a. Following your initial consultation, if you have been booked to have any procedure/surgery that cannot be performed under local anaesthesia (numbing the local area), you are likely to receive a formal face-to-face consultation with a pre-operative assessment team.
b. Timing can vary on case-to-case bases. It will depend on the duration between the initial consultation and the provisionally agreed date of surgery. This assessment is generally carried out few days before the planned surgery.
c. A senior nurse, who works quite closely with the surgical and anaesthetic team, carries out this assessment.
a. This assessment includes a detailed evaluation of any pre-existing medical conditions, previous surgical procedures, any problems with previous anaesthetic (if applicable), allergies, etc.
b. Appropriate tests will be carried as applicable including MRSA screening swabs, blood tests, ECG, etc.
c. If any equipment is needed during post-operative recovery period, this can be organized during this visit.
d. General information about the type of anaesthesia, pros and cons of different types of anaesthesia, etc will also be provided to you.
e. If there any concerns regarding post-operative convalescence and the support structure, these will be discussed as well.
f. Occasionally, following this visit, if there are any medical concerns, you may receive further appointment for a face-to-face consultation with a consultant anaesthetist.
a. You will generally see the consultant anaesthetist on the day of surgery. Further discussion will be carried out regarding the type of anaesthesia, risks and benefits, etc. before a final decision is made.
b. Occasionally, if there are any specific medical concerns during your pre-operative assessment clinic visit, you may receive a face-to-face consultation with the anaesthetist prior to surgery, in order to optimize your health before surgery.
a. There are three broad types of anaesthesia:
i. Local anaesthesia: Numbing the local area. This is commonly used technique for injections or small procedures like lump excision, minor foot procedure, etc.
ii. Regional anaesthesia: numbing the whole region around the surgery. A common example for this is spinal or epidural anaesthesia, which numbs your legs. This is a very widely used technique for major procedures like hip or knee replacement.
iii. General anaesthesia: Putting you to sleep. This is a commonly used procedure for a wide range of procedures. With modern techniques and drugs, there are very few (if any) complications with general anaesthesia.
b. The pre-operative assessment team with give you a general idea about pros and cons of various types of anaesthesia. As a surgeon, I can also give you broad principles around the choice of anaesthesia best suited for your needs. However, the final decision will be made following your discussion with consultant anaesthetist.
a. Following your initial consultation, you will generally be given a provisional date for surgery, either on the day of consultation or soon after that by the booking office.
b. Once your pre-operative assessment has been completed and no concerns have been raised, the date for surgery is then finalized (same as the provisional date in vast majority of cases). If there are any medical/social issues to be resolved prior to surgery, the date is amended accordingly.
c. An official letter will be sent out to you confirming the details of when and where to come on the day of surgery.
a. During the initial consultation and during pre-operative assessment, it will be reasonably clear, whether or not your procedure is being done as day-case or on an inpatient basis.
b. If the procedure is being done on a day case basis, it means that you can go home on the same day after the procedure (in vast majority of the cases). Very occasionally, you may need to stay in the hospital that night, if there are any issues like vomiting, difficulty in managing pain, etc. It is advisable that you bring a small bag with some essentials in case you end up staying in the hospital longer than anticipated. Don’t forget to bring your book/iPad or laptop to keep you occupied!!
c. If the procedure is being performed as an inpatient, you will be given a general idea about the anticipated length of stay in the hospital. You can therefore bring essentials accordingly.
d. Please bring all your regular medications to the hospital (along with regular prescription – if applicable)
a. If your procedure is being carried out under local anaesthetic, you can eat and drink on the day of the procedure
b. If your surgery is being performed under spinal/general anaesthesia, you will be given specific instructions regarding eating and drinking. This information will generally be provided to you during your pre-operative assessment. The admission letter should also have information regarding this.
c. As a general principle, if you are coming to the hospital in the morning, you are allowed to eat and drink till midnight, the night before. You can have clear drinks only (i.e. water) up to about 6 am. Please do not consume any milk-based drinks or eat chewing gum after midnight. If you have been called to the hospital around mid-day for your procedure to be carried out in the afternoon, you should be able to eat and drink up to about 6 am in the morning and clear drinks till about 10 am.
d. Once you reach the hospital, further instructions can be given i.e. whether or not you are still allowed clear fluids.
a. Specific information regarding this will be provided to you during your pre-operative assessment.
b. Generally, you are allowed to take all your regular medications on the day of surgery, with sips of water.
c. If you were required to withhold any specific medication, the pre-operative assessment team would inform you.
a. Once you report to the hospital reception, you will be taken to your hospital room
b. The ward nurses will greet you. They will go through a set of assessments in order to complete your admission process.
c. I will be seeing you again on the day of the surgery and go through the consent and answer any queries (if applicable). Your limb will be marked with a marker pen.
d. Consultant anaesthetist will also see you on the day of the operation. He/she will go through pros and cons of anaesthetic options and a plan is formulated by mutual consent.
e. You may see other members of the team like ward doctor, physiotherapists, member of the kitchen team, etc.
a. This is entirely your choice. If you wish anybody to accompany you, they will be allowed to stay with you in the room, until you go to theatre.
a. If your procedure is being done as a day-case, you will be given an approximate time when you can be potentially discharged from the hospital. Pick up can be arranged accordingly.
b. If your procedure is being done as an in-patient, and you are expected to stay in the hospital, your progress will be monitored by members of multi-disciplinary team during your hospital stay. Once the discharge date and time is envisaged, pick up can be arranged accordingly.
c. If hospital transport is required, please discuss with the ward team on admission.
a. Once you taken to theatre complex, you will first be in anaesthetic room. In this room, your details will be re-confirmed and you will be checked in.
b. The anaesthetist and the operating department practitioner will look after you. If you are having general anaesthesia, you will be generally given a mask on your face to breathe in from and a special drug will be given to put you to sleep. A special type of tube is inserted in your throat to oxygenate your lung during the operation.
c. If you are having a spinal anaesthesia, you will generally sit up on the edge of the bed, whilst the anaesthetist will insert a needle in your back and administer special drugs that will numb your legs. You will then be allowed to lie down.
d. Your bed will then be wheeled in to the operation theatre.
a. If you have had general anaesthetic, you will not be aware of anything that goes on in operation theatre. When you wake up (feels like waking up from deep sleep), the operation would have finished and you will be in the recovery room.
b. If you have had spinal anaesthesia, you can opt to be completely awake or decide to have sedation. Most patients prefer to have sedation, which means that you are given a special injection that allows you to relax and doze off to sleep. If you decide to have sedation, you are unlikely to notice anything much during the operation. Some patients prefer to stay awake throughout the procedure. You will not feel any pain but will be aware of your surroundings. You can decide to listen to music or indeed have a chat with the theatre team through your procedure.
a. You will be taken to theatre recovery complex. Operating department practitioner will monitor your vitals and ensure that you are comfortable.
b. After a short while, you will be taken back to the ward.
a. You will have some further vitals done by the nurses in the ward.
b. You will be allowed to eat and drink reasonably soon after you return to the ward.
c. You will be subsequently allowed to mobilize depending on the type of anaesthetic and the type of surgery you’ve had.
a. If your procedure is done as a day-case, you will be allowed home generally few hours after the procedure. During your stay in the hospital, multi-disciplinary team will assess you and once you’ve passed all the assessments, you will be allowed to go home.
b. For a joint replacement surgery, you will generally stay in the hospital for about 3 days. Once you are comfortable and mobile, you can be discharged from the hospital. During your stay in the hospital, multi-disciplinary team (consisting of physiotherapists, nurses, ward doctor, etc.) will monitor your progress.
a. Depending on procedure you’ve had, you may get some medications to take home including painkillers, tablets/injections for reducing the risks of clots, etc.
a. You may receive a date and time for follow up appointment prior to your discharge from the hospital. If not, this will be sent out to you by post.
a. Prior to discharge, you can take details about the direct telephone number of the ward. If you have any queries once you go home, you can ring the ward directly. Ward team should be able to address/answer most of your queries. Occasionally, further medical input may be required.
a. Depending on the procedure you have, physiotherapist will see you in the ward after the surgery. Appropriate assessment will be carried out and advice will be provided. If further outpatient physiotherapy input is required, they will be able to make appropriate arrangements.
a. This will depend on the procedure you’re having. First follow up visit will be few days/weeks after the procedure. Based on your progress, further follow up arrangements will be arranged appropriately.