Pre-Op, Where You Hurry Up and Wait

Hospital Guide, Part 4: Questions, IV, final checks, boredom. Wheel me in already!

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You dutifully awoke in the wee hours so you could get to the hospital by the appointed hour. For your trouble, now you're in hurry-up-and-wait mode in a hospital bed or gurney. The anesthesia team is readying the or for your surgery based on a review of your chart and a brief conversation you'll soon have. At Sentara Heart Hospital in Norfolk, Va., patients and their families at least get to pass the time in private rooms. More typically, you'll be put in a large "holding area" along with other pending surgery cases, with a privacy curtain around each bed.

Various scrubs-clad staff will come by to check who you are and what you're in for. You'll also be asked whether you had anything to eat or drink since midnight the night before. If you ate anything at all, or drank fluids other than a small amount of water permitted to take a medication, you'll have to tick off six to eight hours while your stomach empties—if you're lucky. If not, you'll have to go back home, reschedule the surgery, and redo the early-morning routine all over again.

You're going to be in a pre-op holding pattern for a while. This is where you'll also get stuck to have an IV line inserted so that sedatives, anesthesia drugs, and other medications can be delivered directly into the bloodstream. Blood also may be drawn from this same needle stick to check its clotting ability, especially if you've been taken off blood-thinning meds prior to surgery or had abnormal potassium, say, in your preadmissions blood work.

You can put in a request for a standing order from the anesthesiologist for a local anesthetic such as lidocaine when doing a stick that requires searching for a vein or artery (which could hurt more than a bit, depending on your pain tolerance), especially if yours are hard to find. The numbing agent is injected with a fine needle with the ouch factor of a bee sting before applying the larger one. Lidocaine is medication, meaning that it can't be given without a doctor's order, so you need to make your request before the morning of surgery. Your anesthesiologist will stop by while you're in pre-op, but there's no guarantee that it won't be until after the IV is in.

Brown-bagging. When the anesthesiologist arrives, she will want to review your medical history, allergies, and every drug or supplement you take (again, bring everything in a brown bag). Tell all, and let her decide what is relevant.

She will check your mouth and throat for anything that might give her trouble when she inserts the breathing tube into your windpipe. Most patients given general anesthesia are intubated. A ventilator will breathe for you throughout and just after surgery. To avoid injury that might extend your hospital stay, the doctors and nurses should be told about esophageal disease or surgery, or previous difficulty when you had general anesthesia in the past. This is a good time to review management of your postop pain, since certain approaches need to be initiated prior to surgery.

You'll also get a visit from your surgeon, who will use a marking pen to indicate the correct surgery site. Along with having a heart valve replaced, Sentara patient Margaret Denison got an X and a "yes" on the left side of her neck, indicating that vascular surgeon Noel Parent would work on her left carotid artery. "There's nothing worse than a good operation on the wrong side," said Parent, only half joking. He would shortly clear plaque from the artery, one of a pair that supply blood to the brain. The plaque buildup was limiting blood flow, which often made the 71-year-old from Hertford, N.C., feel lightheaded.

About an hour before surgery, you'll get a dose of an antibiotic. It will be continued for 24 to 48 hours afterward to stave off surgical site infection, which affects an estimated 1 in 7 patients and more than doubles the risk of dying.

Continue reading: Part 5: Finally, the OR >>

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