Preoperative Assessment
Most patients having planned (“elective”) surgery at Woodlands Health attend our Anaesthesia and Pain Clinic (‘APAC’) a few days or weeks beforehand. Some patients are telephoned, either for assessment or to help with pre-operative instructions.
At the PACE clinic the staff will ask you in detail about your health, medications and allergies. You will be examined.
It is very important that we know exactly what medications you take and when, including any traditional medicines and herbal supplements. When you come to the clinic you should bring your prescription or the medicines themselves.
At the clinic you will have your height and weight recorded and your blood pressure will be measured. If you also measure your blood pressure at home you should bring along a note of recent recordings.
If appropriate you will have blood tests, a heart tracing (“ECG”) and any other investigations such as swabs or X-rays that are needed in your case.
Having a family member or companion with you can be very helpful, particularly if you are not sure about your medications or allergies.
After you have been asked questions, examined and had any tests you need, the clinic staff will talk to you about your surgery and anaesthesia, telling you what will happen on the day and afterwards and discussing any risks. You will also be given instructions about your medications, when you can and can’t eat and drink beforehand and what you should bring to the hospital.
You will also have the chance to ask us any questions that you have about any aspect of your care and to tell us if you have strong preferences or feelings about any aspect of your care when you come to the hospital.
Before you come to the hospital
Many patients who have long term medical conditions take medications that have to be stopped or need extra care around the time of surgery and anaesthesia. For example certain kinds of high blood pressure or diabetic medicines should not be taken on the day of surgery and some blood thinners must be omitted for several days beforehand.
If you have been given instructions about your medications please ensure that you understand these and if not contact the APAC. We will also phone some patients to help them to comply.
There also some things that YOU can do before surgery to help reduce risk:
- Give up smoking several weeks beforehand to reduce the risk of breathing problems
- If you have a higher Body Mass Index, losing some weight can make surgery and anaesthesia less risky
- A visit to your dentist is advisable if you have loose teeth or a lot of dental work
- If you know that your blood pressure, diabetes etc is poorly controlled, seek advice early from the doctor managing these conditions
You can also reduce your risk by increasing physical activity in the weeks before surgery to improve your heart function and fitness levels.
Before you come to the hospital, think about what help you might need afterwards. Who will take you home? Will any changes at home be needed while you recover from surgery? What can friends and family do to assist?
On the day of your operation
You will be given clear instructions on when to stop eating and drinking on the day of your surgery. You will have been told what medications to take or omit. These instructions are important for your safety. Patients are fasted before planned surgery to reduce the risk of food or liquid from your stomach entering your lungs during surgery. Some medications can help protect you from complications while others increase risk, so if you are not sure about these instructions, please ask!
It is very important that you understand and comply with fasting and medication instructions. Unfortunately sometimes we have to cancel planned surgery because instructions have been misunderstood or ignored - this is inconvenient and upsetting for everyone.
Do not smoke or vape on the day of your surgery.
If you feel unwell when you are due to come in, please telephone the hospital for advice. It can often be safer to delay surgery and anaesthesia if you are ill, however this is a decision that should be made after discussion with the hospital. Sometimes we need to see and examine patients before making a decision about whether to proceed or reschedule care.
It is best not to bring any valuable items with you to the hospital. You should wear a minimum of jewellery and comfortable clothing. Usually a wedding ring can be worn unless you are having surgery on that hand or arm. Please remove any decorative piercings. Bring any aids that you use such as hearing aids, glasses or your walking stick.
Coming to the Operating Theatre
After you have registered and been admitted to the hospital there are several things we will do before you have your operation. Some of these are patient safety checks which may be repeated several times as you progress towards the operating theatre. Other steps ensure your comfort and preparedness prior to surgery.
You will be asked to undress and wear a hospital gown. A member of staff will tell you what items you can keep on - this will depend on the procedure or operation you are having. At all times we will ensure your modesty and dignity. If you have concerns about this please do ask a member of staff.
If you are female and of child-bearing age you may be asked for a menstrual history or be asked to undergo a urine pregnancy test. This is routine for your safety.
If you have any jewellry or piercings that are not possible to remove these will be covered with tape to protect you. If you wear dentures these will be removed and stored safely. A hearing aid or glasses can be worn when you come to the operating theatre.
If possible we prefer patients to come to the operating theatre with an empty bladder so you will be invited to use the toilet immediately beforehand.
Your identity, operation and consent will be checked more than once. Your surgical site will be marked. You will meet several members of the team looking after you: nurses, operating theatre staff, surgeons and anaesthetists. Each member of staff will introduce themselves to you before asking you questions, giving you information or examining you.
The hospital and operating theatre are also essential teaching and learning environments for health care professions and so students under supervision are often involved in our patient care. If a student is a core part of the team caring for you they will also introduce themselves to you.
At any point you can ask questions of any member of staff. It is important to us that you understand what is happening around you and that you feel safe.
It is now time for your anaesthetic. To learn more about this, read some of our other information topics!
Contributed by Department of Anaesthesia.
