Microsoft word - anaesthetic inguinal hernia pre-op info sheet1.doc
Anaesthetic Information Sheet for Hernia Surgery
Overall philosophy: We aim to provide you with the best and safest anaesthetic care available anywhere. We aim to achieve the best possible pain relief. We aim to do what we can to make your stay in hospital as pleasant as possible. We aim to treat you the way you want to be treated: We do not “do” mediocre. This sheet lists what we do for the majority of our patients: This can always change for any number of reasons, but we will try and let you know if things are going to be different. Before your admission: You will have been given fasting instructions with your hospital letter. It is very important that you observe them. Please have a bath or shower on the morning of your operation. You may also need to have a further shower with a special antibacterial solution after you arrive. Please do not wear any make-up on your day of admission, and please remove all nail varnish before you arrive. Any earrings and body jewellery should also be removed before admission. There are no restrictions in the use of deodorant. Before your operation: Your anaesthetist will normally come and see you in your room before you are taken to theatre. You will be asked if you have any medical problems, if you take any tablets or medicines normally, if you have any allergies, if you have had any previous anaesthetics, whether you smoke and whether you have had any recent colds or chest infections. Your anaesthetist will check that you have understood the contents of this sheet: Any sections can be clarified if necessary so please feel free to ask questions at any time. Make a list of questions before you arrive if you think that this would be easier. You will need to be examined to make sure that you are generally fit. Either your anaesthetist or one of the ward medical staff will need to listen to your lungs and heart, feel your tummy and inspect your groins and legs to see where we will be operating. For this you will need to get undressed but you will be given a gown to wear. After getting changed into the operating gown, many patients prefer to wear a dressing gown on top: Please bring one with you if you wish. Before you are transferred to the theatre suite, we will give you some tablets (pre-medication) and also put some cream on the backs of your hands. The tablets are to protect your stomach and lungs during the procedure and the cream makes the skin on your hand become numb to reduce any discomfort you may feel when you have your injection. The tablets will not make you feel sleepy, but if you are particularly nervous or apprehensive we may be able to give you something extra to make you more relaxed. Please ask your anaesthetist if you think that this is necessary.
If you would rather, it is possible to do this operation with you awake under a form of local anaesthesia called a “spinal anaesthetic”. This would involve a small injection into your back that would make you go completely numb from the ribs downwards for a couple of hours. If you would rather have this instead of a general anaesthetic, please let your anaesthetist know. In theatre: When we are ready, you will be collected on a trolley and transferred to the Pre-operative area of the theatre suite. Here we will get you ready for anaesthesia. A small plastic tube (cannula) will be inserted into one of the veins on the back of your hand, a blood pressure cuff will be put around your arm and some ECG electrodes will be attached to your chest. We will then wheel you into the operating theatre itself and slide you onto the operating table. You will still be awake at this stage, but you should not see anything you might regard as unpleasant while you are inside the theatre. The operating table is heated to keep you warm and comfortable while you are asleep. Once you are on the table it takes a further two minutes to get our equipment plugged in and ready to go. Going off to sleep: We will tell you when we start to inject your anaesthetic and all the drugs will be pumped slowly into the cannula on the back of your hand. You may feel the drugs going into your vein, but this should not be uncomfortable; however on occasions some patients feel a tingling or even hot sensation as this happens. We do not normally put anything over your face, so you will just lie on the table and gradually drift off to sleep. It is far better and safer to induce anaesthesia slowly and gently, and it will take three minutes from when we tell you that we are starting until you finally lose consciousness. Over the first minute very little will happen. Over the second minute you will get progressively more woozy and relaxed and you will gently doze off during the third minute. Most patients find the experience very pleasant indeed! The operation takes about 45 minutes per side, slightly longer if you have had similar surgery before. We do several things after you are asleep to ensure that you are not in pain when you wake up. We put local anaesthetic into the wound(s) we need to make in your groin(s), and this will provide good pain relief for two hours after the operation. We give you a drug called Voltarol (diclofenac) that will provide excellent additional pain relief for about eight hours after the operation. Voltarol is a drug that can irritate your stomach if we give it to you by tablet when your stomach is empty, so after you are asleep it will be inserted into your bottom (rectally) as a suppository. In some cases we may inject some local anaesthetic into one of the major nerves supplying your groin or thigh. If we do this, part of your leg, bottom or groin may be numb when you wake up. It is also possible that your leg may become slightly heavy for a few hours afterwards. This is nothing to worry about, and your leg(s) will soon return to normal. For some patients we leave a small tube in the wound so that more local anaesthetic can be infused as required. Waking up: When your operation has finished, you will still be on the operating table when you first come round. Therefore please do not think that something has gone wrong, and that it is still the middle of the operation! We will be in the process of putting on your dressings
and bandages, but the surgery itself will be completed. You should not be in pain when you wake up, but if you are, please let us know immediately. It would be most unusual for you to feel sick afterwards, even if you have been sick after previous anaesthetics. After the operation: You will be transferred to the recovery area for a short while, and then returned to your room on the ward. You will be allowed to drink and eat as soon as you feel that you want to. We will give you a combination of pain killing tablets regularly while you are on the ward, but there will also be some more powerful ones available for you to ask for should you need them. You will be given a supply of pain-killers to take home with you. In some cases it may be possible for you to go home on the evening of your operation, however you should initially assume that you will be staying in the hospital overnight. If you do go home on the day of surgery there must be a responsible adult with you overnight, and you cannot drive for 24 hours after discharge. When you get home: We genuinely welcome comments and suggestions about the care we provide. Please feel free to write to me (or to the Chief Executive if you prefer) with any comments however trivial, either positive or negative, so that we can further improve the standard of care we give to our patients in the future.
New York State Medicaid Pharmacy and Therapeutics Committee Meeting Summary June 16, 2011 Agenda and Introduction The Medicaid Pharmacy & Therapeutics Committee met on Thursday, June 16, 2011 from 8:45 AM to4:30 PM in Meeting Room 6, Concourse, Empire State Plaza, Albany, New York. A. Background Materials Provided: The Committee was provided copies of written materials submi
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