Preparing for your Operation

Bathing and Showering

Please bathe or shower with soap and wash your hair before the operation. This reduces the risk of developing an infection. You are required to shower both the night before and the morning of your surgery. Shower with a special soap called chlorhexidine, or a similar antibacterial product.

Smoking

Do not smoke on the morning of your surgery. If possible, try to give up smoking altogether, or cut down before you are due to come into hospital. The longer you can give up beforehand, the better. It is very important that you try to stop smoking at least 4 to 6 weeks before the date of your operation, if possible. Smoking reduces the amount of oxygen in your blood and increases the risk of breathing problems during and after an operation.

Smokers:

Need more anaesthetic during surgery
Need more oxygen therapy in the recovery room
Have slower wound healing.
Have a higher risk of developing chest infections after surgery
Have a higher risk of developing deep vein thrombosis (DVT)
Have a higher risk of non-union of the bone, especially after fractures

Your Weight

If you are very overweight, many of the risks of having an anaesthetic are increased. Reducing your weight before the operation will help to mitigate these risks.

Being overweight increases your chance of experiencing side effects and complications during surgical procedures, such as:

Difficulties locating veins for anaesthesia and medications
Complications determining the right dosage of medications and anaesthesia to give
Challenges with providing the amount of oxygen and airflow during surgery, which increases the risk of breathing problems
Increased time to regain consciousness after surgery and recover from surgery (as well as any complications, if they are experienced)

Teeth

If you have loose or broken teeth or insecure crowns, you may want to visit your dentist for treatment before your operation. The anaesthetist may need to put a tube in your throat to help you breathe, and if your teeth are insecure, they may be damaged.

Problems with your teeth and gums can be a major source of bacteria and lead to infection. Bacteria can enter the bloodstream or the lungs, causing complications during or after surgery.

We recommend brushing your teeth for two minutes last thing at night before you go to bed and on one other occasion every day to reduce the amount of bacteria in your mouth.
You should use a pea-sized amount of toothpaste
We encourage you to use a dry, small-headed, medium-bristle toothbrush. If you use an electric brush, we recommend one with an oscillating or rotating head.
DO NOT wet your toothbrush before brushing. After brushing, spit and DO NOT rinse with water or mouthwash. This gives your toothpaste time to work at protecting your teeth.
Make sure you brush all the surfaces of all your teeth, which should take about two minutes. Remember to brush the inside surfaces, outside surfaces and the chewing surfaces of your teeth. Try and angle your toothbrush at the gum and use a small gentle, circular motion when brushing – there is no need to scrub.

Medical History

Suppose you have long-term medical problems such as diabetes, asthma or bronchitis, thyroid problems, heart problems or high blood pressure (hypertension). In that case, you should ask your doctor for a check-up before your operation.

Health check before your anesthetic

Before your anesthetic, we need to know about your general health. We will conduct a health check by asking you questions at the Pre-operative Assessment Clinic. You may also need some tests, such as an ECG, to ensure you are fit enough for the anaesthetic.

Admission Time

You will be asked to arrive at a specific time of day, according to where you are on the surgeon’s operating list. It is very important to arrive at the time you have been given. If you arrive too early, they may not have room for you to wait, and if you arrive too late, your operation may be cancelled.

If you have a general anaesthetic and are leaving the hospital on the same day, you will need to have a responsible adult with you overnight and for the next day. This is because it can be risky for you to be alone after having a general anaesthetic.

Eating and Drinking

We will give you specific and clear instructions about eating and drinking before your operation when you come for your Pre-operative Assessment appointment.

In brief – you must not eat any food, chew gum or suck sweets for 6 hours before a general anaesthetic or sedation.

You may drink clear fluids only (such as water or squash) up to 2 hours before having general anaesthetic. Drink plenty of fluids (preferably water) the day before your operation to help keep your body hydrated.

Clear, see-through liquids include:

Water
Clear fruit juices such as apple juice and white cranberry juice
Plain tea or black coffee (NO milk or creamer)
Clear, electrolyte-replenishing drinks such as Pedialyte, Gatorade, or Powerade (NOT yogurt or pulp-containing “smoothies”)
Ensure Clear or Boost Breeze (NOT the milkshake varieties)

If you are asked to arrive between 7.30 am and 12 noon do not have anything to eat, chew gum, suck sweets, or have any drink with milk in it after midnight the night before. You can drink water or clear non-milky beverages (e.g., squash, black tea/coffee) up to 2 hours before admission.
If you are asked to arrive after 12 noon, you may have a light breakfast of tea or coffee with a piece of toast before 7 am. Do not have anything more to eat, chew gum, suck sweets or have any drink with milk in it after this time. You may drink water or clear, non-milky beverages (e.g., squash, black tea/coffee) until 11 am.
Certain procedures may require special preoperative fasting instructions. For example, patients undergoing colonoscopy, bariatric (obesity) surgery, or colorectal surgery may be instructed to be on a clear liquid diet before surgery for a day or more prior to their procedure.

For your own safety, it is very important that you do not have anything to eat or drink after the times stated. If there is any food in your stomach when you have a general anaesthetic or sedation, it could come up into the back of your throat and then go into your lungs. This would cause choking or serious damage to your lungs. If you do have something to eat or drink after.

The relaxation of the body’s muscles that occurs under anesthesia increases the risk of food regurgitation and potential aspiration. The fasting guidelines, while seemingly strict, are necessary to try to mitigate this risk as much as possible. Adhering to these guidelines contributes to our common goal of a smooth anesthetic and procedure.

If food is had then, your operation will have to be delayed or even postponed to another day.

Bowel Surgeries

Suppose you are undergoing a colorectal procedure/surgery requiring bowel cleansing. In that case, you will be given specific instructions related to fasting, clear fluids, and additional bowel preparation.

Medicines

Before a general anaesthetic, we need to know all about your medicines, including any inhalers or creams and off-the-shelf medicines. You should continue to take your regular medicines up to and on the day of your surgery, unless your anaesthetist or surgeon has asked you not to.

If you take drugs to thin your blood (such as Warfarin, Aspirin, Clopidogrel etc.), medications for diabetes, or any herbal remedies, you will be given specific instructions about when to stop taking these at your Pre-operative Assessment visit.

Please bring all your medicines with you to hospital in their original containers.

What to bring with you on the day?

Please remember to bring with you:

all your medicines
something to pass the time while waiting for your operation (a book or magazine).
Do not wear makeup on the day of surgery
Do not wear nail polish
Do not wear your eye contacts
Leave valuables and jewelry at home

Meeting your Surgeon

Your surgeon will come to see you to talk to you about your operation and to answer any remaining questions you may have. The surgeon will then ask you to sign the consent form. This confirms that you understand the risks and benefits of the operation and are happy to proceed. If appropriate, the surgeon may also mark the operation site on your body with a marker pen. If you have any questions or concerns, this is the time to ask.

Meeting your Anaesthetist

You will normally meet your anaesthetist before your operation. Anaesthetists are doctors who have specialist training in anaesthesia and pain treatment, intensive care, and emergency care (resuscitation).

Your anaesthetist is responsible for:

your wellbeing and safety throughout your surgery
agreeing on a plan with you for your anaesthetic (if appropriate)
giving you your anaesthetic
Planning your pain control with you
managing any transfusions (of medicines or blood) you may need
your care in the Intensive Care Unit (if necessary).

Your anaesthetist will review the results of your health check and may ask you additional questions about your health. They may also need to listen to your chest with a stethoscope, examine your neck and jaw movements, and look in your mouth.

The anaesthetist will discuss the choice of anaesthetic methods suitable for your surgical procedure, highlighting the benefits and risks associated with each. This will help them agree with you on the best and safest anaesthetic option for your operation. If you have any questions or concerns about the anaesthetic, this is a good time for you to ask the anaesthetist.

Very common side-effects and complications

Feeling sick and vomiting after surgery

This can be treated with anti-sickness drugs (anti-emetics) but may last from a few hours to several days.

Sore throat

If you have had a tube in your airway to help you breathe, it may give you a sore throat. The discomfort or pain lasts from a few hours to a few days.

Dizziness and feeling faint

The anaesthetic you receive may lower your blood pressure and make you feel faint. This may also be caused by dehydration (not being able to drink enough fluids). Fluids or drugs (or both) will be given into your drip to treat this.

Shivering

If you get cold during your operation, you may shiver. Care is taken to keep you warm during and after your operation, and we may use a hot-air blanket to do this. However, due to the effects of anaesthetic drugs, shivering can happen even when you are not cold.

Headache

There are many causes of headaches, including the anaesthetic, the operation, dehydration and feeling anxious. Most headaches get better within a few hours and can be treated with pain-relieving medicines.

Aches, Pain and Backache

This may be from lying still for a long time and from the operation itself.

Bruising and Soreness

This may develop around injection and drip sites and the area that has been operated on. It normally settles without treatment.

Confusion and Memory Loss

This is more likely in older people who have had an operation under general anaesthetic or if they already have memory difficulties. It is usually temporary but sometimes permanent (you may not remember certain memories from just before your operation).

Chest Infection

A chest infection is more likely to happen to people who smoke and may lead to breathing difficulties. It is very important to give up smoking for as long as possible before your anaesthetic, and to give up permanently for your future health.

Bladder Problems

After certain types of operation, men may find it difficult to pass urine (urinary retention) and women can tend to leak. To prevent these problems, you may have a urinary catheter inserted during the procedure.

Going to the Operation Theatre

You will need to put on your dressing gown and slippers. Depending on the type of surgery you are having, you may be able to wear cotton pants when you go to the theatre, or you will be given a pair of disposable pants. The nurses will be able to let you know what you can wear.

If the anaesthetist has prescribed a pre-medication, the nurse will give it to you before you leave the ward or reception area.

A member of staff will escort you to the anaesthetic room where you will be asked to lie down on a trolley. Theatre staff normally wear blue ‘pyjamas’ (scrubs), paper hats and may already be wearing face masks. Because of this, they all look much the same, but you will probably recognise your anaesthetist and surgeon as you should have met them already.

If you have walked to the anaesthetic room, you will now need to get onto a theatre trolley for your anaesthetic. The trolley is narrower and higher than a hospital bed and may feel cold and hard. A member of staff will help you climb onto it.

The nurse will go through a safety checklist with you, checking your identification bracelet, your name and date of birth. They will also ask you about other details in your medical records, as a final check that you are having the right operation and will re-check your consent form.

If you have a general anaesthetic, you will probably need to remove your glasses, hearing aids, and dentures to keep them safe. If you would prefer to leave your dentures in place, ask your anaesthetist if this would be alright.

To monitor you during your operation, your anaesthetist will attach you to several machines:

Three small sticky patches will be placed on your chest to monitor your heart.
A blood-pressure cuff will be placed on your arm which will inflate and deflate occasionally to check your blood pressure.
A clip will be placed on your finger (a pulse oximeter) to monitor the oxygen level in your blood.

If you have a general anaesthetic, regional block or sedation, the anaesthetist will use a needle to put a thin plastic tube (a ‘cannula’) into a vein in the back of your hand or forearm. This can be used to give you fluids or medications during the operation. It will be covered with a sterile dressing to stop it from moving.

If you are having a General Anaesthetic

Starting the Anaesthetic (induction)

To send you off to sleep your anaesthetist will inject the anaesthetic drugs into one of your veins through the cannula in your hand or arm. This is called an induction to anaesthesia. Induction happens very quickly, and you will become unconscious (asleep) within a minute.

Waking up from a general anaesthetic

At the end of the operation, your anaesthetist will stop giving you the anaesthetic drugs and / or gases and you will wake up gradually. If muscle relaxants have been used, you will be given a drug that reverses their effect. After all but very major operations (such as open heart surgery) you will be breathing normally soon after the operation is over.

When your anaesthetist is sure you are recovering normally, you will be taken to the recovery room. A designated recovery nurse will always be with you and continue to monitor your blood pressure, oxygen levels and pulse rate. You will be given oxygen through a lightweight clear-plastic mask covering your mouth and nose. Breathing oxygen keeps up the oxygen levels in your blood while the anaesthetic wears off. The staff will remove your mask as soon as the oxygen in your blood stays at the right level without you having to breathe in extra oxygen.

You may temporarily need a urinary catheter. This is a thin soft tube that is put into your bladder while you are asleep, to drain your urine during and after a surgical procedure.

After your Operation

After your operation, you may spend some time in the Post-Anaesthetic Care Unit (PACU) before being taken back to the Day Surgery Unit or to your ward.

Before you are taken back to the ward, the recovery staff must be totally satisfied that you have safely recovered from your anaesthetic, you are comfortable, and all your observations (such as blood pressure and pulse) are stable.

The type of operation you have had will affect how long it will be before you can drink or eat. After minor surgery, this may be as soon as you feel ready. Even after a major surgery, you may feel like sitting up and having something to eat or drink within an hour of regaining consciousness.

Preventing blood clots whilst you are in hospital

Blood clotting is vital to ensure that when we cut ourselves, a clot forms to stop bleeding. However, there are times when the clotting process goes wrong, and blood clots inside our veins, causing a Deep Vein Thrombosis (DVT). This is more likely to happen when the blood flow around the body is slower or when the blood becomes sticky—for example, when we stay in bed for a few days or when veins are injured during an operation.

A DVT is the name given to a blood clot which forms inside a vein that is deep beneath the skin of your leg, or sometimes in your pelvis. The clot blocks blood flow through the affected vein and can cause swelling or pain.

Sometimes, part of the clot breaks off and passes through your circulation until it reaches your lung. This is called a Pulmonary Embolism (PE) and can cause shortness of breath and chest pain.

Venous Thromboembolism (VTE) is the collective name for DVT and PE. VTE can be a very serious and potentially life threatening condition.

Leaving Hospital

Once the doctor has decided that you are able to leave hospital you will need to arrange for the person who is taking you home to come and collect you. If you are having your procedure as Day Surgery, please make sure that this person can be contacted and is available to collect you at any time during the day.

If you are discharged the same day after having a general anaesthetic

The next 24 hours

You need to have a responsible adult accompany you home and stay with you for the next 24 hours. This is because a general anaesthetic can make you feel sleepy and disorientated for up to two days afterwards.
You will also need help to look after any children or pets you may have.
Do not operate machinery or appliances, such as the cooker or kettle.
Do not lock yourself in the bathroom or toilet, or make yourself inaccessible to the person looking after you.
Drink plenty of fluids and eat a light diet, avoiding heavy or greasy foods.
Avoid alcohol.
Avoid strenuous exercise.
Do not make any important decisions or sign any legal or important documents.

Driving

Anaesthetic drugs remain in the body for up to 48 hours; they gradually wear off over this time. For 48 hours after your anaesthetic, while you still have the drugs in your body, you ideally should not drive a car or any other vehicle, or a bicycle.

Wound care after surgery

You will be given specific advice about caring for your wound by the ward nurse that discharges you.

When you return home, watch out for any signs of infection, such as:

swelling
increased redness around the wound
pus or bleeding from the wound
the wound feeling warm
an unpleasant smell from the wound
increasing pain
a high temperature (fever) of 38°C (100.4°F) or above
swollen glands.