Chilling Out in the Operating Room

Hospital Guide, Part 5: The OR is warmed up only near the end, to cut infection and hasten healing.

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Down the corridor you roll, through the swinging doors and into the OR. Your gurney will be pushed up next to the operating table and adjusted to the same height, and you'll be eased over. The table may seem awfully skinny, which it is. That's to let the OR team get close to their work. Around you is a dance of purposeful activity as nurses, technicians, and doctors roll carts of instruments and supplies into place. If a sedative wasn't started in pre-op it will be now, to blunt your jitters and keep you comfortable.

A needle will be inserted into an artery, most likely in your wrist, to monitor blood levels of oxygen and carbon dioxide and keep closer tabs on your blood pressure than a cuff would. If this "arterial stick" is done in pre-op, as is customary in some hospitals, it can be painful. Arteries have more nerves than veins and are deeper and their muscular walls thicker, so puncturing them is more difficult. With sedation and injection of a local anesthetic first—standard practice at Sentara Heart Hospital in Norfolk, Va.—pain is greatly reduced. That's something else to bring up with your hospital.

Then it's lights out. Closely monitoring your blood pressure and heart rate, the anesthesiologist starts the sleep-inducing drug to push you under. "I remember the anesthesiologist telling me he was putting drugs in the IV," says Sentara patient Thomas Adams; after that, nothing. It was not only because he lost consciousness. As is commonplace, he also had received a drug, typically Versed, the causes amnesia.

The anesthesiologist grazes your eyelashes with his fingertips, looking for complete absence of any reaction. Then your eyelids will be taped shut to keep your eyes from drying out. (Special tape that won't irritate the skin when stripped off after surgery can be requested ahead of time.) A paralyzing drug flows into your body to prevent involuntary movement during surgery. "Paralyzing" in this case doesn't mean rigid, with muscles locked. Just the opposite—you're as floppy as a wet noodle and incapable of twitching. The anesthesiologist will then slide a breathing tube down your throat and into your trachea.

Now you will be further prepped. Finally, a urinary catheter will be inserted and your body will be scrubbed, painted with a liquid antiseptic, and draped to expose only the relevant portions.

Enter the perfusionist, who oversees the heart-lung machine that oxygenates and cools the blood and pumps it through the body when the heart is stopped. (Certain bypass procedures can be done on a beating heart without going through the chest.) When the clamps that kept your heart free of blood are released, your heart may start back up on its own—if not, a defibrillator will be used.

Chilled surgical patients are more likely to have slow-healing or infected incisions. So as surgery ends, IV fluids are warmed, a heated inflatable blanket may be taped to exposed parts of your body, and the OR temperature is turned up.

Your anxious family probably will get word twice by phone from the circulating nurse in the OR—once when you go "on pump" and your heart is stopped, then several hours later when you come off the pump and your heart is restarted. Depending on the hospital, the surgeon might appear only after he puts in the final closing stitch, or he could come out earlier and allow a more junior physician or a specialized nurse to close.

The operation itself is harder on families than on their blissfully unaware loved ones. Several years ago, nursing director Jennifer Chiusano found herself waiting in a Kentucky hospital for word from the OR about her mother, who was undergoing bypass surgery. Her anxiety was a revelation. Until you're on the other end, she says, "you just don't realize how valuable that phone call is."

Continue reading: Hospital Guide, Part 6: Into the Surgical ICU >>

This story was originally reported on 7/15/07.