Preoperative Logistics and Arrival
Final pre-op verification: identification, consent, site marking, and safety checks
Your day kicks off with safety checks. Several team members will confirm your identity using two identifiers (usually your full name and date of birth) and match them to your wristband and medical record. Your surgeon will review and re-confirm consent—purpose, alternatives, risks, benefits—just to make sure you’re comfortable and on the same page. If your procedure involves a specific side or site (say, right knee arthroscopy), your surgeon will mark it with a permanent marker per the Universal Protocol to prevent wrong-site surgery. Feel like you’re repeating yourself? That’s on purpose. Redundancy protects you.
Fasting (NPO) status, medication reconciliation, and allergy confirmation
Next up: when you last ate or drank. Teams verify that you followed fasting (NPO) instructions, which typically look like:
- Clear liquids up to 2 hours before anesthesia (unless told otherwise)
- A light meal 6 hours before
- No gum, mints, or smoking the morning of surgery
- Continue: beta-blockers; many inhalers; most antidepressants
- Often hold: ACE inhibitors/ARBs on the morning of non-cardiac surgery (depends on context); SGLT2 inhibitors 3–4 days pre-op to reduce euglycemic DKA risk; certain antiplatelets/anticoagulants per a bridging plan; and GLP-1 receptor agonists may be continued or adjusted based on current guidance and your symptoms
- Supplements: many (like fish oil, garlic, ginkgo) are stopped due to bleeding or anesthesia interactions
What to pack and what to leave at home: documents, essentials, and medical devices
Pack light and keep it simple:
- Bring: photo ID, insurance card, payment method (if needed), a current medication list with doses, advance directives, and your escort’s phone number. If you use CPAP, bring your device and mask. Pack your inhalers, eyeglasses with a case, and hearing-aid cases. Using an insulin pump or CGM? Bring spare supplies and your settings.
- Wear: loose, front-opening clothing and slip-on shoes. Skip makeup and nail polish (they can interfere with monitoring).
- Leave at home: jewelry (body piercings included), valuables, and large amounts of cash. Remove contact lenses; you can keep your glasses on until anesthesia begins.
Check-in through pre-op holding: vitals, IV access, prophylaxis, and risk screening
After check-in, you’ll change into a gown and store your belongings. In pre-op holding:
- Nurses take your vital signs, start an IV, and review your history.
- You may get preoperative prophylaxis: antibiotics (timed for the incision), VTE prevention like intermittent compression devices, and glucose management if needed.
- Risk screens often include fall risk, bleeding risk, obstructive sleep apnea (e.g., STOP-Bang), frailty, and pregnancy testing when appropriate.
- Depending on your procedure, you might receive nasal decolonization, antiseptic skin wipes, or a warming blanket to maintain normal temperature.
Intraoperative Workflow and Safety Protocols
Operating room handoff: team introductions, monitors, and positioning precautions
When you roll into the OR, you’ll meet the team—surgeon, anesthesia professional, nurse, scrub tech, and possibly trainees. You’ll be connected to standard monitors and positioned carefully with padding to protect pressure points and nerves. Eyes are protected. Special devices (arm boards, egg-crate pads, safety straps) help reduce nerve injury and skin breakdown.
The surgical safety checklist: sign-in, time-out, and sign-out
Most hospitals use the WHO Surgical Safety Checklist:
- Sign-in (before induction): identity, procedure, site marking, allergies, airway/aspiration risks, equipment checks.
- Time-out (before incision): everyone pauses to confirm patient, procedure, site, imaging, antibiotics, and key steps.
- Sign-out (before leaving the OR): instrument and sponge counts, specimen labeling, priorities for recovery, and any equipment issues.
Intraoperative monitoring: ECG, pulse oximetry, capnography, temperature, and fluids
You’re continuously monitored:
- Electrocardiography (ECG) for heart rhythm
- Pulse oximetry for oxygen saturation
- Noninvasive blood pressure at regular intervals
- Capnography to confirm ventilation and tube placement when relevant
- Temperature monitoring to prevent hypothermia
- Urine output in selected cases
Aseptic technique, specimen handling, and operative documentation
Sterile technique is maintained throughout. Any specimens are labeled with two patient identifiers and precise source descriptions; special chain-of-custody rules apply when needed. The operative note captures the indication, findings, key steps, implants, estimated blood loss, counts, complications, and the postoperative plan—critical for continuity of care.
Discharge Preparation and Going Home
Discharge education: medications, wound care, and activity restrictions
Before you leave, a nurse or clinician will review clear written instructions. Expect details on:
Medications:
Medications:
- Scheduled acetaminophen and NSAIDs (if not contraindicated) are the backbone of pain control.
- Opioids, if prescribed, are for breakthrough pain—and only for as long as necessary; pair with a stool softener and good hydration.
- Antiemetics as needed.
- Restart timing for anticoagulants/antiplatelets and disease-specific meds (e.g., insulin adjustments) per your plan.
- Keep dressings clean and dry; change them as directed.
- Ask when you can shower (often 24–48 hours) and when to avoid soaking incisions.
- Some bruising and mild drainage are normal—know what’s “too much.”
- Weight-bearing status, lifting limits (e.g., “no more than 10 pounds for 2 weeks”), and how to use assistive devices (sling, brace, crutches).
- Breathing exercises or incentive spirometry after chest/abdominal surgery.
- Driving resumes when you’re off opioids, can safely control a vehicle, and your surgeon clears you—procedure-dependent.
Transportation, escort requirements, and legal considerations after anesthesia
Most centers require a responsible adult to take you home and stay available for the first 24 hours. Rideshare or a taxi alone doesn’t cut it after sedation or general anesthesia. Because judgment and coordination can lag:
- Don’t drive, operate machinery, drink alcohol, or sign legal documents for 24 hours—unless your team says otherwise.
- Have your escort hear the instructions with you and keep the written copy.
Home setup and safety: fall prevention, hydration, nutrition, and red flags
A little prep goes a long way:
- Safety: Clear tripping hazards, keep essentials at waist height, use night lights, and consider a shower chair or raised toilet seat if mobility will be limited.
- Hydration and nutrition: Start with clear liquids and bland foods; advance as tolerated. Protein supports healing. If nausea lingers, take antiemetics and sip fluids frequently.
- Bowel regimen: Begin stool softeners with opioids; add fiber and fluids to prevent constipation.
- Sleep apnea: Use your CPAP the first night (and beyond); consider side sleeping or head-of-bed elevation if recommended.
- Fever over 101.5°F (38.6°C) or shaking chills
- Worsening redness, swelling, or pus-like drainage from the incision
- Uncontrolled pain, inability to keep fluids down, or persistent vomiting
- Shortness of breath, chest pain, or one-sided leg swelling/pain
- New confusion, severe headache, or fainting
Follow-up appointments, documentation, and return-to-work planning
You’ll leave with:
- The date/time of your postoperative visit and instructions for suture or staple removal if needed.
- Implant cards (if you received hardware) and details on pathology follow-up for any specimens.
- Return-to-work and driving guidance. Timing depends on your surgery and your job:
- Minor arthroscopy or laparoscopic procedures: often 1–2 weeks for desk work
- Larger abdominal, thoracic, or orthopedic operations: several weeks to months
- Jobs with heavy lifting or safety-sensitive tasks may need longer restrictions
- Help with FMLA/disability forms if needed—ask who handles the paperwork.
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