Pre-Operative Goals
The results and findings from diagnostics, physical and neurological examinations can help the medical team provide the patient with the following:
– Correct dosage of anesthesia
– Pre-operative medical treatment
– Monitoring during a surgical procedure
– Post-operative pain management and care
In addition to these, the preoperative evaluation can be very useful in providing opportunities for the patient, primary care physician, treating specialists, surgeon, and anesthesiologist to communicate concerns before and after surgery.
Discuss Your MRI or CT scan results with your Patient Care Manager
Once your report and images have been reviewed, your Patient Care Manager will discuss personalized treatment recommendations and next steps with you.
Medical History and Examination
A detailed medical history would contain information about the following:
– Known Allergies from medication, food, allergens, etc.
– Side effects from medications especially anesthesia.
– Dietary supplements are taken daily.
– Pre-existing medical conditions such as diabetes, high/low BP, etc.
– Health issues in the family line and history.
– Tobacco and alcohol use.
– Previous surgical experiences (i.e. negative experiences with anesthesia).
– History of unusually bleeding following bruising.
Our physician would conduct a detailed physical examination of the patient to determine and record the following:
– The patient’s blood pressure, pulse, respiratory rate, body temperature, height, and weight.
– The patient’s heartbeat and breathing.
– Takes note of any abnormalities of the head, neck, eyes, ears, nose, throat, etc.
– Patient’s physical stamina while walking, climbing stairs, or running.
– Observes the patients range of motions while moving the neck, back or other parts of the body.
Our physician can also conduct a neurological examination to determine the patient’s mental status, and consider sensory and motor functions.
All these test and examinations are carried out because any condition affecting the cardiovascular, pulmonary, gastrointestinal, endocrine, and nervous systems can increase surgical risk. Determining, understanding and addressing these health issues before and during surgery can reduce risks and make the spinal surgical procedure safer.
Pre-Operative Tests
1. Blood Test
Testing a small blood sample can provide information about the patient’s general health.
Pre-operative blood tests are done to check for the following conditions:
– A low red blood cell (hemoglobin) count may indicate anemia.
– A low white blood cell (leukocytes) count may indicate viral infections.
– A partial thromboplastin time (PPT) test will indicate the time it would take for a clot to form in the blood sample.
The level of glucose in the blood sample would indicate if the patients are diabetic (high blood glucose level) or hypoglycemia (low blood glucose level).
2. Urinary Test
Urinalysis is done to detect urinary tract infection (UTIs), Kidney function, type 1 and 2 diabetes, and hydration/dehydration state of the body.
3. Pregnancy Test
All female patients within the productivity (childbearing) age will undergo a pregnancy test.
4. Test for Medication
Test for medication is done to determine the level of medication in the patient’s system because some medications like anti-arrhythmics (cardiac rhythm control drugs) can affect anesthesia.
5. Cardiovascular Test
Male and female patients over the ages of 50 and 60 respectively may be given a preoperative electrocardiogram (EKG), which is a routine test that determines the electrical and muscular functions of the heart. More so, patients with a history of diabetes, angina, peripheral vascular disease, cardiovascular surgery, or smokers may undergo the EKG test not minding the age. They may also be given a chest X-ray.
6. Pulmonary Test
The process of pulmonary (lung) function test requires the patient to breathe into a spirometer (i.e. an instrument that measures the volume of air inhaled and exhaled). Arterial Blood Gases (ABG) will also be used to measure the amount of oxygen and carbon dioxide levels in the blood. It also measures the movement of oxygenation and the movement of air in and out of the lungs (ventilation).
Other Pre-operative Considerations
1. Blood Loss
Loss of blood is always a possibility in every type of surgical procedure. A member of the medical team handling your case (surgeon or anesthesiologist) will discuss the benefits and downsides of donation your own blood (autologous donation) as compared to taking someone else’s blood.
2. Smoking or Tobacco Use
If you smoke or use tobacco, our surgeon would advise you to stop smoking or using tobacco several weeks before spine surgery. The following risks are some of the reasons why we advise for a halt in smoking:
– Cigarettes and other tobacco products contain toxins that can limit blood cells from carrying oxygen.
– Intake of tobacco increases the risk of surgical complications.
– Smokers are prone to suffer from respiratory ailments than non-smokers.
– Smokers would normally require supplementary oxygen during surgery and may need assistance breathing after spine surgery.
– Patients who smoke stand higher chances of failed fusion.
3. Consent Form
Before your surgery, we’ll schedule a meeting between you and your surgeon and/or anesthesiologist, and during this meeting, we’ll review the following:
– Your medical records
– The benefits of the proposed surgery
– Type of anesthesia to use
– The surgical procedure(s)
– Potential risks and complications
– Pain management
– Pre and post hospitalization
– Rehabilitation
– Recovery
Therefore, the surgical and anesthesiology plan for surgery is put into writing in the Consent Form. Hence, by signing the Consent Form, the patient gives his/her permission to the surgeon and/or anesthesiologist to perform the surgical procedure(s) as stated in the Consent Form.
Note: The surgical and anesthesiology Consent Forms may be together or in separate documents.
Pre-operative Checklist
Before a pre-planned spine surgery, you will be instructed (usually in writing) on do’s and don’ts before surgical procedure. The list below is not all-inclusive, but it’s close to what your spine specialist would give you.
Some types of over-the-counter medication (e.g. Anticoagulant drugs such as Coumadin and aspirin) can thin the blood cells and delay/hinder blood coagulation. You will be advised to stop taking such drugs a week or more before your surgery.
Prepare for your transportation back home after the surgery because we won’t allow you to drive yourself home.
You may need home assistance or someone to stay with you depending on the type of spine surgery you’ll undergo. If there is a need for home health care aid, our physician can help you to make the arrangement.
Ensure you do meal planning, purchase groceries, and re-arrange your bathroom/kitchen for safety and convenience before the surgery.
Follow the physician’s advice about eating and drinking the day before and day of surgery.
If you take a particular medication every day (e.g. blood pressure pills), consult your doctor to know if you should take the medication on the day of surgery.
Reach out to your physician if you have any questions to ask.
Day of Surgery
You will need to read and adhere to the following instructions before hospital admission:
– Leave your house early enough if you are coming to the surgical center or hospital on the day of surgery. Feeling rushed may make you tensed.
– Wear loose clothing that would be easy to take off and out back on.
– We suggest you wear shoes that you can slip off and on.
– If you will spend the night in the surgical center, ensure to pack nightclothes, slippers, and toiletries.
– Do not bring your jewels, earrings, and watches to the hospital or surgical center.
– Bring along your hearing aids, glasses, and dentures.
– After hospital admission, you may undergo the following preparative procedures:
– You will be moved to the pre-operative section.
– Medical staff will review your medical history and other reports.
– Medical staff will check and recheck your vital signs before an intravenous line (IV) is started.
– Anesthetics and other drugs will be administered through the IV.
You will be wheeled into the operating room (you may or may not be awake at this point).
In the operating room, the anesthesiologist will put you to sleep and keep monitoring your signs during the surgery.
Post-operative procedures (following the surgery):
– You will wake up in the recovery section of the hospital.
– Medical staff will monitor your pulse, blood pressure, respiration, and other signs.
– The medical staff will manage your post-operative pain.
– When you’re fully awake and stable, you’ll be taken into the hospital room.
– If your procedure allows you to go home the same day, our medical staff will give you a written instruction to follow.