Procedures Before Surgery

After all the preparations by the nurses and the anesthesia providers you are finally ready to move on to the beginning of your operative experience.  Many patients may require special procedures prior to undergoing anesthesia or surgery.  If you require these techniques this is the time when they are likely to be performed. In most situations, you will be taken to a special procedure area directly outside the operating room where this will take place.  There are many different procedures which could be suggested such as nerve blocks, epidurals, arterial lines and central lines.  We will briefly discuss each of these.

Nerve blocks are techniques used to decrease the sensation of pain or to completely eliminate all sensation and allow surgery to take place without going to sleep.  The nerve block is chosen based on the surgery to be performed and nerves that are located in the area of surgery.  One of the most commonly used nerve blocks is an interscalene nerve block for shoulder surgery.  The anesthesiologist will carefully sedate you and inject medications in the neck area where the nerves to the shoulder originate.  The medications will then cause the nerve to “go to sleep” and all sensation will be lost or decreased depending on the dose of the medication.  The beauty of this technique is that sometimes the procedure can be done with this alone with no need of General Anesthesia.  When the patient awakens, they will feel no pain for hours or even a day later.  The benefit is obvious.  In addition, it will decrease the use of narcotics, a common cause of post-operative nausea. Because patients awaken with no pain their stay in recovery is decreased and they can be discharged home earlier.  Despite these benefits there are some potential complications that need to be considered.  Though these are infrequent, you as a consumer need to know about these.  A separate chapter will discuss this in more detail.

A second type of procedure often performed before surgery is an intravascular procedure.  In layman’s terms, a small needle with a plastic catheter is inserted into a vessel such as an artery or central vein.  

The arterial catheter is most often inserted in a small artery at the level of the wrist.  This artery is the radial artery located at the base of the thumb where you see a crease.  This catheter will allow the anesthesiologist to monitor a pulse and blood pressure during the course of surgery.  This is often required during cardiac surgery or any serious vascular procedure.  You will also need this for thoracic surgery.  These catheters will also serve in the post-operative period when there is a need to obtain blood for tests.  The nurses will not have to keep sticking needles in your arms for blood, which is a blessing.  The risks of these catheters are low and seldom will you see reports of problems that are long standing.  

The central venous catheters are plastic catheters placed in larger vessels usually in the neck area or upper chest.  These catheters help the anesthesiologist and/or surgeon to give large volumes of fluid and allow them to measure the pressure of blood volume and the flow of blood around the heart.  The use of these central lines is essential for complicated heart and vascular cases.  Because of their location there is the possibility of complications such as a collapsed lung and accidental puncture of major arteries.