Time for surgery

A patient's surgery experience
What to expect during surgery

Surgery involves a huge amount of trust in a complete stranger (the surgeon), after meeting for only a brief period of time. If I were to say to you "give me all your money, your car keys, and the deed to your house, and I'll give them back to you tomorrow, you would say "what are you, nuts?" And yet, each day, a patient will trust a surgeon, who has spoken with them for literally minutes, to say that we will put them to sleep, make an incision, get down to nerves, take out a disk or fuse the spine, close them up, and then awaken them. Can there be a greater level of trust bestowed upon one human by another?

Day of the operation:
Often, surgery will begin in the morning, unless the operation is "following" another. A typical start time will be 7:30 AM or 8:00 AM. The patient will have been instructed to not eat or drink anything for at least six hours before surgery. This decreases the risk of aspiration during the intubation process (the placement of a breathing tube into the lungs, by the anesthesiologist).

The patient will often be given a sedative just before going back to the operating room (OR).  In the OR, there will be a lot of activity, which might be disconcerting to the patient.  What the patient must remember is that all the activity in the room is for the benefit of the patient. Everyone is focused on a particular task, in order to make sure the patient has a safe and successful surgery.  The room may seem cool, and the personnel might appear impersonal, but this is only because they are focused on a number of tasks.

Various lines may be placed. This means that the patient might have additional intravenous (IV) lines started, to supply fluid. A central line, which is essentially a large IV placed either under the collar bone or into the jugular vein in the neck, might be inserted. Although this sounds like a big deal, for an anesthesiologist this is a routine task. A Foley catheter to drain the bladder may be placed if the procedure is anticipated to last several hours.  An arterial line, which is essentially a line to measure arterial blood pressure instantly, might be placed. Some of these lines might be placed after the patient is put to sleep.

Next the patient will go to sleep. The anesthesiologist will insert the endotracheal tube into the lungs (this will breathe for the patient while asleep). The patient will then be positioned appropriately for the surgery, with the knees, elbows and any other delicate areas carefully cushioned to decrease the risk of pressure sores.

The surgeon will then usually mark the skin in the region of intended incision.  The circulating nurse will "prep" the skin with antibiotic solution and scrub, and the scrub nurse will "drape" the patient with towels and an iodine impregnated plastic "sticky" drape known as ioban.  The remainder of the body is now draped off. 

While the body is being prepped and draped, the surgeon will generally "scrub" his hands and forearms.  He will then enter the room, "don" his gown and gloves, step up to the field, and start operating. 



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