LDS Emergency Preparedness

Be Prepared, Not Scared!

Survival Guilde for Outpatient Surgery

Posted by Elise on October 24, 2010

Of the approximately 35 million annual surgeries in the US, outpatient procedures account for at least 60% of them. Advances in pain management and surgical techniques (such as laparoscopic procedures, which require only a small incision) mean that patients who once would have spent several days in the hospital now can be discharged the same day from an outpatient facility.
Complication rates typically are very low for these procedures, but patients can further reduce their risks — and recover faster after the surgery — by taking an active role… in advance. Before scheduling your procedure, be sure to…

Check out the facility. It is important that the facility where you have the procedure has a so-called crash cart — the equipment and drugs that are used for cardiac emergencies. Crash carts are mandatory in hospitals but optional in many outpatient clinics.
Also important: Ask your surgeon if the facility stocks dantrolene (Dantrium). It’s an antidote for malignant hyperthermia, an anesthesia-related complication that occurs only rarely but can be fatal unless dantrolene is given immediately.

Check out the surgeon. Before scheduling a procedure, make sure that the surgeon…
Is board-certified in that particular specialty. To find out, ask the doctor. If you are uncomfortable doing so, you could mention that you read in this article that board-certification is important and that is why you are asking.

Does many procedures. If you’re having cataract surgery, for example, someone who does 40 or 50 cataract procedures a week is likely to have better results, with fewer complications, than someone who does the procedure only occasionally.

Review and report your medications. Your surgeon and anesthesiologist should know about every drug (and supplement) that you’re taking. Bring a list of your medications and supplements (and/or the bottles) when you meet with the doctor.

Why it matters: You might need to adjust the doses or frequency of drugs or supplements that you’re currently taking. If you have asthma, for example, the stress of surgery can cause a flare-up. You might be advised to use an inhaler prior to the procedure. Diabetics who use insulin, on the other hand, might be told to skip (or reduce) a dose before surgery. The combination of presurgical fasting and a normal dose of insulin could cause blood glucose to fall too low.

In addition, some commonly used drugs and supplements, such as aspirin and ginkgo, inhibit blood clotting and can be risky when taken within several days of some procedures.

Ask about pain control. Don’t assume that your surgeon will aggressively manage pain — many do not. Uncontrolled pain releases the stress hormone cortisol, which impairs immunity and slows healing. People in pain also move around less, which increases the risk for blood clots.

In the past, surgeons mainly depended on narcotics (such as codeine) for postsurgical pain relief. These drugs are effective but may cause side effects, including urinary retention, nausea and even itching.
Ask your surgeon (or the anesthesiologist) to discuss non-narcotic alternatives, such as nerve blocks (which can control pain for several days). One type of nerve block is the “ON-Q,” which dispenses a drip of anesthetic into surgical wounds. It also can offer patient-controlled analgesia, which allows patients to manage their own pain with the push of a button.

PRESURGERY PREParations

As you get closer to the time of the surgery, do the following…

Stop smoking for at least 72 hours before the procedure — longer is better. Not smoking prior to surgery will improve circulation and wound healing as well as ciliary function — the ability of hairlike projections in the lungs to remove mucus — important for the prevention of postsurgical pneumonia.

Eat lightly the day before the procedure. Clear soups, rice, fruits and vegetables are ideal. Anesthesia frequently causes constipation. Easy-to-digest foods leave less residue in the digestive tract and help reduce postsurgical gas and cramping.

Don’t chew gum prior to surgery. It stimulates the secretion of gastric juices that can interfere with your breathing and cause choking (asphyxia) during the procedure.

Don’t shave the area that is undergoing the surgery. Even a new blade can cause thousands of invisible abrasions/nicks that can allow bacteria to enter. Shaving ahead of time gives bacteria a chance to multiply and cause an infection. If a surgical site needs to be shaved, someone on the operating team will do it right before making the incision.

PostSurgery Care

What you can do to feel better and recover faster…

Stay warm. The blankets used in medical settings are notoriously thin. If you’re cold when you wake up in the recovery room, ask for extra blankets. Patients who maintain a normal body temperature, known as normothermia, during and after surgery heal more quickly and get fewer infections than those who are cold.

Breathe deeply and cough. The drugs used for general anesthesia can impair normal lung movements and increase the risk for pneumonia.

Recommended: As soon as you’re physically able, take deep breaths for a few minutes every hour or two. Make yourself cough, even if you don’t have to. Coughing and other exaggerated respiratory movements help clear the airways. This is particularly important for those who are older, sedentary or overweight.

Move as soon as you can. Moving soon after a procedure reduces the risk for blood clots, improves muscle strength and helps clear the lungs. If you can, stand up and walk. If you’re not able (or allowed) to stand, move in bed. Stretch your arms and legs… roll from one side to the other… or merely flex your muscles.

Don’t put up with nausea. It is among the most frequent — and the most feared — side effects of anesthesia. Anesthesiologists now can choose from among six to eight different drugs to prevent it. If you feel sick when you wake up, tell your doctor. If one drug doesn’t work, another one probably will.

Source:   David Sherer, MD, anesthesiologist with the Mid-Atlantic Permanente Medical Group in Falls Church, Virginia, and the former physician-director of risk management. His research interests include the use of anesthesia in starting intravenous lines and the importance of patient autonomy for hospital and outpatient care. He is author, with MaryAnn Karinch, of Dr. David Sherer’s Hospital Survival Guide: 100+ Ways to Make Your Hospital Stay Safe and Comfortable.

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