Pre Op Check list - patient
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In the reception bay, various details are checked by the theatre team. They will ask you to confirm the side of the operation, verify the ‘arrow mark in you arm and then ask you to confirm your signature in the consent form. They will confirm with you that you still want to proceed with the operation. You can still turn back if you are not sure!
In the anaesthetic room, a venflon (small plastic cannula) will be seated in your arm ready for various anaesthetic agents to be pumped in. You will be connected to an oxygen mask and ECG leads will be placed in your chest and a pluse oximeter probe attached to one of your finger so that we can monitor the level of oxygen in your blood. Occasionally we will also attach a probe to your forehead to monitor the brain waves to monitor the depth of anaesthesia.
If the anaesthetist has discussed the use of nerve block typically interscalene block, then this will be administered now. Usually this step is done with you awake and more often than not with the help of an ultrasound machine to enable the placement the local anaesthetic at the precise spot.
There are many methods used to anaesthetise a person starting with inhalation agents which you breath in to an injection which is administered via vein. These agents are short acting and when they are stopped you will wake up within few minutes.
Once you are anaesthetised, you will be moved into the main theatre and will be transferred to the main operating theatre. For most arthrosocpic shoulder surgeries, you will be turned to one side such that the operating side is on the top. Your body will be supported by combination of props and a ‘vacuum
bean mattress’. The arm to be operated will be held in place by a gentle non-adhesive skin traction with about 6lb weight as traction. Due care will be given for pressure points, support of head and neck and please be reassured the mattress on the operating table is a special mattress which minimises the risk of pressure sore. Your dignity will be respected and maintained at all times.
Before taking any more step, I follow ‘check list’ as proposed by WHO to make sure that the correct operation is done on the correct patient on the correct side. I will cover your head with a soft adsorbent paper towel and rest of the body will be covered with warming mattress which will blow heated air during surgery to make sure that you are kept warm..
The arm and the shoulder region will be cleaned with chlorhexidine gluconate (unless you are allergic to it) which may have a pink colour dye on it. and I generally inject local anaesthetic in the skin and the joint region before I start. The skin will be cleaned again with an antiseptic solution and we will allow it to dry naturally. Particular attention will be given to the arm pit region..
The arm will be draped with sterile disposable sheets and the operating field will be isolated and sealed. I will draw on the skin to identify landmarks. Surgery will be done via keyhole and all action can be watched on a television screen. All equipment used will be sterile and sealed to minise the risk of infection. Do not be surprised to see my art work on the skin when the pressure dressing comes off.
After the surgery, you will be placed back to the trolley and taken to the recovery bay where you will be very carefully recovered b a nurse who will provide you with care and attention. Please be advised when you wake up you will feel some pain as your body has not fully recovered from anaesthesia and some signals are felt in an amplified way. .