When the diagnosis has been established and the surgeon has concluded that the treatment of choice is by operation, he is charged with the responsibility of preparing the patient to the optimal conditions for the procedure. This is preoperative preparation. In many cases this will be a relatively simple phase of the patient’s management, but in other cases it will be formidable.
Such preparation for operation begins as soon as the decision to operate has been made and continues until the operation actually begins. If the patient is not already in the hospital, plans for admission are made. Some minor operations may not require hospitalization, but are arranged in the surgeon’s office.
One of the most important phases of preparing the patient is the psychological preparation. This phase of the care cannot be overemphasized, and here the patient himself may play an important role. Fear and worry are usual emotional reactions when a patient learns he must undergo a surgical procedure. Your surgeon will want to put you in as calm a frame of mind as is possible. He will try to explain to you, in as much detail as time allows, the entire plan of your treatment. You should have a general conception of just what is wrong and how your operation will correct it. You will also be given some estimate of the length of your convalescence, the required preparation, and the seriousness of both the disease and the operation. These facts are presented to you to keep you informed and let you know just what is going to take place. By so doing the surgeon hopes to put your mind at ease and allay apprehension. If there is some part of the plan which is not fully understood or about which you are particularly concerned or apprehensive, confide in your surgeon and let him explain more fully to put your mind at ease. Your mental preparation is actually just as important as the physical preparation.
Fear of anesthesia was justified years ago when little was known of the effects and controls of anesthetic drugs, but today the hazards are minimized by the improved methods, standardized drugs, and skilled personnel. You must dispel all false conceptions from your mind. Many patients are afraid that the anesthetic may be ineffective, that it may wear off too soon, or that the surgeon may begin operation before the anesthetic has taken effect. This is always unfounded fear. Modern anesthesia fulfills all the requirements for modern surgery.
Your illness may bring on many new personal worries and even aggravate your usual problems. There may be financial problems, family responsibilities, and occupational obligations which confront you. All such worries obviate a normal frame of mind. You must try as best you can to free yourself of all worry during your hospitalization and convalescence. Friends and neighbors are always anxious to share your family burdens during such circumstances; arrangements for deferring concern about increased expenses can usually be made, and one usually finds his job waiting for him when he is well again.
The role of spiritual guidance in your life will not be forgotten or belittled by your surgeon. Regardless of your religious affiliation, he will recognize that your faith in The Higher Power is often as therapeutic as medication or operation. If you desire counsel with your church officials, never hesitate to make your wants known.
Often time passes very slowly during the preoperative and convalescent phases of your care. Finding recreational and other diversional activities frequently makes the time pass more quickly, leaving less time for worry. Such things as reading, listening to the radio, handicrafts, cards, and other games are good diversions. Work within your physical capabilities is also self-satisfying; you may find gratitude in helping other patients as well as yourself.
In effect, anything you can do to free yourself from emotional disturbances and anxiety is your greatest contribution to your own preoperative preparation. Your worst fear will be that of the unknown. Therefore the more understanding you can obtain about all phases of your own case and the future probabilities, the better will be your adjustment.
The physical preparation of patients for operation may necessitate further diagnostic studies to further evaluate the general physical condition and to make certain that there is no concurrent disease present. The surgeon may want further review of past medical history, more complete physical examination, or additional laboratory tests and x-ray pictures. In all cases of major operation, urine analysis and complete blood count will be done, and in most cases a chest x-ray picture will be taken. Preoperative measurements of the blood pressure, temperature, pulse, and respirations will be made.
Patients whose general condition has been weakened by their illness, or who have an additional disease, will require special preoperative measures. A common condition that affects the operative state of a patient is dehydration. Whenever there has been persistent vomiting or diarrhea or an inadequate liquid intake, the fluid and chemical proportions in the body may be upset. This disturbance must be remedied before the patient is a good surgical risk. The surgeon employs medications, dietary measures, infusions, and other techniques outlined in Chapter 4 to re-establish normal fluid and chemical equilibrium. In many cases infusions play an all-important role, making possible many operations which otherwise would be hazardous. Whole blood and plasma transfusions may even be indicated.
Malnutrition is another condition which increases the surgical risk. This may have been the result of a poorly balanced diet, intestinal disease, or a chronic loss of body fluids and minerals. It is important to assure an adequate level in the body of calories, proteins, salts, minerals, and vitamins in all people, but especially so in patients who are to undergo an operation, because these substances play a major role in tissue repair and other phases of convalescence. Special diets, infusions, and synthetic sources of the vital substances are employed in the treatment of malnutrition.
Obesity also lends added risk to surgery. Since obese patients have a greater percentage of complications from operation than the individual of normal weight, the surgeon will often attempt to reduce the patient and defer surgery until there has been an appreciable weight loss, if this is at all practicable.
Patients with associated medical illnesses, such as cardiac (heart) disease, diabetes, and respiratory diseases, will require appropriate treatment of the concurrent disease before and throughout their surgical course. In many cases, the operation may have to be postponed until the coexisting disease has been eliminated or controlled. It is not uncommon to delay an operation for a few days when a patient has a common cold. In case of pregnancy operation is deferred until after delivery, whenever practical. Anemia, when present, has to be corrected by diet and transfusions. In cases of severe medical illnesses, where operation is indicated, your surgeon may engage another specialist for consultation if he deems it necessary.
Preoperative Care in Emergencies
When an emergency operation is necessitated, immediate attention to the patient’s general physical condition is paramount. In the case of hemorrhage, bleeding must be stopped and the lost blood replaced by transfusions. In shock, infusions and medications will be given to place the patient in good operable condition. Stimulants may be required to raise the blood pressure and aid respiration. Oxygen may be given. Other drugs may be needed immediately to control pain, allay fear, relieve muscular tension, combat infection, or for a host of other reasons. In emergency conditions and injuries of the digestive tract, evacuation of the stomach contents by suction tube may be necessitated. In urinary cases preoperative catheterization of the bladder is often needed. Whenever open wounds are present, their proper care is one of the first preoperative steps. The necessary laboratory tests are performed immediately. In all cases of emergency operation the preoperative preparation is carried out as quickly as possible, but this phase of the treatment can never be economized in any manner.
Throughout the preoperative period the surgeon strives to prepare the patient for the optimal condition for operation and recovery. Not only will he attempt to correct all unfavorable conditions, but he will also take prophylactic measures to guard against any anticipated conditions which may hinder the patient’s normal course. Certain vitamins and minerals are necessary for normal wound healing, so, if such deficiencies are suspected or anticipated, a course of vitamin and mineral therapy will be given. If anemia is present or anticipated, medications to stimulate blood formation are employed. If infection is present in the body at any site, drugs to combat the process are used. The necessary drugs for the preoperative period vary, of course, from case to case, and to mention all the possible conditions and drugs would be a formidable task. Moreover, many patients will require none of these special medications during their preoperative care. If medication is prescribed for you in preparation for your operation, either before or after you enter the hospital, take it faithfully according to instructions. If none is ordered in your case, do not be concerned about it; have confidence that your surgeon is aware of your medicinal needs through his examinations and laboratory tests.
The proper time for the patient to enter the hospital is determined by the surgeon. In many cases admission a few hours before operation provides sufficient time for all preparations, but in others several days of hospitalization are necessary. In most instances of elective operation, the patient will enter the hospital on the day prior to the day of operation.
This period of hospitalization permits the patient to become adjusted to the hospital routine before the operation, as well as providing a period of evaluation of the patient. The necessary laboratory tests and examinations are performed, and all other necessary preparations for operation carried out. This period of evaluation and re-evaluation is most important, to make sure that there has been no significant change in the surgical condition and no superimposed illness. Complications from the operation or the anesthetic can be due to a concurrent illness, such as a common cold or other infection, but such complications can be precluded if the surgeon has had ample time to carry out all necessary preoperative tests in the hospital. An extra day spent in the hospital during the preoperative period may save many days during the recovery period. Let the surgeon dictate when you are to enter the hospital.