Introduction
- Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain what you propose to do
- Confirm the operation that is planned
- Ask about what they know so far
- Explore concerns and ask about anything specific they want to know
Before the operation
- Pre-operative assessment
- Aims to assess medical fitness for an operation/anaesthetic; ascertain mobility, independence, who is at home, medications and allergies
- Involves a history and physical examination
- Will confirm which medications to stop and when
- Pre-operative investigations
- May include: blood tests, chest x-ray, ECG, echocardiography, cardiopulmonary exercise testing
- There may be special pre-operative measures which the patient will be told about if needed, e.g. bowel prep
- The timing of admission will be discussed, e.g. whether on the morning of or evening before surgery
- Consent will be taken by a surgeon prior to theatre
- The surgeon will discuss the procedure, the risks and benefits
- A consent form will need to be signed (but the patient can change their mind at any time)
- The patient will not be pressured
- The patient should be instructed about fasting (when to stop eating and drinking)
- Usually ‘2-6 rule’ = no food for 6 hours pre-op; can have clear fluids up to 2 hours pre-op; nothing thereafter
- If the operation is on one side (left or right), then the correct side will be ‘marked’ with a black arrowÂ
You can also learn how to undertake a pre-operative assessment…
Pre-operative assessment is covered here!
During the operation
- The patient will be taken to the anaesthetic room by a theatre nurse
- Relatives may stay with the patient until this point
- The patient will then meet the anaesthetist who will insert a cannula to give an anaesthetic
- If a general anaesthetic is required, the patient will be intubated, e.g. ‘you will have a tube through your mouth to control breathing during the operation. You will not remember this but you may have a sore throat afterwards. It will be taken out when you are waking up.’
- The operation will then be performed – offer details about the specific operation
Types of anaesthetic
Type | Detail | Examples where it may be used |
General | Medication that is inhaled or injected to induce a reversible loss of consciousness | Many operations |
Spinal | Needle is inserted into the lower back and a local anaesthetic is injected into the cerebrospinal fluid (the fluid in the subarachnoid space that surrounds the spinal cord) to numb the lower body | Operations below the umbilicus, e.g. lower limb surgery, pelvic surgery, C-section/childbirth |
Epidural | Catheter is inserted into the back and a local anaesthetic is injected as required into the epidural space (the outermost part of the spinal cord) to numb the lower body. | Epidural is usually performed for longer operations or when analgesia is required post-operatively |
Nerve block | Local anaesthetic injected around the nerve(s) that supplies the area being operated on | Procedures on hands, arms, feet, legs or face |
Local | Local anaesthetic injected directly into the area that is being operated on | Minor procedures on small areas |
After the operation
- The patient will wake up in the recovery area
- There may be tubes that were inserted in theatre, e.g. catheter, drains
- Pain control – there are a variety of options that may be used:
- Intravenous (patient-controlled analgesia) – ‘you will be given a button that you can press whenever you want pain relief’
- Oral
- Local wound catheters – ‘local anaesthetic may be directly injected into the site by a small tube’
- Depending on the type of surgery, there may be limitations on what the patient is allowed to eat/drink for a period afterwards
- VTE prophylaxis: the patient will usually be given a heparin (‘a small injection in the skin of your tummy each day’) and may be asked to wear compression stockings to prevent blood clots
- Physiotherapy: the patient will be seen by physiotherapists to build up their mobility after the operation
- Occupational therapy: if required, the patient will be assessed by therapists who will help arrange care or modify their home to help them cope after the operation
Risks/complications
These must be explained using lay terms. Try not to scare the patient. Explain most complications are rare and how the risk of complications is minimised.
Generic risks
- Anaesthetic complications (e.g. arrhythmias, hypo-/hypertension, hyperthermia, breathing problems, MI/stroke, allergy, teeth/lip/tongue damage, sore throat)
- Bleeding/haematoma
- Damage to nearby structures/organs
- Infections: local (wound/surgical site) or systemic (chest/UTI/sepsis)
- Venous thromboembolism (DVT/PE)
- Pain
- Fluid collections
Here’s some more detail on post-operative complications…
Post-operative complications are covered here!
Try some related OSCE stations!
- Pre-operative prescribing
- Post-operative complication
- Surgery cancelled
- Find hundreds of OSCE stations here