chilled and to experience discomfort, numbness,
or pain. The surgeon may infiltrate the operative
site with a local anesthetic to provide localized
pain relief for 12 to 24 hours after the operation
or place tiny catheters in the surgical wound to
instill a continuous irrigation of a local anesthetic
for extended pain relief. Most often the person is
already receiving analgesic medications to relieve
pain and generally receives PATIENT CONTROLLED
ANALGESIA(PCA) during the recovery period. When
fully stable the person may go to a room in the
hospital, if an overnight stay in the hospital is nec-
essary, or home to recover and recuperate. Before
discharge the PACU staff provide instructions for
WOUND CARE, pain management, possible complica-
tions such as unusual bleeding, and follow-up
appointments with the surgeon.
See alsoPREOPERATIVE PROCEDURES; SURGERY BENE-
FIT AND RISK ASSESSMENT.
preoperative procedures The events that take
place to prepare a person for a surgical OPERATION.
Preoperative procedures for elective (nonemer-
gency) operations may begin several days to a
week before the scheduled surgery with activities
such as
- preoperative consultation with the surgeon or a
member of the surgeon’s staff to discuss the
preparations for surgery, including any revi-
sions to routine medications, dietary restric-
tions, LAXATIVES or ENEMA, or SKIN-cleansing
procedures as well as expectations for the oper-
ation’s outcome and the anticipated recovery
period - signing of informed consent documents that
specify, in detail, the planned operation and the
reasons for it, the scope of surgery the surgeon
may perform, and the operation’s possible com-
plications and risks - routine BLOODtests to assess blood cell counts,
HEMOGLOBINlevel, COAGULATION(clotting) times,
LIVERfunction, and kidney function - possible chest X-RAY, ELECTROCARDIOGRAM(ECG),
and other diagnostic testing, depending on the
operation and the person’s health status and age- consultation with the anesthesiologist or anes-
thetist to determine the optimal anesthesia
choices for the person’s health status and the
planned operation - health insurance preauthorization or financial
arrangements
- consultation with the anesthesiologist or anes-
The doctor will provide instructions about not
eating for a specified period of time before the
scheduled operation, and about taking any daily
medications on the day of the operation.Before signing informed consent docu-
ments, it is crucial to fully understand
the scope of the planned OPERATION, the
expected benefits of the operation, the
anticipated course of recovery, and pos-
sible complications and risks of the
operation and of the ANESTHESIA.Most people arrive at the AMBULATORY SURGERY
FACILITY or hospital surgery unit several hours
before the scheduled time of the operation. In
preparation for the operation, a person undresses
and puts on a surgical gown. The preoperative
nurse starts an intravenous (IV) infusion to main-
tain HYDRATIONand to administer medications. Sur-
gical staff may apply electrodes to the chest to
monitor HEART RATE, place a BLOOD PRESSUREcuff
around the arm to monitor blood pressure, and
place a PULSE oximeter over the tip a finger to
monitor blood oxygenation. Some surgical facili-
ties allow a family member or close friend to be
present during these early preparations. The sur-
geon or assistant surgeon often visits the person
before sedation or anesthesia begins to confirm
the person’s identity, the planned operation, and
the location of the operative site (such as left leg
or right BREAST). Other staff may also make these
same confirmations to prevent errors. Many sur-
geons use a marking pen on the skin to identify
the operative site. As the time for the operation to
begin draws near, most people receive a sedative
for relaxation and comfort.
See also POSTOPERATIVE PROCEDURES; SURGERY BEN-
EFIT AND RISK ASSESSMENT.276 Surgery