During surgery, you will be given some form of anesthesia, which is medication administered for the relief of pain and sensation during surgery.
The anesthesiologist decides the type and dosage of anesthesia. There are various forms of anesthesia. The type of anesthesia you will receive will depend on the type of surgery and your medical condition. You will meet with the anesthesiologist or nurse anesthetist before the surgery to review your medical condition and history. Usually, an anesthesiologist will administer a sedative in addition to the anesthetic.
Pre-anesthesia Testing Clinic (PATC)
Before you have anesthesia for surgery at City of Hope, your surgeon or doctor will schedule an appointment for you at the Pre-anesthesia Testing Clinic. This is a service provided by the Department of Anesthesiology. The clinic is located on the second floor of Helford Clinical Research Hospital at City of Hope.
Making your operation safer
The primary goal of the PATC is patient safety, that is, to minimize anesthetic risk by assuring that any issues relating to a patient’s coexisting conditions are addressed. Optimizing your health before surgery not only maximizes your safety, but also reduces your time to surgical therapy.
The PATC visit gives you an opportunity to ask questions, and it helps our anesthesiologists create the ideal anesthetic plan for you. After your PATC visit, you should know what to expect both in the time leading up to your surgery and during your recovery.
If you are scheduled for a PATC visit, you will undergo a history and physical examination by the PATC provider, an advanced practice nurse, with special emphasis on aspects of your health that are pertinent to the administration of anesthesia. The decision to obtain further tests will be based on your individual health, relative to your upcoming surgical procedure. Preparing a patient for surgery often requires collaboration between a primary care physician, anesthesiologist, surgeon and specialty consultants such as cardiologists or pulmonologists.
Ensuring successful outcomes for our patients is a team effort
At City of Hope, we have a variety of consulting specialists available for our patients. For those who require further testing, we coordinate this aspect of your care during the PATC appointment.
To expedite the PATC visit, many patients find it helpful to have completed the PATC Intake form prior to arrival. The form is also available in Spanish. The PATC intake questionnaire reviews past medical/surgical history, current medications and allergies, and it asks questions pertinent to potential medical issues that may not have been previously evaluated.
As part of your PATC visit, we will perform a pre-anesthetic medical evaluation and give you instructions about when to stop taking certain medications and when to stop eating and drinking before surgery. It is important to coordinate medication changes with your primary doctor, your surgeon and your anesthesiologist. For example, it is important to inform the PATC if you are taking blood thinners (Plavix, Aspirin, Coumadin, or Lovenox), antibiotics, and diabetes or heart medications. Some of these medications may need to be continued through surgery, while others may need to be stopped several days in advance.
If you have a pacemaker or a Automatic Implantable Cardioverter Defibrillator (AICD) you will need to bring your device identification card and the details of its latest checkup so that the appropriate evaluation may occur. These devices are managed differently depending upon the medical reason for the device and type of surgery.
Frequently asked questions about the PATC
What can I expect during my appointment at the PATC?
During your appointment, the PATC staff will:
- Take your medical history
- Perform a physical examination
- Review pertinent tests ordered by your doctors
- Discuss what medications you should or should not take before your surgery
- Order any additional tests that may be necessary to make sure it is safe to proceed with surgery
- Perform an EKG and, possibly, basic blood work
If I need additional testing, can this be done the same day as my visit to the PATC?
- All blood testing can be done the same day. However, if a consultation with another specialist is needed, this may need to be scheduled another day, when there is an available appointment.
Will you have enough information to know if I am ready for surgery?
- In most cases, if your medical records are complete and up to date, your visit will supply your PATC provider with enough information to know if you are ready for surgery.
- However, sometimes a previously unknown underlying problem might be identified that needs to be addressed before surgery. When this occurs, arrangements will be made for further evaluation.
Will my surgery be delayed or postponed for any reason?
- Generally, your surgery will not be delayed. However, even a simple problem like a common cold can make surgery less safe. Other times, tests may show that an existing medical condition such as high blood pressure or diabetes is less than optimally controlled.
- If you have a condition in need of further optimization, your PATC provider may send you to your primary care doctor or the appropriate consulting specialist to start treatment to improve your health and reevaluate your condition before surgery. The PATC clinic will inform you and your surgeon about any conditions that require further attention before surgery.
What do I need to bring to my visit to the PATC?
It is important to get as complete a picture of your medical history as possible. Therefore, in order to save you time during your visit, please bring all the information you have about the following:
- All your relevant medical records and details of your past medical history
- All of your medications or a clear, printed list with their complete names, dosages and how often you take them
- A list of the operations you have had, including the hospitals at which they took place
- The name and phone number of your family doctor and any other doctors who take care of you regularly (like your heart doctor or your lung doctor)
- Copies of the reports of any recent tests that you may have had, particularly stress tests, echocardiograms, cardiac catheterizations or lung function tests. If you do not have the results of any of these tests, information regarding when and where they were performed would be helpful, including any phone numbers to which you may have access
- If you have a pacemaker, Automatic Implantable Cardioverter Defibrillator (AICD) or coronary stent, the card that goes with that device
- Any recent laboratory studies you may have had outside of City of Hope
- Preoperative Medical Questionnaire (to be completed before your clinic visit)
Once you are in the operating room, the anesthesiologist will place a variety of monitors on you to measure your blood pressure, heart function, breathing and the oxygen content in your blood. You will be given oxygen to breathe through a mask.
Then, you will be given anesthetic drugs through your IV (intravenous) line, or you will be given anesthetic gases to inhale. The anesthesiologist adjusts your medications to keep you asleep and pain free for the entire procedure. During surgery, your condition is carefully monitored, evaluated and controlled. A member of the anesthesia team is with you throughout the surgical procedure.
At the end of the surgical procedure, the anesthetic agents are stopped and medications may be given to reverse the effects of earlier medications. You will then be transferred to the Post-anesthesia Care Unit for recovery.
During your surgery and recovery time, your family and friends can stay in a special waiting area where the surgeon will meet with them at the end of the procedure.
The Post-anesthesia Care Unit (PACU)
When your surgery is over, you will be observed for a period of time in an area known as the PACU, also known as the Recovery Room. There, the nursing staff will watch you closely. You should tell the nurse if you are having any pain, nausea or any other discomfort. Once your condition has met certain criteria, you will be discharged from the PACU.
Admission to the Inpatient Unit
Depending on your type of surgery and condition, you may need to stay overnight or longer in the hospital. If this is the case, you will be taken from the PACU to your hospital room. Your family and friends can join you in your room. Any personal belongings stored by hospital staff will be brought to your room.
If your procedure does not require an overnight stay, you may go directly home. If you need additional observation before being discharged from the hospital, you will be brought to a special room for a short period of time. There, your nurse will watch you closely until you are ready to go home. Before going home, you will be given instructions on how to take care of yourself. Instructions should include use of any equipment, any special care or procedure you need to do, medications, any activity restrictions, diet, a follow-up appointment plan, any signs to watch for and to report, and a contact number for your doctor or nurse. If you do not receive this information, do not understand the instructions, or have any questions, please speak with your doctor or nurse.
Important information for outpatient surgery patients:
- You must have someone drive you home after surgery
- Make arrangements for someone to stay with you for the rest of the day or for 24 hours after your procedure if you had general anesthesia.
- Stay at home the remainder of the day and rest. If you do not feel recovered the next day, continue to rest for another day or two. Even minor surgery may be taxing on your physical strength and resistance.
- If you have small children, make arrangements for someone else to care for them.
- Do not operate a vehicle or dangerous equipment, sign contracts or make important decisions for 48 hours after surgery.
Information about driving and conducting business after your surgery
Even though you will probably feel well after the first day, your reflexes are depressed and can take up to 48 hours to return to normal. Therefore, we recommend that you do not drive, operate heavy machinery, sign contracts or make important decisions for 48 hours after surgery.
What are common side effects?
Common side effects such as headache, sleepiness, nausea, vomiting, thirst and shivering can occur in a greater or lesser degree with all types of anesthesia. However, you may experience other, more specific, side effects, depending on the type of anesthesia you were given.There may be other side effects the anesthesiologist will tell you about. It is important to tell your doctor or nurse if you are having any of these side effects. Your doctor anticipates these situations and may be able to provide some relief.
If you will be going home after surgery, arrange for someone to drive you and stay with you for the rest of the day. Make transportation and personal arrangements in advance. Provide the admitting nurse with your driver’s name and contact number or location.