The Operating Room

• Choice of Anesthetic
• During Your Surgery

The Operating Room: our first priority

Most anesthesiologists spend their working hours in hospital Operating Rooms making sure patients are safe during surgery. This complex task begins with a thorough assessment of each individual patient. Your Anesthesiologist needs to know about their patient’s past medical history, current medications, allergies, and to have a sense of your ability to undertake physical exertion. He or she will review your medical history, assesses any laboratory results (ECGs, pulmonary and cardiac testing, bloodwork), and will examine you. Based on this information, your anesthesiologist will develop an anesthesia plan, discuss it with you, and answer any questions about the anesthetic and postoperative management of pain and other potential complications.

This process may occur immediately before your surgery in the holding area of the hospital. Increasingly, however, anesthesiologists are moving the preparation for surgery to an earlier phase which is most commonly done in a Pre-Operative Assessment Clinic, where anesthesiologists see patients days or weeks before surgery. This ensures co-ordination of care between the surgeon, the patient’s family doctor, the anesthesiologist, and any other specialists caring for the patient. It allows for any additional testing to be done, and for the patient to be made as fit as possible before surgery.

The anesthetic plan includes the following components:

• Preoperative: Are there any potential problems with this patient or with the anticipated surgical procedure? Is there any special testing that needs to be done to further clarify the anesthetic problems or the plan? Could a blood transfusion be necessary? Do any other specialists need to be involved in the care of this patient before, during or after surgery? What medications need to be taken before surgery? Does the patient need a pain killer, a drug for anxiety, for nausea, or to decrease stomach acid, before surgery?
• Monitoring: Does the patient just need routine monitors of heart rate, ECG, oxygenation and blood pressure, or are additional monitors necessary? If the need arises, anesthesiologists are skilled in inserting tubes into arteries, major veins, and even directly into the heart, in order to measure pressures and take blood samples.
• Pain relief: What are the best drugs to use during and after surgery? Would the patient benefit from nerve blocks or an epidural for postoperative pain? Is this patient suitable for “Patient Controlled Analgesia”, the pain pump which allows patients to control the amount of painkilling drugs they get?
• Postoperative plan: Will it be appropriate for the patient to go home after surgery? Will special arrangements need to be made to manage things at home after surgery? Will they need to be admitted and if so will they be appropriate to go back to the ward or should plans be made to admit the patient to a specialized unit post such as a Surgical Stepdown Unit or to the Intensive Care Unit after surgery?