The preadmission appointment is a hospital's version of confession. It's where you come clean about everything: your allergies to seafood, eggs, and sunscreen (some people strongly react to paba, a chemical in sunscreen); your garlic supplements or Viagra; your penchant for ginseng tea. If you're sensitive to latex, "it's a big deal," says David Schinderle, a cardiac anesthesiologist at Sentara Heart Hospital in Norfolk, Va. Patients with a latex allergy are always done as the first case of the day, he says, so that latex residue from a previous surgery isn't lingering in the OR when an allergic patient comes in. Gloves, catheters, the rubber stoppers on vials of medications—all are switched out with nonlatex replacements.
Such caution is not overdone. Certain anesthesia drugs may contain substances that cause you hives or a trip to the emergency room. Some herbal supplements, such as ginkgo biloba, garlic, and ginseng, promote bleeding; others, including kava and St.-John's-wort, prolong the effects of anesthesia. Throw every prescription, over-the-counter drug, and herbal and dietary supplement (vitamins count) into a bag, and bring it to the appointment. A written or printed list falls short. "We don't want people to self-select what they think is important," says Mark Lema, president of the American Society of Anesthesiologists and chair of anesthesia at the State University of New York at Buffalo.
Test parade. The surgeon and anesthesiologist need a clinical baseline, so you'll be run through a gamut of tests in your preadmission session. Blood work for cardiac bypass patients will, among other things, allow the transfusion service to prepare a unit of blood, should one be needed, before surgery. You may get a chest X-ray and an EKG. If there's any test that you weren't expecting or don't understand, you're entitled to an explanation.
This is also the time you'll discuss specific changes to your current drug regimen. It is nearly certain, for example, that you will be told to stop taking aspirin, even so much as a baby tablet, a week or so in advance. Aspirin deactivates blood platelets, possibly leading to excessive bleeding during or after surgery.
But your surgeon will probably want some drugs—a beta blocker for high blood pressure, say—continued right up to the morning of surgery. If that's the case, it is important to understand the instructions for taking the pill that morning, since food and drink will be off limits typically from midnight the night ahead of surgery, but water may be acceptable. Explicit details, recorded in a notebook, will keep it straight.
Who determines the medications and dosages after surgery should be sorted out at this appointment. It could get complicated, says respiratory therapist Fran Griffin, a director at the Institute for Healthcare Improvement, a Cambridge, Mass.-based group that promotes safety initiatives. Patients often come to the hospital on a drug regimen determined by their internist, who, Griffin notes, may or may not be involved in their postop care. The course of the surgery could affect the mix of medications immediately afterward and during your stay, and knowing in advance who will make the call for changes is information you should have.
Continue reading: Hospital Guide, Part 3: The Countdown Begins >>
This story was originally reported on 7/15/07.