Same Day Surgery

Alternative Names: outpatient surgery

Definition
Same day surgery allows a person having an operation to go home later the same day.

What is the information for this topic?
Medical advances have now made it possible to go home the same day of an operation. For this to happen, everything must go smoothly and the person must feel comfortable. Any same-day surgery may get turned into an overnight stay if needed.

For same-day surgery, people are asked to come in early. Usually, a person must "check-in" at least 1 to 2 hours before surgery. Basic information is taken at the registration desk and the person is brought into the surgery area.

Several questions and forms may need to be taken care of before surgery. Basic personal information as well as who to call in an emergency, insurance, and other issues will need to be recorded. Once this is done, the person is asked to change into a hospital gown. They are then taken to the surgery prep area.

The surgery prep room is where a person spends the final minutes before going to the operating room. A person generally lies on a portable bed with wheels as they wait. Most people will have an intravenous or IV started in the surgery prep room if they don't already have one. An IV is almost always necessary before going into the operating room. Inserting an IV involves putting a needle through the skin and into a vein, usually on the hand or forearm. A bag of fluid may be hung so that it drips into the IV.

Blood tests may be required, depending on the surgery and any medical problems. More than one person may ask about the person's medical history. Questions may include medical conditions, medications, and allergies. People will be asked when their last meal was. A recent meal may cause the surgery to be cancelled due to risks. It is important to answer all questions completely and honestly. The heart rate, blood pressure, and temperature may be recorded, sometimes more than once.

If consent forms and other legal documents were not previously completed, they will need to be signed before surgery. The anesthesiologist usually comes to talk to people about the anesthesia. Anesthesia is the medicine used to control pain and put people to sleep. A mild sedative may be given to relax the person.

Many different healthcare team members may come to the person's bedside, some of whom the person has not met before. In some cases, family members will be allowed to wait in the surgery prep room with the person. At other times, this may not be allowed. If a person is not sure who someone is, or what role they play in their healthcare team, they should feel free to ask. Any last-minute questions should be asked at this time.

If the person has not met the surgeon yet, the surgeon will introduce himself or herself. Alternatively, the surgeon may come by and say hello if the person already knows him or her.

At this point, people are usually wheeled to the operating room on a portable bed or a wheelchair. Many people are drowsy or even asleep from a sedative given earlier. The actual trip to the operating room and the operation are often not remembered at all. The next thing most people remember is waking up after the surgery. People usually wake up in an area called the surgery recovery room. The recovery room is usually located right next door to the operating room area.

The initial few minutes in the surgery recovery room are usually confusing. It is not unusual for people to wake up in the recovery room and have no idea where they are. People go from a deep sleep or heavy sedation to a room they have never seen before. For most people, the only thing they will remember when they wake up is the last few minutes before surgery. An oxygen mask may be in place when the person wakes up. The IV that was put in before surgery will still be in place. The blood pressure, pulse, breathing rate, and temperature are monitored closely. Nausea is very common when people first wake up. Vomiting sometimes occurs. Pain medication is given as needed to control discomfort.

The recovery room is often busy with activity. New people come into the room after surgery as others are leaving. There may be loud beeping noises made by the different monitoring machines.

When the person meets the criteria for discharge from the surgery recovery room, they will be transferred to the same-day surgery area. Once the anesthesia has worn off, the IV is removed and the person can go home. Someone else must drive the person home in almost all cases. This is because the medication used for pain usually impairs the ability to function normally for several hours. The doctor or nurse should give home care instructions before a person leaves. A follow-up appointment and phone number for the doctor are usually given at this time. Any questions should be asked before a person goes home.

Operating Room

Alternative Names: OR, surgery suite

Definition
The operating room is the place where most surgery takes place. The operating room may be inside a hospital, a same day surgery facility, or even a doctor's office.

What is the information for this topic?
The surgery prep area is where a person is prepared for surgery. Here, people are often asked to remove their clothes and put on a hospital gown. Questions are asked about the person's medical history, allergies, and other information. A meeting with the anesthesiologist often occurs at this time. This is the doctor who controls the anesthesia, which are the medications given to make sure no pain is felt during the surgery.

Medications may be given before the operation. This depends on the surgery and the person's medical history. A sedative is often given to help relax the person. Many people are drowsy or even sleeping before they get to the operating room.

A person is brought to the operating room by wheelchair or on a portable bed with wheels. The person is then moved onto the operating table. The operating table is at the center of most operating rooms. Around the operating table may be various other tables. These hold the equipment needed for the operation.

The anesthesia and monitoring equipment are kept at the head of the bed. This is where the anesthesiologist sits and monitors the person during surgery. Several of the operating room staff may already be in the room. Usually, at least one nurse and one technical assistant are present. Other people may be there as well, depending on the surgery. The operating room staff wear special outfits called "scrubs." Caps, masks, and rubber gloves may also be worn. These help protect both the person having surgery and the operating room staff against infection.

Once the person is correctly positioned on the table, the anesthesiologist enters the room. More medication is given to cause relaxation and, sometimes, sleep. In some types of surgery, the person is put totally to sleep with general anesthesia. In other cases, the person may be awake but a local anesthesia or regional anesthesia is used to prevent feeling pain.

At this point, the surgeon comes in and the final preparation begins. The area of the surgery is often cleaned with an antibacterial chemical. A sterile drape is then put around the area of the surgery. Many people are already asleep or heavily sedated at this point.

The surgery is then performed. If a person is not asleep and feels uncomfortable, more medication can be given. After the surgery, the medication is turned off and the person slowly wakes up. Once in a stable condition, the person is brought to the surgery recovery room.

General Anesthesia

Alternative Names: total anesthesia

Definition
General anesthesia is a method used to stop pain from being felt during a procedure or surgery. In this form of anesthesia, medication is given to make the person unconscious.

Who is a candidate for the procedure?
General anesthesia is the most powerful form of anesthesia. It is usually reserved for major surgery, such as surgery inside the skull, neck, chest, abdomen, and pelvis. Other procedures may also require general anesthesia.

How is the procedure performed?
General anesthesia uses medication to make a person unconscious. Medications are commonly breathed into the lungs or injected into the veins through an intravenous line inserted into the vein of the hand or arm. An individual may also be paralyzed with other medications to prevent movement during the surgery.

A ventilator, or artificial breathing machine, breathes for the person during the procedure. This is because the chest muscles are paralyzed. A ventilator requires a tube to be put into the windpipe, known as endotracheal intubation. The tube goes through the mouth and into the windpipe. Oxygen and inhaled medication can then be delivered to the lungs.

The person is watched closely during the procedure. The oxygen levels in the blood, pulse, blood pressure and other functions are monitored. Fluids are usually given through an intravenous line to prevent dehydration and low blood pressure.

The individual is totally asleep and unable to feel pain during the surgery. When the procedure is complete, the medication is turned off. The person will have no memory of the surgery when he or she wakes up.

What happens right after the procedure?
The person is taken to an area called the surgery recovery room after the procedure. When the person can breathe independently, the ventilator is turned off. It may take several minutes for the person to wake up and he or she may feel groggy at first. Doctors and nurses monitor the person in the recovery room. Pain medications are given as needed. Gradually, the person wakes up and begins the recovery process. The person may need to stay in the hospital for a few days to recover from the procedure. Often the person can go home after a few hours. The person must be stable and feel well enough to go home, and someone must be available to drive the person home. The medications cause coordination problems and slowed reflexes for several hours after surgery.

What happens later at home?
After getting home, the person should rest for the remainder of the day. By the next day, the anesthesia is usually out of the system. The following day, the pain from the surgery usually causes more problems than the anesthesia. A person should not drive for at least 12 hours after the procedure. Some people may take a few days to feel that they are back to normal.

What are the potential complications after the procedure?
The most feared complication of general anesthesia is death. This occurs in roughly 1 out of every 10,000 people. It is not possible to predict who will have this type of severe reaction.

The medications used in general anesthesia can cause severe reactions. These include: liver damage kidney damage seizures low blood pressure allergic reactions Nausea is fairly common for a few hours after the procedure. Other side effects may occur, depending on the medication used.

The American Society of Anesthesiologists recently issued a warning about the potential side effects and interactions of herbal remedies with medications used before, during, and after surgery. The group recommends that a person stop taking all herbs at least two weeks before planned surgery.

Other complications are possible, such as damage to the mouth or throat from the breathing tube. The surgery itself may also have complications.

Surgery Recovery Room

Alternative Names: recovery room, post-anesthesia care unit, PACU

Definition
The surgery recovery room is an area of a hospital used for the close monitoring of people who have had an operation in which anesthesia was given. The recovery room may also be used to perform special procedures. Occasionally, people come from other parts of the hospital, such as the X-ray department, following a procedure that involved sedation.

What is the information for this topic?
The recovery room is usually located next door to the operating room. This allows for the safe transfer of people. There is also ready access to surgeons and the anesthesia department. As a person starts to wake up from surgery, they are taken to the recovery room until the effects of anesthesia have worn off.

The first few minutes in the recovery room are usually confusing. It is not unusual for people to wake up in the recovery room and have no idea where they are. People go from a deep sleep or heavy sedation to a room they have never seen before. For most people, the only thing they will remember is the last few minutes before surgery.

An oxygen mask may be in place when the person wakes up. The intravenous or IV that was put in before surgery will still be in place. The blood pressure, pulse, breathing rate, and temperature are monitored closely. Nausea is very common when people first wake up.

Vomiting sometimes occurs. Pain medication is given as needed. The recovery room is often busy with activity. New people come into the room after surgery as others are leaving. There may be loud beeping noises made by the different monitoring machines.

When the person is ready for discharge from the recovery room, they will either go to the surgical inpatient unit, the intensive care unit or the same-day surgery area. They will continue to recover and will be sent home when appropriate.

Nausea

Definition
Nausea is a feeling of queasiness in the stomach. It is usually associated with the feeling that one is going to throw up, or vomit.

What is going on in the body?
Nausea is a feeling that almost everyone has had at some point in their lives. It can be caused by many different conditions, ranging from pregnancy or exercising too much to infection or cancer. Determining the cause of nausea is not always easy.

Most people with nausea have some of the following symptoms as well: abdominal distress a lack of appetite vomiting excessive sweating There may be other symptoms, too, depending on the cause of the nausea.

The list of conditions that can cause nausea is very long. It is best broken down into general categories. These include: an infection in the digestive tract, such as food poisoning an infection in another part of the body, such as the flu or an ear infection known as acute otitis media pregnancy alcohol gastroesophageal reflux peptic ulcers problems with balance and equilibrium, such as motion sickness anxiety and other psychological conditions certain drugs, such as antibiotics, narcotics, cancer chemotherapy, oral contraceptives, and pain medications problems in the abdomen, such as appendicitis, gallbladder disease, gallstones, kidney stones, hepatitis, pancreatitis, or bowel inflammation a blockage in the stomach, bowels, or esophagus, the tube that connects the mouth to the stomach. Esophageal atresia is an example of this type of blockage. systemwide conditions, such as poorly controlled diabetes, headaches, cancer, chronic renal failure, heart attacks, being overly tired, overexerting oneself, and hormone or salt imbalances birth defects in the digestive tract, such as a poorly formed stomach or intestine. These may include duodenal atresia, pyloric stenosis or imperforate anus. Other causes are possible. In some cases, no cause can be found.

Prevention is related to the underlying cause. For example, avoiding alcohol can prevent nausea from drinking too much. Medications can help with the nausea caused by traveling. If the nausea is due to morning sickness during pregnancy, eating crackers and avoiding fatty foods can help. There are many other examples of prevention depending on the specific cause.

People can diagnose nausea on their own. A healthcare provider can help a person figure out the cause of the nausea. The first step is a history and physical exam. In some cases, this may be all that is needed to diagnose the cause. In other cases, many other tests may be needed. Blood, urine, and x-ray tests are commonly done.

Nausea itself has no serious long-term effects, though it may be distressing and prevent sleep and other activities. The underlying cause may be very serious, however. For example, cancer is a rare cause of nausea that can lead to death. If vomiting occurs with the nausea, dehydration and salt imbalances may occur.

What are the risks to others?
Nausea itself is not contagious and poses no risk to others. In some cases, nausea is due to an infection that may be contagious.

Treatment is directed at the underlying cause. For example, if the cause is gastroesophageal reflux, medications can be given to treat the reflux. If the cause is appendicitis, surgery is needed to remove the appendix. Medications are also available to treat nausea if the cause cannot be treated or avoided. For example, people who need chemotherapy to treat cancer are often given drugs to reduce nausea before chemotherapy begins.

Some drugs that may help reduce nausea are available over-the-counter, such as Pepto-Bismol or diphenhydramine. Others are more powerful, such as ondansetron or dronabinol, and require a prescription.

What are the side effects of the treatments?
All medications have possible side effects. For example, diphenhydramine makes many people sleepy. Pepto-Bismol can turn the stools black. Other drugs can cause allergic reactions, diarrhea, or other side effects. Specific side effects depend on the medications used. Any surgery carries a risk of bleeding, infection, and reactions to pain medications.

If the underlying cause can be found and treated, the nausea should stop. If the cause cannot be found or cannot be treated, drugs to reduce nausea may help. For example, some people may need narcotics to control pain, but the narcotics make them nauseous. In this case, drugs to treat nausea can be given at the same time as the pain medications.

People with nausea can monitor it themselves as well as how it responds to treatment. The underlying cause of nausea may need further monitoring and treatment.

Pain Medications

Alternative Names: analgesics, pain drugs

Definition
A pain medication lessens the amount, duration, or sensation of pain.

What is the information for this topic?
There are many different types of medications used to lessen pain.

Some of these work directly on pain receptors in the brain. Others affect pain by decreasing inflammation. Other medications decrease pain by modifying how the central nervous system recognizes it. Some pain medications can be bought without a prescription from a healthcare provider. These are called over-the-counter pain medications. The two most common are acetaminophen and nonsteroidal anti-inflammatory drugs or NSAIDs. Acetaminophen is commonly found in the brand name Tylenol. It is good for relieving pain and fever. It is fairly easy on the stomach and is safe for children. However, this drug can be toxic to the liver in high doses. NSAIDs, such as aspirin and ibuprofen, are good for reducing fever and inflammation. This includes inflammation from arthritis, muscle injuries, and other conditions.

All NSAIDs may cause side effects. Examples include stomach irritation and bleeding, especially in older people. Kidney problems may also occur with long-term use. Aspirin should not be given to children unless it is specifically ordered by a healthcare provider. Aspirin in children has been linked to Reye's syndrome, a serious condition that can cause liver and brain damage.

Some pain requires stronger medications, such as prescription NSAIDs or narcotics. Narcotics directly affect the pain receptors in the central nervous system. They require a doctor's prescription. Narcotics are controlled by the US Drug Enforcement Agency (DEA). This is because narcotics can be addictive and sometimes, abused. People who receive these medication usually have intense pain that requires stronger medicine. Unfortunately, narcotics often don't work well for arthritis and many back injuries.

Some prescription medications work by changing the way the brain receives pain signals. These include tricyclic antidepressants, such as amitriptyline. These medications are often helpful for people with nerve damage and other types of chronic pain. Seizure medicine, such as gabapentin, may also be useful for chronic pain.

Some people have severe pain that won't respond to over-the-counter pain medicines. These people should talk to their healthcare provider. Pain can be a sign of a serious problem. If it is not, a healthcare provider can prescribe stronger medicine or suggest a specialist who can help control chronic pain.

Stress

Definition
Stress is any factor in a person's life that causes change. It can include emotional, physical, social or economic pressures.

Stress can be short-term (acute) or long-term (chronic). Acute stress is the reaction to an immediate threat. This is commonly known as the "fight or flight" response. The threat can be any situation that is experienced as a danger. Common stressors include, noise, crowding, isolation, illness, hunger, danger and infection. Imagining a threat or remembering a dangerous event can also evoke a stress response.

Modern life frequently results in on-going stressful situations. These may include difficult work or personal situations. Psychological pressures such as relationship problems, loneliness, and financial worries can lead to chronic stress. Physical illness, especially chronic conditions, is another common source of stress.

What is the information for this topic?
For most people, stress is almost always present. Too much stress can seriously affect physical and mental well being. Stress decreases the quality of life by reducing feelings of pleasure and accomplishment. At some point in their lives, almost all people will go through stressful events or situations that overwhelm their ability to cope.

Stress affects the body in many ways, including:

the release of chemicals called catecholamines from the brain. These are a group of hormones that include adrenaline and epinephrine.

An increase in heart rate and blood pressure occurs as the heart and lungs work harder. The rate of breathing also increases and the lungs take in more oxygen.

The blood flow increases to get the body ready for added demands.

Dryness of the mouth and throat.

Blood flow decreases to areas that are less important for basic survival, including the mouth. This causes dryness of the mouth and difficulty talking and swallowing.

Cool and clammy skin:

As blood flow is diverted to vital organs and muscles slowing down of digestion of food Long term stress can lead to physcial or psychologic damage to the body.

Stress can cause the following problems:

psychological disorders. Chronic stress may develop into more serious problems, such as an anxiety disorder or depression.

heart disease.

Mental and physical stress is a trigger for unstable angina, which is chest pain due to not enough oxygen reaching the heart. There is a higher risk for serious heart events, such as heart attacks. Death can occur from such events. Sudden stress can cause the heart arteries to constrict, causing blockage of blood flow to the heart.

People under a great deal of stress are also more likely to have high blood pressure, which can further increase the risk of coronary artery disease. stroke. The high blood pressure which can occur with stress has been linked to higher risk of strokes.

increased risk of infection.

Chronic stress causes the immune system to become less effective. This leaves a person more vulnerable to colds and flus. digestive problems. Prolonged stress can disrupt the digestive system, irritating the large intestines. This can lead to diarrhea, constipation, abdominal bloating, and cramping. Stress may predispose a person to peptic ulcers.

weight problems.

The effects of stress on weight can vary. Some people lose their appetite and lose weight. Others develop craving for "comfort foods" such as salty or sweet food, which can lead to weight gain. diabetes. Chronic stress has been associated with the development of diabetes and the impairment of a person's ability to manage the disorder.

pain.

Chronic pain caused by arthritis and other conditions may be made worse by stress. sleep disorders. it is important for a person under stress to get enough sleep. However, stress may cause trouble sleeping or insomnia, or cause the person to awaken during the night or early morning.

skin.

Stress plays an important role in a number of skin conditions, including acne, hives, psoriasis, and eczema.

sexual and reproductive disturbances.

Stress can lead to decreased sexual desire and erectile dysfunction, and may affect fertility. Stress hormones have on impact on the hypothalamus gland, which makes reproductive hormones.

When stress does occur, it is important to recognize and deal with it. People handle stress differently. What works for one person may not work for another. Some examples of ways to help ease the tension from stress include: being physically active. This may relieve the "up tight" feeling that is common with stress. Walking, running, playing tennis, or working in the garden are some examples.

talking to someone.

It often helps people to share their concerns with others. Talking with a friend, family member, teacher, or counselor can help people see their problems in a different light. When stress becomes overwhelming, different psychological therapies can be helpful These include identifying sources of stress, changing priorities, changing one's response to stress, and finding methods for managing and reducing stress.

taking care of one's body.

Getting enough rest and eating well can help increase a person's ability to deal with stressful situations. relaxing. It is important for individuals to balance work with play.

practicing deep breathing.

Breathing becomes shallow and rapid during episodes of stress. Taking deep breaths can help a person "wind down."

getting involved with other people.

People may feel better by helping someone else. It is also helpful to establish a support system. making lists. Making a list and eliminating items when they are complete can help make tasks feel less overwhelming. It also lends a feeling of accomplishment.

not holding back tears.

Sometimes a good cry makes people feel better.

A healthcare provider should be consulted for unmanageble stress. It is important to seek help if stress is causing insomnia, depression, severe anxiety, or affecting a person's ability to function.

Author: Gail Hendrickson, RN, BS Date Written: 07/06/00 Reviewer: Adam Brochert, MD Date Reviewed: 07/06/0

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