Preparing for Surgery

WHAT TO EXPECT

Undergoing a surgical procedure can be a stressful experience for many patients. The staff at New England Hand Associates can provide you the tools you'll need to feel at ease with your upcoming procedure. The following is a brief timeline to help you understand - and prepare for - each part of your surgical experience.

• Leading Up To Your Surgery
• The Morning of Surgery
• Anesthesia
• The Operating and Recovery Rooms
• Recovering

LEADING UP TO YOUR SURGERY

Depending on your type of surgery, you may go home the same day or be admitted. Please be sure to plan accordingly, considering your work schedule, holidays and upcoming family plans.

Clearance:
If you have a history of medical issues - even if you are scheduled to go home the day of surgery - your surgeon may request a pre-operative medical clearance. Routine testing may include an EKG or a chest x-ray; some patients need additional testing such as a cardiac stress test.

Medications:
You may be instructed by your surgeon or your primary care physician to stop taking certain medications (such as blood thinners like Plavix or Coumadin) several days to a week before your surgery. In addition, you may be instructed to take some of your medications the morning of surgery even though you won't be able to eat that morning. It is important for you to bring a list (or a bag of pill bottles) of all your medications to your medical clearance appointment; this includes vitamins, over-the-counter medications and nutritional supplements. A number of medications and supplements may interact with medications you may receive after surgery.

THE MORNING OF SURGERY

On the morning of your surgery, you will arrive several hours before your procedure is scheduled to begin.

"Holding Area":
You will come to the pre-operative "Holding Area", where you will be prepared by facility staff for surgery. A locker will be provided for your personal belongings; however, you are advised to leave any valuables at home. This includes all jewelry, which you will be asked to remove before entering the operating room. You will change into a hospital gown and be assigned a holding bed. Your family can be with you during this time. A nurse will start an intravenous line. If you are a woman of child-bearing age, you may be asked to provide a urine specimen for a pregnancy test.

Pre-operative Exam:
You will be asked to confirm what type of surgery you are having and will be asked to sign a consent for that surgery if you have not already done so. Your surgeon or one of their assisting physicians will speak with you and will have you sign your surgical site. This is a safeguard to confirm where on your body the surgery will be performed. You will also meet your anesthesiologist at this time, who will discuss the type of anesthesia you will receive.

ANESTHESIA

Your surgery can be performed under two major types of anesthesia: general or regional.

General anesthesia:
Involves being put to sleep with medications that are given to you through your intravenous line. Once you are completely asleep, a breathing tube is placed in your windpipe and your breathing will be assisted with a ventilator. You will remain completely asleep and comfortable until the surgery is complete. Following the procedure you will resume breathing on your own, the tube in your windpipe will be removed, and you will awaken comfortably in the operating room.

Regional Anesthesia:
Involves an injection that blocks the nerves going to the area involved in your procedure. You will be comfortably sedated before the injection and, depending on your preference, can be either lightly or heavily sedated for surgery. When you receive this type of anesthesia, you will feel no pain during surgery. As a result, you will need less sedative and pain medication. This will allow you to recover faster and have fewer side effects such as sleepiness and nausea. In addition, the anesthesia will last for several hours following the procedure, significantly reducing your pain and smoothing the transition to oral pain medications.

If your recovery requires an inpatient stay, your anesthesiologist will choose one of two options to control your post-operative pain. He or she may elect to place a tiny plastic catheter at the site of the injection, allowing you to receive a continuous infusion of pain medication after surgery. The other option - called intravenous patient-controlled analgesia or PCA - allows you to administer your own pain relief. This is done using a computerized pump to administer small doses of intravenous pain medication as you need them.

THE OPERATING AND RECOVERY ROOMS

Anesthesia/Surgery:
After your consultation with the anesthesiologist, you will be taken to the operating room. Once there, your anesthesiologist will put on standard monitors, such as a blood pressure cuff and EKG leads, and will begin giving you sedative medication. One of the forms of anesthesia discussed above will be administered and the surgery will begin. An anesthesiologist will be with you the entire time. When the surgery is complete, your surgeon will speak with your family and you will be taken to the recovery area.

Recovery:
In the post-anesthesia recovery area you will fully awaken from sedation and will eventually be given ice chips followed by small sips of water. Your doctor or someone from his/her team will come by and speak with you about the surgery and follow-up plan. If you are going home that same day, you will receive detailed instructions for taking care of yourself at home and a prescription for pain medication. If you are staying in the hospital, you will be assigned a room and transported there. While in recovery, your pain will be controlled with the infusion catheter, the PCA or by oral pain medications.