Women’s Health Articles

What to expect on the day of surgery

by Dixie J. Mills, MD, FACS

The morning of your surgery is often a very rushed, nerve-wracking time, but using your relaxation breathing should help get you through the bumps. Hopefully you will have met with your surgeon beforehand, and know by now exactly what the day of surgery holds. (For essential questions to ask, and how you can get yourself and your support team ready, see our article on preparing for surgery.)

You should have already reviewed issues about blood donation, if this may be necessary, and also discussed advanced directives. The surgeon’s office also should have called and had you precertified with your insurance company — this is another detail you or a family member will want to be on top of so there are no surprises. If you need to have any tests, imaging or procedures done before your surgery, these should also have been explained.

In many hospitals, a pre-op nurse will call patients the day before surgery to remind them not to eat after midnight — NPO (nil per os, or “nothing by mouth”) is essential or your case could be cancelled. You can, however, take certain medications, like heart pills, with a sip of water. All this should be reviewed with you in advance. If your surgery is scheduled for later in the morning or afternoon, you may be permitted clear liquids up to four to six hours before going in. But they have to be clear fluids — no milk in your tea or, again, the case will be delayed.

The pre-op area of an operating suite is usually a very busy place, but everyone has his or her role, and things are typically well-run. A quick medical history should be taken again by the pre-op nurse — they have check-lists now so that nothing gets missed. You will probably be asked the same questions over and over again, but it’s important for them to get the right information. In addition, there is now a universal surgery protocol for preventing devastating errors from being made. This involves marking the part of the patient’s body to be operated on prior to surgery in consultation with the patient after confirming the identity of the patient.

An IV tube (the intravenous tube that carries fluids into your system during the case) is inserted, usually by an IV nurse or a nurse anesthetist or anesthesiologist. This is often the time when a pre-op medication is given to help you relax. Newer drugs have been developed in the last ten years that make the entire experience much better than it used to be, when nearly everyone got sick to their stomachs in the RR (recovery room) and didn’t wake up for hours.

Before you receive this medication, be sure you’ve seen your surgeon, had all your questions answered and signed your informed consent forms. You may feel normal, but the drugs have a quick effect, and many people, in fact, do not remember anything after receiving these drugs, experiencing a mild form of retrograde amnesia. (Versed, a popular anti-anxiety medication now used for shorter, more straightforward surgeries, such as colonoscopies and dental extractions, was initially used with women giving birth, but this practice was discontinued because mothers couldn’t remember delivering their babies!)

After saying goodbye to friends or family, you are wheeled into the operating room. Some institutions have holding areas where family members are not permitted access, but I don’t agree with this practice. Nowadays most places allow a family member to stay with the patient as long as possible if a patient’s case is delayed.

Once in the operating room itself, you will be shifted onto a hard OR table and “strapped in” for your safety. Again, there is a team of nurses here who have checklists and a strict order for doing things. You may not remember any of the OR room due to the medications. However, it is not really like it appears on TV shows. The OR team wear mouth and eye masks, hats, scrubs and gowns. All of the trays are sterile, and the instruments are laid out in certain ways.

If you are having light or IV sedation, the new anesthetic propofol (we often call it the “white medicine”) may be used along with a sedative. This drug is wonderful, although expensive. But because it doesn’t have the aftereffects of other anesthetics, it pays for itself with shorter recovery room times. The anesthesiologist will put EKG leads on your chest and an oxygen monitor on your finger, then start your sedation through the IV. This is also the time when the affirmations are read. No one has you start counting backward anymore. Instead, many will ask you to imagine yourself in your favorite place.

If you are having general anesthesia, you will be given the same IV medication and maybe some others, and then a tube will be inserted into the back of your throat and down your air pipe to keep your lungs open. You will not be conscious for this either. The tube should be removed before you wake up, so you won’t remember having it. This is how you are given what was previously known as “the gas,” or inhalation drugs to keep you asleep and prevent you from moving. The method and recipes for the drugs are usually left up to the anesthesiologist — they all seem to have their own special cocktails.

Patients can also have regional anesthesia, where a nerve block is given to, say, an arm, and then the patient has no feeling in the arm. In this situation, the patient is off in la-la land, but breathing on her own. This is a form of “conscious sedation.”

At this point, the surgical team should be ready to do their work!

For guidance in how you can prepare your mind, body, and environment for a successful surgery and recovery period, see our full article on preparing for surgery.

Original Publication Date: 09/07/2007
Last Modified: 02/16/2010
Principal Author: Dixie Mills, MD, FACS