Preparing for your surgery

Ask 3 Questions

Preparation for your Appointments

We want you to be active in your healthcare. By telling us what is important to you and asking questions you can help with this. The three questions below may be useful:

• What are my options?
• What are the possible benefits and risks of those options?
• What help do I need to make my decision?

This leaflet gives you information on preparing for your surgery. References and sources of further information, including contact details, are available at the end of the leaflet.

We hope this answers any questions you may have and
helps prepare you for your appointments. If there are any
changes in your health or medications between being seen in preadmission and coming in for surgery please telephone the preadmission unit.

Pre-Operative Assessment Questionnaire

Before your surgery at North Bristol Trust, you need to complete an online health questionnaire.

Please go to https://www.synopsishome.com to complete your questionnaire. It should only take 10 minutes to fill in.

What you need ready before you start:

• Your height and weight
• Any dates for previous operations (if applicable)
• A list of your current medications (if applicable)

When you have answered all the questions, you will need to click the share button.

When sharing with the hospital, you will need to:

• Begin to type North Bristol NHS Trust in the Hospital box
• You will need your North Bristol Hospital number which
• usually can be found at the top of your letter.
• When you have completed the form please click the green agree and share button.

Please contact your surgical team if you have any queries or are unable to complete the questionnaire.

Before coming into hospital

Here are some things that you can do to help prepare yourself for your operation:

• Stop smoking: This reduces the risk of breathing problems and makes your anaesthetic safer.
• Have paracetamol and ibuprofen (if you are able to take it: supply at home for postoperative pain relief on your discharge from hospital.
• Speak to your dentist: If you have any loose teeth or crowns, treatment from your dentist may reduce the risks of damage to your teeth from equipment used during anaesthesia to support your breathing.
• Lose weight: If you are overweight, reducing your weight will reduce many of the risks of having anaesthetic and surgery.
• Speak to your GP: If you have a long-standing medical problem such as diabetes, asthma or bronchitis, thyroid problems, heart problems or high blood pressure (hypertension) you should ask your GP if you need a check up and bring any results with you.
• Speak to us: If you are pregnant or breastfeeding so that we can make an appropriate plan for your surgery.
• Know your regular medicines: You will be advised what medication to continue and what to stop before you come into hospital. You must bring a complete, up to date list of your medication with you to all hospital appointments and on admission e.g. a printed prescription or letter from your GP.

If you feel unwell (including fevers, productive cough,
diarrhoea, vomiting, or a skin infection over the proposed site of surgery) during the 72 hours before you are due to come into hospital, please telephone us on 0117 414 0637.

We may phone you in the week before your surgery to check that you still want to have your operation on the planned date and that there have been no changes in your general health since your preoperative assessment.

What to bring with you

• A warm dressing gown and slippers with a non-slip sole.
• Day clothes and underwear.
• A list of any medications you are currently taking.
• Please bring all your belongings in a bag which is no bigger than 40cm high by 25cm wide and 85cm deep, so that it will fit in a patient locker whilst you are having your operation.

Valuables

You are strongly advised not to bring valuables into the hospital.

The Trust can offer limited safe keeping of valuables until
arrangements can be made for them to be taken home or until they are returned to you on discharge. This will involve a written record being made of the items to be held in storage and then the items will be stored in a sealed security bag and put into a locked unit. The valuables can be accessed during your stay only in an emergency.

We cannot accept responsibility or liability for cash, valuables or personal property brought into the premises unless they are handed in for safe keeping under circumstances as specified within Trust policy.

MRSA (Meticillin resistant Staphylococcus aureus)

What is MRSA?

MRSA is a common bacterium which has developed resistance to Meticillin (a type of penicillin), and some other antibiotics that are used to treat infections.

MRSA is carried harmlessly on the skin and in the noses of many people, without causing an infection. However in hospital, particularly in patients undergoing invasive procedures, it can cause serious infections and can spread easily from one person to another by touch, via hands.

Screening for MRSA

MRSA can only be found by testing in a laboratory from swabs taken from skin and wounds, or samples of urine.

Who is screened for MRSA?

• Patients who are going to have certain procedures.
• Other high risk patients including those previously found to have MRSA.

Swabs are taken from several areas of the body including the nose, any wounds and urine if a catheter is in place.

This will not hurt and takes only a few minutes.

If you are coming into hospital for an operation the screening will be done prior to your operation or procedure.

• If you are found to be carrying MRSA you will be contacted and given a course of treatment.
• If MRSA is not found you will not be contacted.

Treatment

Treatment will consist of an antibacterial liquid soap for washing skin and hair, and an ointment for application inside the nose.

This treatment can be completed whilst at home.

It must be commenced 3 full days before admission. If surgery is delayed you will be contacted with further advice.

If you develop an MRSA infection whilst you are in hospital, you may be given antibiotics via an intravenous line (drip).

You can help yourself and other patients by:

• Always washing and drying your hands after visiting the toilet and before you eat.
• Not touching your wound or any device that is in your arm, leg, bladder or body cavity e.g. a drip, drain or catheter.
• Not exposing your wound to show your visitors.
• Keeping the space around your bed tidy and uncluttered so that the cleaning staff can clean all surfaces easily.
• Telling your nurse if you notice any unclean or dusty areas.
• Showering / washing daily if you can.
• Ask your visitors not to come in large groups, or visit if you are unwell.
• Ask visitors not to sit on your bed or use the patient toilets.
• Do not share your possessions or equipment with other patients unless they are cleaned between uses.
• Remind staff about hand washing and drying if they forget – they won’t be offended.

For the majority of patients and hospital staff MRSA poses no threat to their health.

On the day of your operation

At home

• Have a bath or shower: This will clean your skin and reduce the risk of infection.
• Wash your hair: If you are having an operation on your head or neck.
• Do not shave anywhere near the site of surgery.
• No make-up or body lotions: This will ensure heart monitor pads and dressings can stick to your body.
• Remove nail varnish.
• Do not smoke: This will help avoid breathing problems during your anaesthetic.
• Remove jewellery: If you cannot remove your jewellery, it will be covered with tape to prevent damage to it or to your skin.
• Wear warm clothing.
• Take your medications: Unless you have been advised otherwise, and bring your medicines with you in their original labelled containers.
• Leave plenty of time to get to your appointment.

Nothing to eat or drink – Fasting (‘Nil by mouth’). It is
important you follow these instructions because if there is
food or liquid in your stomach during your anaesthetic it
could come up to the back of your throat and damage your lungs.

Admission time and guidance
7am - Do not eat or drink anything (except water) from 2am on the morning of your operation. You may drink water until 6am.
9am - Do not eat or drink anything (except water) from 3.30am on the morning of your operation. You may drink water until 7.30am.
11am - Have a light breakfast, such as tea or coffee and toast before 6am. You may drink water until 10am.
1pm - Have breakfast before 7.30am. You may drink water until 11.30am.
3pm - Have breakfast before 9.30am and drink water until 1.30pm.

You will be given 50mls of water each hour to drink between admission and your operation.

Please do not chew gum or suck sweets for 2 hours before admission time.

On arrival

At the appropriate time you will be taken into a mediroom to prepare for surgery in the following way:

You will be asked to wear a hospital gown (and your own dressing gown) and a pair of elastic stockings (TEDS).

You will be asked to remove contact lenses.

You can keep your pants on as long as they won’t get in the way of the operation.

Anaesthetists are doctors with specialist training who assess your health and are responsible for giving your anaesthetic and maintaining your safety throughout your surgery.

You may be visited by the anaesthetist and surgeon to confirm your plan for surgery. Nothing will happen to you until you understand and agree.

Please ask any questions you have.

Premedication (‘premed’) are drugs which are given before some anaesthetics to help with relaxation or pain relief. They may make you drowsy after the operation. A needle may be used to start your anaesthetic. If this worries you, please let us know.

One person is allowed in the mediroom with you prior to your procedure. We ask that you and your relative / companion be respectful of other patients that are being cared for. The safety and privacy of all our patients is important to us.

When you are called for your operation

When it is time for your operation a member of staff will go with you to the theatre.

You may be asked to walk to the operating theatre but this will depend on your general health and whether you have had a premedication. If you are walking, you will need your dressing gown and slippers.

Theatre staff will check your identification bracelet, your name and date of birth and will ask you about other details in your medical records as a final check that you are having the right operation.

The theatre may look and feel quite different from other hospital departments – more cold and clinical and will be brightly lit. The theatre staff normally wear coloured ‘pyjamas’ and hats (scrubs).

You will be asked to remove your glasses and dentures. These will be returned to you immediately after your operation.

The anaesthetist or anaesthetic assistant will then attach machines which measure your heart rate, blood pressure and oxygen levels.

General anaesthetics

There are two ways of starting a general anaesthetic:

• Anaesthetic drugs are usually injected into a vein through the cannula (tube in your hand).
• Occasionally you can breathe anaesthetic gases and oxygen through a mask, which you may hold if you prefer.

Once you are unconscious, an anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised.

As soon as the operation is finished, the drugs will be stopped or reversed so that you regain consciousness.

Regional (spinal, epidural or nerve blocks) and local anaesthetics

A regional anaesthetic or “block” is an injection of local anaesthetic to make part of your body numb. They are a type anaesthesia and pain relief that can be used with, or sometimes instead of, a general anaesthetic. They are used to enhance your recovery by reducing pain and some side effects that can occur with general anaesthesia and other types of pain relief.

The local anaesthetic is injected very carefully and may be guided by an ultrasound machine or sometimes a nerve stimulator, which you may feel as gentle twitching. Blocks are usually performed with you awake or sedated if you prefer. If you are having a general anaesthetic they may sometimes be performed after you are asleep. The “blocked” area of your body will become warm, heavy
and numb and may last several hours – so after surgery you’ll be advised how to protect yourself until normal sensation returns. You’ll also be reminded to take regular painkillers around this time to ensure you remain comfortable when the numbness wears off.

Regional and local anaesthetic techniques are generally safe and effective although risks may occasionally include an incomplete block, bruising around the injection site or damage to veins, arteries or nerves. Other serious complications such as seizures or heart problems are rare and your anaesthetic team are trained to deal with these.

Your anaesthetist will explain everything that is involved in having a regional anaesthetic, including how any benefits and risks relate to you and your operation. For more information “Nerve Blocks: An Information Video for
Patients” can be found at: http://www.ra-uk.org/index.php/patient-info-video/video/nerveblocks-an-information-video-for-patients

Blood transfusion

Blood is essential for carrying oxygen around the body and a lack of red blood cells is called anaemia. In some cases anaemia can be treated with medicines; in others, a blood transfusion may be the best treatment. You can reduce the need for a blood transfusion by eating foods containing iron before your operation.

You may have a blood sample taken in pre-op assessment before your operation to see if you are anaemic. A second sample of blood is required within five days of the operation and is often taken on admission.

If you have previously been given a card which states that you need to have blood of a specific type, please show it as soon as possible to your doctor, nurse or midwife and ask them to tell the hospital transfusion laboratory.

Blood transfusion is only needed for a small number of patients during or after surgery. Sometimes it is possible to recycle your own blood during the operation.

A blood transfusion is usually given through a tiny tube directly into a vein, and you will be observed before, during and after.

You do have the right to refuse a blood transfusion, but you need to fully understand the consequences of this. If you have any concerns you should discuss these with your doctor, nurse or midwife.

Recovery from anaesthesia

After the operation, you will be taken back to a mediroom. Recovery staff will be with you at all times and will continue to monitor your blood pressure, heart rate and oxygen levels.

Oxygen will be given through a lightweight clear plastic mask, which covers your mouth and nose. Depending on the operation you have had, you may have a urinary catheter. This is a soft tube put temporarily into the bladder to drain it.

If you are going home on the same day, once you have had something to drink / eat and are considered “ready for discharge”, you may be taken to a seated recovery area to await collection or transport.

Whilst we make every effort to reunite you with your relative / companion following your procedure the nurses will assess this on an individual basis. Your relatives / companions are welcome to enquire at the reception desk about your progress.

Pain relief after your operation

Good pain relief is important and some people need more pain relief than others.

If you can breathe deeply and cough easily and you can move around freely after your operation, you are less likely to develop a chest infection or blood clots.

Occasionally, pain is a warning sign that all is not well, so you should ask for help when you feel pain.

Here are some ways of giving pain relief:

• Pills, tablets or liquids to swallow. You will need to be able to eat, drink and not feel sick for these drugs to work. They take at least half an hour to work.
• Injections. These may be given through a needle in your vein or muscle and take up to 30 minutes to work.
• Suppositories. These waxy pellets are put into your back passage (rectum). They are useful if you cannot swallow or if you might vomit.
• Patient controlled analgesia (PCA). This is a method using a machine that allows you to control your pain relief yourself.
• Local anaesthetics and regional blocks

How you feel afterwards will depend on the procedure and anaesthesia you’ve had - please speak to us if you feel uncomfortable.

Possible side effects and complications:

Very Common and Common (1 in 10 - 1 in 100)

• Feeling sick and vomiting after surgery
• Sore throat
• Dizziness and feeling faint
• Shivering
• Headache
• Itching
• Aches, pains and backache
• Pain
• Confusion and memory loss
• Bruising and soreness
• Chest infection

The risks to you as an individual will depend on:

• Your age and whether you have any other illness.
• Factors such as smoking or being overweight.
• Surgery which is complicated, long or done in an emergency.

Uncommon side effects and complications (1 in 1000)

• Breathing difficulties
• Damage to teeth, lips or tongue
• Awareness
• An existing medical condition getting worse

Rare or very rare complications (1 in 10,000 - 1 in 100,000)

• Damage to the eyes. Your eyelids may be held closed with tape to protect them - please try not to rub your eyes after your operation.
• Serious allergy to drugs - Anaphylaxis.
• Nerve damage. Most nerve damage is temporary (lasts less than 3 months), but in some cases damage is permanent.
• Equipment failure causing significant harm. Anaesthetic equipment can fail but the continued presence of a vigilant anaesthetist combined with equipment checks, appropriate monitoring and alarms, keeps patients safe when equipment fails. 
• Death or brain damage. Deaths cause by anaesthesia are very rare. There are approximately ten deaths for every million anaesthetics given in the UK.

DVT - Deep Vein Thrombosis. A blood clot that forms in a vein.

PE - Pulmonary Embolus. A blood clot that has travelled to the lungs.

VTE - Venous Thromboembolism. A term to describe both DVT and PE.

Causes

Sometimes a DVT occurs for no apparent reason. Some people inherit or develop an increased risk of DVT. Being unwell and having reduced mobility (for example, when recovering from an operation) can lead to changes in the blood and sluggish blood flow through the leg veins. These events make blood more likely to clot and form a DVT.

The highest risk is associated with major joint operations such as those for joint (hip or knee) replacement or hip fracture, major trauma or major spinal surgery, especially if someone has multiple risk factors for DVT.

Possible Symptoms

• Skin warmth
• Swelling
• Redness
• Tenderness
• Breathing difficulties
• Chest pain
• Death

How to reduce the risk 

On admission to hospital or at your pre-operative assessment, you will have an assessment of your risk of DVT and any reason not to use preventative treatments. The assessment will decide the recommended preventative measures (known as thromboprophylaxis) to be used in hospital and what is recommended after leaving hospital.

These may include:

• Avoiding dehydration.
• Mobilising early and frequently.
• Use of elastic support (anti-embolic) stockings.
• Injections of heparin (an anticoagulant or “blood thinner”).
• Intermittent compression boots (to gently squeeze the legs) may be recommended.
• Occasionally the use of tablet anticoagulation medication (e.g. warfarin, dabigatran or rivaroxaban).
• Vena Cava Filter (an umbrella shaped device inserted into a large vein to stop blood clots moving towards the lungs).

What happens if VTE does develop?

An assessment is made by the medical team and a scan can be done. If the test results are positive anticoagulation treatment with heparin and warfarin is given to prevent further clot formation and allow the DVT or PE to breakdown.

If you are having an operation and you are taking a drug that thins your blood (e.g. aspirin, warfarin, dabigatran, rivaroxaban, clopidogrel) your healthcare team should assess the risks and benefits of stopping this drug temporarily in the week before your operation with or without different treatment in its place.

Hospital Discharge

Day case patients

For 24 hours after a general anaesthetic:

You should:

• Have a responsible adult with you.
• Drink plenty of fluids.
• Take things gently including having time off work until you feel fully recovered.

You should not:

• Make any important legal or financial decisions or sign any such documents.
• Be left alone caring for children.
• Drive.
• Cook, boil a kettle or operate machinery.
• Drink alcohol or take sleeping tablets.

Longer stay patients

If you remain in hospital longer than is necessary you are at far greater risk of losing your independence or developing complications such as infections or DVT.

From the day you are admitted to hospital the staff involved in your care will work together with you and your relatives/carers to assess your needs in preparation for leaving hospital.

On the first day of your stay you will receive an estimated date of discharge (EDD) which may change as your care progresses.

As part of your treatment it may be necessary for you to move to another ward, sometimes at short notice but you and your relatives/carers will be given as much information as possible.

Where possible you will be able to vacate your hospital bed by 10am on your day of discharge, but you may need to wait in the hospital discharge lounge until transport arrives.

Before you leave hospital you will be given a limited supply of any medication that is required and any changes that have been made will be explained to you.

You will be given a written discharge summary which includes details of your medication and any changes. Please also take a copy of this to your next GP appointment.

Discharge arrangements may include any of the following options:

• Returning to your usual place of residence with no additional support.
• Returning home with either short term or long term support services in place. Please let us know as soon as possible if you already have support services in place.
• Moving to a short term rehabilitation or intermediate care setting as close to your home as possible.
• Moving to alternative housing or care home.

Preparation

When your discharge date is identified you
and your relatives /carers will need to make the
necessary arrangements which may include:

• Suitable clothing and footwear
• Transport home. Where possible you will be expected to arrange your own transport to arrive by 10am.
• Access to a key to your property.
• Reinstate any private care arrangements. 
• A suitable supply of food and adequate heating in your home.

References and sources of further information

Southmead Hospital preadmission unit 0117 414 0637

The Royal College of Anaesthetists
Churchill House
35 Red Lion Square
London WC1R 4SG
Phone: 020 7092 1500
Fax: 020 7092 1730
E-mail: info@rcoa.ac.uk
Website: www.rcoa.ac.uk
www.rcoa.ac.uk/document-store/you-and-your-anaesthetic

The organisation is responsible for keeping up standards in anaesthesia, critical care and pain management throughout the UK.

Association of Anaesthetists of Great Britain and Ireland
21 Portland Place
London W1B 1PY
Phone: 020 7631 1650
Fax: 020 7631 4352
E-mail: info@aagbi.org
Website: www.aagbi.org

This organisation works to promote the development of
anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.

NHS Constitution. Information on your rights and responsibilities available at: www.nhs.uk/nhsconstitution

NHS information on MRSA available at: www.nhs.uk/conditions/MRSA

NICE guidance on venous thromboembolism available at: guidance.nice.org.uk/CG92

Information about blood transfusion available at:
www.nhs.uk/Conditions/Blood-transfusion/Pages/Introduction.aspx
and at www.transfusionguidelines.org.uk/index.aspx

 

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published April 2021. Review due April 2023. NBT002067.