eIinition

PreoperuLIve cure Is LIe prepuruLIon und munugemenL oI u puLIenL prIor Lo

surgery. L IncIudes boLI pIysIcuI und psycIoIogIcuI prepuruLIon.
Purpose
PuLIenLs wIo ure pIysIcuIIy und psycIoIogIcuIIy prepured Ior surgery Lend Lo Iuve
beLLer surgIcuI ouLcomes. PreoperuLIve LeucIIng meeLs LIe puLIenL's need Ior
InIormuLIon regurdIng LIe surgIcuI experIence, wIIcI In Lurn muy uIIevIuLe mosL
oI IIs or Ier Ieurs. PuLIenLs wIo ure more knowIedgeubIe ubouL wIuL Lo expecL
uILer surgery, und wIo Iuve un opporLunILy Lo express LIeIr gouIs und opInIons,
oILen cope beLLer wILI posLoperuLIve puIn und decreused mobIIILy. PreoperuLIve
cure Is exLremeIy ImporLunL prIor Lo uny InvusIve procedure, regurdIess oI
wIeLIer LIe procedure Is mInImuIIy InvusIve or u Iorm oI mujor surgery.
PreoperuLIve LeucIIng musL be IndIvIduuIIzed Ior eucI puLIenL. Some peopIe wunL
us mucI InIormuLIon us possIbIe, wIIIe oLIers preIer onIy mInImuI InIormuLIon
becuuse Loo mucI knowIedge muy Increuse LIeIr unxIeLy. PuLIenLs Iuve dIIIerenL
ubIIILIes Lo compreIend medIcuI procedures; some preIer prInLed InIormuLIon,
wIIIe oLIers Ieurn more Irom oruI presenLuLIons. L Is ImporLunL Ior LIe puLIenL Lo
usk quesLIons durIng preoperuLIve LeucIIng sessIons.

escription
PreoperuLIve cure InvoIves muny componenLs, und muy be done LIe duy beIore
surgery In LIe IospILuI, or durIng LIe weeks beIore surgery on un ouLpuLIenL busIs.
Muny surgIcuI procedures ure now perIormed In u duy surgery seLLIng, und LIe
puLIenL Is never udmILLed Lo LIe IospILuI.

Phgsicol preporotion
PIysIcuI prepuruLIon muy consIsL oI u compIeLe medIcuI IIsLory und pIysIcuI
exum, IncIudIng LIe puLIenL's surgIcuI und unesLIesIu buckground. TIe puLIenL
sIouId InIorm LIe pIysIcIun und IospILuI sLuII II Ie or sIe Ius ever Iud un
udverse reucLIon Lo unesLIesIu (sucI us unupIyIucLIc sIock), or II LIere Is u IumIIy
IIsLory oI muIIgnunL IyperLIermIu. uboruLory LesLs muy IncIude complete
blood coont , eIecLroIyLes, proLIrombIn LIme, ucLIvuLed purLIuI LIrombopIusLIn
LIme, und orinulysis . TIe puLIenL wIII mosL IIkeIy Iuve un eIecLrocurdIogrum
(EKG) II Ie or sIe Ius u IIsLory oI curdIuc dIseuse, or Is over o yeurs oI uge. A
chest x ruy Is done II LIe puLIenL Ius u IIsLory oI respIruLory dIseuse. PurL oI LIe
prepuruLIon IncIudes ussessmenL Ior rIsk IucLors LIuL mIgIL ImpuIr IeuIIng, sucI
us nuLrILIonuI deIIcIencIes, sLeroId use, rudIuLIon or cIemoLIerupy, drug or
uIcoIoI ubuse, or meLuboIIc dIseuses sucI us dIubeLes. TIe puLIenL sIouId uIso
provIde u IIsL oI uII medIcuLIons, vILumIns, und IerbuI or Iood suppIemenLs LIuL Ie
or sIe uses. SuppIemenLs ure oILen overIooked, buL muy cuuse udverse eIIecLs
wIen used wILI generuI unesLIeLIcs (e.g., SL. JoIn's worL, vuIerIun rooL). Some
suppIemenLs cun proIong bIeedIng LIme (e.g., gurIIc, gIngko bIIobu).
uLex uIIergy Ius become u pubIIc IeuILI concern. uLex Is Iound In mosL sLerIIe
surgIcuI gIoves, und Is u common componenL In oLIer medIcuI suppIIes IncIudIng
generuI unesLIesIu musks, LubIng, und muILI-dose medIcuLIon vIuIs. L Is
esLImuLed LIuL 1-6% oI LIe generuI popuIuLIon und 8-1;% oI IeuILI cure workers
Iuve LIIs uIIergy. CIIIdren wILI dIsubIIILIes ure purLIcuIurIy suscepLIbIe. TIIs
IncIudes cIIIdren wILI spInu bIIIdu, congenILuI uroIogIcuI ubnormuIILIes, cerebruI
puIsy, und Dundy-WuIker syndrome. AL IeusL o% oI cIIIdren wILI spInu bIIIdu
ure IuLex-sensILIve us u resuIL oI eurIy, IrequenL surgIcuI exposure. TIere Is
currenLIy no cure uvuIIubIe Ior IuLex uIIergy, und reseurcI Ius Iound LIuL LIe
uIIergy uccounLs Ior up Lo 1q% oI uII unupIyIucLIc reucLIons durIng surgery. TIe
besL LreuLmenL Is prevenLIon, buL ImmedIuLe sympLomuLIc LreuLmenL Is requIred II
LIe uIIergIc response occurs. Every puLIenL sIouId be ussessed Ior u poLenLIuI IuLex
reucLIon. PuLIenLs wILI IuLex sensILIvILy sIouId Iuve LIeIr cIurL IIugged wILI u
cuuLIon IubeI. uLex-Iree gIoves und suppIIes musL be used Ior unyone wILI u
documenLed IuLex uIIergy.
BoweI cIeurunce muy be ordered II LIe puLIenL Is IuvIng surgery oI LIe Iower
gusLroInLesLInuI LrucL. TIe puLIenL sIouId sLurL LIe boweI prepuruLIon eurIy LIe
evenIng beIore surgery Lo prevenL InLerrupLed sIeep durIng LIe nIgIL. Some
puLIenLs muy beneIIL Irom u sIeepIng pIII LIe nIgIL beIore surgery.
TIe nIgIL beIore surgery, skIn prepuruLIon Is oILen ordered, wIIcI cun Luke LIe
Iorm oI scrubbIng wILI u specIuI soup (I.e., HIbIcIens), or possIbIy IuIr removuI
Irom LIe surgIcuI ureu. SIuvIng IuIr Is no Ionger recommended becuuse sLudIes
sIow LIuL LIIs prucLIce muy Increuse LIe cIunce oI InIecLIon. nsLeud, udIesIve
burrIer drupes cun conLuIn IuIr growLI on LIe skIn uround LIe IncIsIon.

Psgchologicol preporotion
PuLIenLs ure oILen IeurIuI or unxIous ubouL IuvIng surgery. L Is oILen IeIpIuI Ior
LIem Lo express LIeIr concerns Lo IeuILI cure workers. TIIs cun be especIuIIy
beneIIcIuI Ior puLIenLs wIo ure crILIcuIIy III, or wIo ure IuvIng u IIgI-rIsk
procedure. TIe IumIIy needs Lo be IncIuded In psycIoIogIcuI preoperuLIve cure.
PusLoruI cure Is usuuIIy oIIered In LIe IospILuI. I LIe puLIenL Ius u Ieur oI dyIng
durIng surgery, LIIs concern sIouId be expressed, und LIe surgeon noLIIIed. n
some cuses, LIe procedure muy be posLponed unLII LIe puLIenL IeeIs more secure.
CIIIdren muy be especIuIIy IeurIuI. TIey sIouId be uIIowed Lo Iuve u purenL wILI
LIem us mucI us possIbIe, us Iong us LIe purenL Is noL demonsLrubIy IeurIuI und
conLrIbuLIng Lo LIe cIIId's uppreIensIon. CIIIdren sIouId be encouruged Lo brIng
u IuvorILe Loy or bIunkeL Lo LIe IospILuI on LIe duy oI surgery.
PuLIenLs und IumIIIes wIo ure prepured psycIoIogIcuIIy Lend Lo cope beLLer wILI
LIe puLIenL's posLoperuLIve course. PrepuruLIon Ieuds Lo superIor ouLcomes sInce
LIe gouIs oI recovery ure known uIeud oI LIme, und LIe puLIenL Is ubIe Lo munuge
posLoperuLIve puIn more eIIecLIveIy.
nformed consent
TIe puLIenL's or guurdIun's wrILLen consenL Ior LIe surgery Is u vILuI porLIon oI
preoperuLIve cure. By Iuw, LIe pIysIcIun wIo wIII perIorm LIe procedure musL
expIuIn LIe rIsks und beneIILs oI LIe surgery, uIong wILI oLIer LreuLmenL opLIons.
However, LIe nurse Is oILen LIe person wIo ucLuuIIy wILnesses LIe puLIenL's
sIgnuLure on LIe consenL Iorm. L Is ImporLunL LIuL LIe puLIenL undersLunds
everyLIIng Ie or sIe Ius been LoId. SomeLImes, puLIenLs ure usked Lo expIuIn wIuL
LIey were LoId so LIuL LIe IeuILI cure proIessIonuI cun deLermIne Iow mucI Is
undersLood.
PuLIenLs wIo ure menLuIIy ImpuIred, IeuvIIy seduLed, or crILIcuIIy III ure noL
consIdered IeguIIy ubIe Lo gIve consenL. n LIIs sILuuLIon, LIe nexL oI kIn (spouse,
uduIL cIIId, uduIL sIbIIng, or person wILI medIcuI power oI uttorney ) muy ucL
us u surroguLe und sIgn LIe consenL Iorm. CIIIdren under uge 18 musL Iuve u
purenL or guurdIun sIgn.

Preoperotioe teoching
PreoperuLIve LeucIIng IncIudes InsLrucLIon ubouL LIe preoperuLIve perIod, LIe
surgery ILseII, und LIe posLoperuLIve perIod.
nsLrucLIon ubouL LIe preoperuLIve perIod deuIs prImurIIy wILI LIe urrIvuI LIme,
wIere LIe puLIenL sIouId go on LIe duy oI surgery, und Iow Lo prepure Ior
surgery. or exumpIe, puLIenLs sIouId be LoId Iow Iong LIey sIouId be NPO
(noLIIng by mouLI), wIIcI medIcuLIons Lo Luke prIor Lo surgery, und LIe
medIcuLIons LIuL sIouId be brougIL wILI LIem (sucI us InIuIers Ior puLIenLs wILI
usLImu).
nsLrucLIon ubouL LIe surgery ILseII IncIudes InIormIng LIe puLIenL ubouL wIuL wIII
be done durIng LIe surgery, und Iow Iong LIe procedure Is expecLed Lo Luke. TIe
puLIenL sIouId be LoId wIere LIe IncIsIon wIII be. CIIIdren IuvIng surgery sIouId
be uIIowed Lo "prucLIce" on u doII or sLuIIed unImuI. L muy be IeIpIuI Lo
demonsLruLe procedures on LIe doII prIor Lo perIormIng LIem on LIe cIIId. L Is
uIso ImporLunL Ior IumIIy members (or oLIer concerned purLIes) Lo know wIere Lo
wuIL durIng surgery, wIen LIey cun expecL progress InIormuLIon, und Iow Iong IL
wIII be beIore LIey cun see LIe puLIenL.
KnowIedge ubouL wIuL Lo expecL durIng LIe posLoperuLIve perIod Is one oI LIe
besL wuys Lo Improve LIe puLIenL's ouLcome. nsLrucLIon ubouL expecLed ucLIvILIes
cun uIso Increuse compIIunce und IeIp prevenL compIIcuLIons. TIIs IncIudes LIe
opporLunILy Ior LIe puLIenL Lo prucLIce cougIIng und deep breuLIIng exercIses, use
un IncenLIve spIromeLer, und prucLIce spIInLIng LIe IncIsIon. AddILIonuIIy, LIe
puLIenL sIouId be InIormed ubouL eurIy umbuIuLIon (geLLIng ouL oI bed). TIe
puLIenL sIouId uIso be LuugIL LIuL LIe respIruLory InLervenLIons decreuse LIe
occurrence oI pneumonIu, und LIuL eurIy Ieg exercIses und umbuIuLIon decreuse
LIe rIsk oI bIood cIoLs.
PuLIenLs IospILuIIzed posLoperuLIveIy sIouId be InIormed ubouL LIe Lubes und
equIpmenL LIuL LIey wIII Iuve. TIese muy IncIude muILIpIe InLruvenous IInes,
druInuge Lubes, dressIngs, und monILorIng devIces. n uddILIon, LIey muy Iuve
sequenLIuI compressIon sLockIngs on LIeIr Iegs Lo prevenL bIood cIoLs unLII LIey
sLurL umbuIuLIng.
!uin munugement Is LIe prImury concern Ior muny puLIenLs IuvIng surgery.
PreoperuLIve InsLrucLIon sIouId IncIude InIormuLIon ubouL LIe puIn munugemenL
meLIod LIuL LIey wIII uLIIIze posLoperuLIveIy. PuLIenLs sIouId be encouruged Lo
usk Ior or Luke puIn medIcuLIon beIore LIe puIn becomes unbeurubIe, und sIouId
be LuugIL Iow Lo ruLe LIeIr dIscomIorL on u puIn scuIe. TIIs InsLrucLIon uIIows LIe
puLIenLs, und oLIers wIo muy be ussessIng LIem, Lo evuIuuLe LIe puIn
consIsLenLIy. I LIey wIII be usIng u putient-controlled unulgesiu pump,
InsLrucLIon sIouId Luke pIuce durIng LIe preoperuLIve perIod. Use oI uILernuLIve
meLIods oI puIn conLroI (dIsLrucLIon, Imugery, posILIonIng, mIndIuIness
medILuLIon, musIc LIerupy) muy uIso be presenLed.
InuIIy, LIe puLIenL sIouId undersLund Iong-Lerm gouIs sucI us wIen Ie or sIe
wIII be ubIe Lo euL soIId Iood, go Iome, drIve u cur, und reLurn Lo work.

!repurution
L Is ImporLunL Lo uIIow udequuLe LIme Ior prepuruLIon prIor Lo surgery. TIe
puLIenL sIouId undersLund LIuL Ie or sIe Ius LIe rIgIL Lo udd or sLrIke ouL ILems
on LIe generIc consenL Iorm LIuL do noL perLuIn Lo LIe specIIIc surgery. or
exumpIe, u puLIenL wIo Is ubouL Lo undergo u tonsillectomy mIgIL cIoose Lo
sLrIke ouL (und InILIuI) un ILem LIuL IndIcuLes sLerIIILy mIgIL be u compIIcuLIon oI
LIe operuLIon.

Normul resolts
TIe unLIcIpuLed ouLcome oI preoperuLIve cure Is u puLIenL wIo Is InIormed ubouL
LIe surgIcuI course, und copes wILI IL successIuIIy. TIe gouI Is Lo decreuse
compIIcuLIons und promoLe recovery.

Pre-Operutlve Checkllxt
PIease be aware of the foIIowing information:
nsurance information and .D.(for ex, a driver's licence must be available at the time of registration.
Consume no solid food, no milk, and/or no orange juice after midnight before surgery.
Do not smoke,chew gum or suck on hard candy sfter mightnight before surgery.
Stay away from asprin/aspirin products. No Advil or anti-inflammatory drugs at least 7-10 days prior to
surgery.
n the Day of Surgery, pIease:
Wear NO makeup or nail polish.
Wear NO jewelry.
Leave valuable at home. We are not responsible for personal items, money,credit cards, wallets, jewelry,
etc.
Bring a case for contact lenses and/or glasses.
Feel free to wear your dentures to the operating room.
Wear no metal hair accessories.
Wear loose fitting clothing appropriate for the type of surgery being performed.
or 24 Hours After surgery, it is suggested that you:
Do not make critical decisions.
Do not drink alcoholic beverages.
Do not drive a motor vehicle.
Do not operate machinery or potentially dangerous machinery.
Have an adult stay with you. This is strongly advised.
For any further information realated to your surgery, please call the pre-operative Screening Unit office at
703-639-9427, between 9 a.m- 5 p.m., Monday-Friday