On the Day of Surgery

When do I present to hospital?

The hospital bookings office will clarify with you either the day prior, or in the days leading up to your surgery date, what time and where you need to present to the hospital. Usually, you will present to admissions on the day of surgery, but occasionally you will be asked to present the day prior to surgery. If you are unsure of your admission details, please call Dr Agolley’s rooms or the Tweed Hospital bookings office.

When you arrive at the hospital, present to the admissions office or front desk. You will be admitted by the clerk, and moved to the day surgery, where a nurse will greet you and have you get changed in to hospital gown attire appropriate for the operating theatre while you wait for your surgery time. If you have brought someone with you, they may wait with you.

Why does every one keep asking me the same questions, don’t they know why I am here?

During your admission process, you will meet several different health professionals who you may not have met before. They will ask you.

• What is your name?
• What is your date of birth?
• Why are you here / What operation are you having today?
• Which limb are we operating on?
• Is this your signature on this consent form?
• Do you have any questions?

Even when Dr Agolley or one of his assistants meets you on the day of surgery, you will be asked the same questions, and your surgery site will be marked. This process is repeated for every patient to ensure that NO assumptions are made about who you are, and what procedure you are having. The process is all part of our high standard of care.

How long will my operation be?

Depending on the procedure you are booked for, your actual operation time while under anaesthesia may vary from 10 minutes, to a few hours for complex operations. Ask Dr Agolley how long your surgery will take. The whole process though, from when you enter the operating theatre, to when you arrive on the ward to recover, will likely be a few hours to allow for processing time.

What Happens In the Operating Theatre?

When the operating theatre is ready for you, you will be transferred from day surgery to the operating theatre where your loved one will need to leave you. You will be moved in to the Anaesthetic bay, where if you haven’t already, will be met by your Anaesthetic nurse and Anaesthetist. You will discuss with them details of your anaesthetic and you may ask questions. They will attach monitoring devices to you, such as a blood pressure cuff, and sticky dots on your chest to allow us to monitor your vital signs while under anaesthesia.

If you don’t have one already, a plastic cannula will be inserted into your vein, to allow administration of fluid, medication and anaesthetic in to your blood stream. You may also receive an anaesthetic block of your nerves while you are awake. If you are receiving a block, you will have discussed this with your anaesthetist prior.

Once the operating theatre has been prepared for you, you will be wheeled in and greeted by other staff. They may already be wearing masks as part of the theatre protocol. You will be transferred on to the operating table, which is sometimes cool, and can feel quite narrow, however we make sure that you will not fall off.

Anaesthesia

Please note: This information is to be used as a guide, and does not replace the information given to you by your anaesthetist.

Different types of anaesthesia may be used individually or in combination as appropriate. For some types of surgery, several options are available to facilitate surgical conditions and to provide pain relief. A specialist anaesthetist will consult with you and Dr Agolley to offer the safest and most appropriate type of anaesthesia for your operation.

Local Anaesthesia

Local anaesthesia involves the injection of local anaesthetic into the tissues near the surgical site. It may be used alone or in combination with sedation or general anaesthesia after consideration of the extent and duration of the surgery and patient requests. It is usually used for minor surgery.

Regional anaesthesia

Regional anaesthesia involves the injection of local anaesthetic around major nerve bundles supplying body areas, such as the thigh, ankle, forearm, hand, shoulder or abdomen. Regional anaesthesia is sometimes achieved by using a nerve-locating device, such as a nerve stimulator, or by using ultrasound. These devices help to locate the selected nerve(s) so that local anaesthetic can be delivered with improved accuracy. Regional anaesthesia may be used on its own or combined with general anaesthesia.

Once local anaesthetic is injected in the desired region, patients may experience numbness and tingling in the area supplied by the nerves and it may become difficult or impossible to move that part of the body.

The duration of the anaesthesia depends on which local anaesthetic is used, the region into which it is injected and whether it is maintained by continual doses or repeated injections. Typically numbness can last several hours but may last up to several days. Generally, the “heaviness” wears off within a few hours but the numbness and tingling may persist much longer. As the local anaesthetic effect wears off, numbness will diminish and surgical pain may return, in which case alternate methods of pain relief, including injections or tablets, will need to be taken by yourself.

Sedation

Conscious sedation is defined as a medication-induced state that reduces the patient’s level of consciousness during which the patient may respond purposefully to verbal commands or light touch. A variety of medications and techniques are available for procedural sedation and/or analgesia (sedation or pain relief which is administered to allow a specialist to perform a procedure). The most common medications used that are injected into a vein are benzodiazepines (which act on the brain and the nervous system) such as midazolam for sedation and opioids (which decrease the patient’s perception of pain), such as fentanyl, for pain relief.

Deep levels of sedation, where patients lose consciousness and respond only to painful touch, may be associated with the patient having difficulty with breathing normally and their heart function may be affected. The anaesthetist is trained to manage these situations.

General anaesthesia

General anaesthesia involves the patient being put into a medication-induced state which, when deep enough, means that the patient will not respond to pain and includes changes in breathing and circulation.

Under general anaesthetic, a patient is in a state of carefully controlled unconsciousness.

Postoperative pain relief

Please note: You must let Dr Agolley and his staff know of any medication or pain relief that does not agree with you.

Your comfort after surgery is a vital part of your successful rehabilitation. Our well trained anaesthetists, acute pain service, and nursing staff liaise closely with Dr Agolley, to ensure that you are receiving an optimum amount of pain relief (analgesia).

All surgery is associated with some pain, however you pain needs to be managed so that it is bearable for you to part take in your physiotherapy exercises. Some patients tell us that “It doesn’t hurt if I don’t move it and lie still”. However if you don’t move your limb when you are required to by Dr Agolley, it may mean the difference between you having an excellent or very poor outcome after your operation.

Analgesia (pain relief) can be administered via different ways to your body

• Orally (e.g. tablet form)
• Injection
• In to your drip
• Under your skin
• In to your muscle
• Rectally, like an enema in to your back passage (uncommon)

You will usually be given pain relief orally in the form of a tablet, unless you are fasting or are unable to swallow a tablet. The benefit of analgesia is obvious, you are comfortable, however we need to balance this carefully with the side-effects which include;

• Delirium / confusion
• Constipation
• Rash
• Sleepiness
• Gastrointestinal upset
• Nausea and vomiting

We manage common side effects expectantly, but if you are experiencing any of these, let your nurse or Dr Agolley know, so they can manage you optimally.

After anaesthesia

Once you are under anaesthesia, you may have a tourniquet applied to your limb, and a urinary catheter placed into your bladder if necessary. Your surgery site is prepared with a special antiseptic solution, and sterile drapes are placed around your limb to allow us to create the most modern and clean environment for your surgery to take place.

After surgery

Once your surgery is performed, your surgical site is dressed with a sterile dressing, and you are moved into the recovery room to wake up from your anaesthesia. In the recovery room, your nurse will monitor your vital signs, and continually ask you if you have any pain, and ask you to rate it out of 10. 10 is the worst pain imaginable and zero is no pain. Let the nurse know what rating you give your pain so they can accurately give you enough analgesia to keep your pain controlled. Surgery is usually painful but it should be able to be controlled with appropriate amounts of pain relief. If you are still in severe pain, you need to let the nurse know.