to go home and resume normal activities sooner. The amount and type of pain you have following surgery may be different from anyone else, even if they have had the same surgery. Discuss pain control choices with your surgeon before you have surgery. Talk about pain control methods that have worked well for you in the past.

How do I report my pain?

If you are having pain, tell someone! While you are recovering, your nurses will frequently ask you to rate your pain on a scale of 0 to 10, with “0” being “no pain” and “10” being “the worst pain you can imagine.” Reporting pain as a number helps the nurses know how well treatment is working and whether to make any changes. Special scales are available for those patients who might have difficulty understanding or using the “number” scale.

What other techniques may be used to treat postoperative pain while I am in the hospital?

PCA (Patient Controlled Analgesia) – This tool allows patients to give themselves intravenous pain relief immediately. Using a push button attached to a small pump that is programmed by the nurse, a patient starts the release of pain medicine into the intravenous (IV) line.

Epidural Analgesia – A continuous delivery of pain-relieving medication to nerves within the epidural space of the spinal column.

PCEA (Patient Controlled Epidural Analgesia) – Delivers a continuous infusion of pain medication and allows the patient to self-administer extra medication.

Nerve Blocks – A nerve block is used when pain from surgery affects a smaller region of your body, such as an arm, leg or shoulder. Local anesthetics are injected near the affected nerves to “numb” the surgical area.

Pain Medications Taken by Mouth (Oral) – Swallowed medication is simple to give, and easy to use at home and cause less discomfort than injections into muscle or skin. Generally, most pain pills are not as strong as medications that are injected.

Intravenous (IV) Pain Medication – Medications given by intravenous injection act quickly, but wear off quickly as well.

If my pain is under control, what else do I need to know?

When your pain is under control, your body can focus on the important work of healing. Take medications as soon as needed. This isn’t the time to test how much pain you can stand or “grin and bear it.” Work with your health care team to make your recovery as prompt and pain-free as possible.