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What to Expect on the Day of Surgery
We understand that having surgery can be can be a very anxiety provoking experience and we will try to alleviate much of this anxiety and make this day as easy and as pleasant as we possibly can.
When you arrive at the MGH Orthopaedic Surgery Center, you will be greeted in the reception area and registered as a patient. You will then be escorted to the pre-operative prep area also called the holding area. There a member of the peri-operative nursing staff will admit you.
You will be asked to change into a gown or appropriate dress for your surgical procedure, the nursing staff will start an intravenous line in a vein, and you will be asked several questions in preparation for your surgery. They will ask you: when you last ate or drank, if you took any medications that day, if you have any allergies, what the proposed surgery is to be and the side it is on along with other administrative questions.
You will then meet the Anesthesia Care Team (ACT) that will consist of an Anesthesiologist and a Certified Registered Nurse Anesthetist (CRNA).The Anesthesiologist will then interview you, perform a physical exam of your heart and lungs, and then discuss the available options for your proposed surgical procedure. You may have already discussed these options with your surgeon during your pre-operative office visit. Together we will formulate an anesthetic plan. We will also discuss the possible side effects, risks and benefits of each type of anesthesia. You will then be asked sign an anesthesia consent form.
Your surgeon will also meet you in the prep area and again review the planned surgical procedure. He will also mark the surgical site after answering any questions you may have.
The possible options for anesthesia will include local anesthesia with IV sedation (MAC), general anesthesia, regional anesthesia or a combination of anesthetics (e.g. regional anesthetic with IV sedation or light general anesthesia). If general or MAC anesthesia has been decided on, you will proceed directly to the operating room from this area. However, if it is decided that you will receive a regional anesthetic technique or peripheral nerve block, you will placed into an area designated for the performance of the block. After the nerve block is complete you will proceed to the operating room.
While in the operating room you will be under the care of the ACT. We will give you medications to make sure that you are comfortable during your surgery. Your blood pressure, heart rate, blood oxygen level, breathing and temperature will be monitored to insure a safe anesthetic course.
After your surgery you will be transferred to the post-anesthesia care unit (PACU) also called the recovery room where you will be monitored by a team of PACU nurses under the supervision of the anesthesiologist. These nurses are specially trained in post-anesthetic and critical care. They will monitor your vital signs, help resolve any side effects from the surgery or anesthesia (e.g. nausea +/- vomiting), and assist in your pain management.
If you and your surgeon planned for you to leave on the same day as your surgery, then once you are stable, comfortable, and meet the discharge criteria, your intravenous will be removed and you can get dressed. The PACU nurse will then review your post-operative instructions with you and your responsible adult companion, give you your pain medication prescriptions which should be filled on your way home, and escort you to your vehicle.
If you and your surgeon planned for you to be admitted after surgery, then you will be transferred from the PACU to a hospital room in the orthopaedic ward.
Post-Anesthesia Care Unit (PACU)
While in the PACU, vital signs for all patients will be monitored, pain management initiated, and fluids administered. The nurses in the PACU have extensive critical care experience and work under the direct supervision of the attending anesthesiologist.
The different patient's length of stay in the PACU will be variable. Discharge from the PACU to home will depend on meeting several criteria. First the patient must demonstrate recovery from their anesthetic. Secondly, their vital signs must be stable. Sometimes after surgery patients require medicines to help control their heart rate, blood pressure, respirations, or other metabolic disorders, e.g. diabetes. These patients may require a little more time in the PACU until their vital signs are stable. Thirdly, their post-operative pain management should be initiated and their pain under control and manageable. Fourthly, the patient should not be experiencing severe nausea and vomiting. Again, this may prolong their PACU stay, as they will be treated in the PACU with medication until it subsides. Lastly, when all the above criteria are met, the patient will be given a trial of drinking and eating a snack.
Visitation in the PACU is limited to avoid the risk of infection to other patients, to protect patient privacy, and to permit the PACU staff to concentrate on the care of all the post-surgical patients.
Once the patient has met discharge criteria the patient's Intravenous will be removed and the patient will get dressed in preparation to leave. The patient and their accompanying responsible adult will then be given discharge instructions and a prescription for the pain medication prescribed by the surgeon.
The patient, either walking or in a wheelchair, will then be escorted by an MGH employee to the lobby and discharged to a responsible adult.
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