In order to better understand the role of the anesthesia technician (AT) as a member of the anesthesia team and the flow of patients through the operating room (OR), it is useful to understand the overall surgical experience. This chapter provides a description of the different phases of care a patient may experience while undergoing a surgical procedure. This will serve as an excellent introduction to the perioperative environment.

Mr. Smith has been experiencing abdominal pain for several months. He finally went to his primary care physician. After an examination and preliminary testing, his doctor told him that he had a mass near his pancreas and that surgery would be necessary to remove it and to make a definitive diagnosis. Diagnosis is the identification of a specific disease or an illness gleaned from a history of signs and symptoms, a physical exam, and testing. A surgery patient is usually diagnosed prior to coming to the OR unless it is an emergency or the surgery itself is necessary to make the diagnosis.

Once the decision to proceed with surgery has been made, Mr. Smith will consult with the surgeon’s office staff to schedule the surgery. The timing will depend upon the following:

Prior to surgery, a patient may go through additional testing or consultations to make sure that the medical condition is optimized, as much as time permits, prior to surgery. Standard preoperative (preop) testing may include an electrocardiogram (ECG), lab work, blood pressure, x-ray, urinalysis, etc. The type of testing will depend upon the patient’s medical condition and the scheduled surgery. For many healthy patients, pre-op testing may not be necessary.

Preadmission is the period of time prior to admission to the surgical facility. If the procedure will not take place for several days, the patient may be asked to return to the surgeon’s office for a pre-op visit; otherwise, the pre-op instructions will be given during the current visit. At this time, the surgeon will update the history and physical, provide instructions to the patient, and make sure that the patient understands the risks and benefits of the procedure he or she is about to undergo. Most institutions require that a history and physical be performed within the 30 days prior to a surgical procedure. All necessary documentation, such as the consent form and any legal forms, can also be completed at this time. Patients receive pertinent information regarding what needs to be brought with them the day of the surgery, what to avoid (i.e., not have anything to eat or drink 8 hours prior to surgery), what to expect after surgery, whether or not medications should be continued, and also when they should plan on arriving at the hospital or outpatient surgical facility. The patient will often be given prescriptions for medications to be
taken during the postoperative period and care instructions for the period following the procedure. The vast majority of surgical procedures today are performed on an outpatient basis, and all of the above information is essential to help the patient be prepared for the surgery and the postsurgical period.

On rare occasions, an anesthesia consultation may be requested by the surgeon. These are reserved for patients with severe medical conditions or special considerations that affect anesthesia. For example, the patient may have a family history of a rare, but lethal, reaction to a certain anesthetic.

Mr. Smith arrives at 5:00 in the morning at Sunnyside Hospital. He proceeds through the admission process where paperwork is filled out and his insurance verified. Mr. Smith had to get up at 3:00 am to get ready and have his wife drive them to the hospital, which was an hour away from their home. They are both tired and anxious. To make matters worse, Mr. Smith is asked about his religious preferences and who to designate for power of attorney should anything bad happen to him during surgery. The admissions personnel give Mr. Smith an identifying wristband.

Patients coming in for surgery are asked to arrive 1-2 hours prior to their scheduled surgery time. Upon arrival, the patient will be prepared for the OR. In many cases, the patient will have had an opportunity to fill out admission paperwork in advance. In other cases, the paperwork will need to be filled out at the surgical facility. At the appropriate time, the patient will be referred to the pre-op holding area.

Mr. Smith and his wife wait in the waiting area for about 3 hours. Mr. Smith’s surgery has been delayed because his doctor, Dr. Martin, has been delayed due to an emergency surgery that was added on this morning. Finally, at 9:00 am, Mr. Smith and his wife are escorted to the pre-op holding area. The nursing staff in the pre-op holding area assign him to a bed and have him change into a hospital gown. The pre-op nurse goes over an exhaustive list of questions about Mr. Smith’s medical history and medications. He is told that someone from the anesthesia department will see him soon.

In the pre-op area, patients will be asked to change into a hospital gown and wear a cap to cover their hair. They will also be asked to remove any items such as jewelry, hearing aids, contact lenses, glasses, and dentures, which will be stored away. Their identification bracelet will be checked. If there are any allergies, or any precautions, patients will receive an additional band to alert all medical personnel. A nurse will come in and take vitals, measure height and weight, measure body temperature, and note if there are any changes in health. An intravenous (IV) line will also be placed to keep the patient hydrated and also as a place for administering medications. The nurse will also confirm that the paperwork and the surgical consent form are in order and have been signed by the patient and the surgeon.

Mr. and Mrs. Smith wait in the pre-op holding area for another 30 minutes. Finally, the surgeon arrives. She apologizes for the long delay and begins reviewing the procedure with the Smith’s. Dr. Martin puts her initials on Mr. Smith’s abdomen. Once all of the Smiths’ questions are answered, Dr. Martin hurries off. Shortly thereafter, Dr. Kirby, the anesthesiologist arrives. Once again, Dr. Kirby reviews Mr. Smith’s medical history with him and performs a brief physical examination, which includes asking him to open his mouth wide and extend his neck. Mr. Smith is given the option of an epidural to help him with pain control after the surgery. The Smith’s are unsure but decide to go ahead with the procedure because the doctor must know best. Dr. Kirby finishes up with a discussion of the risks and benefits of the anesthesia, the invasive lines that will be placed, and the epidural. All of the things that can go wrong are a bit scary to Mrs. Smith, but she says nothing so as not to alarm her husband. Dr. Kirby hurries off and says that he will be right back. Soon the surgical nurse arrives and again asks many of the same medical questions. She also verifies the consent form.

Many things happen in the pre-op area. The pre-op nursing staff will take vital signs, go over the patient’s medical history, and start an IV line. They will also record information in the medical record and make sure all the paperwork is in order and up to date. In many cases, the patient will get to briefly meet with the surgeon. The surgeon will answer any last minute questions and “mark” the surgical site on the patient. Marking of the surgical site in cooperation with
the patient is to reduce the risk of wrong-site surgery. In addition to meeting the surgeon, the patient will meet some of the other members of the OR team. The circulating nurse in the OR