special subjects
Surgery
The Day of Surgery
Before most operations, a person removes all clothing, jewelry, hearing aids, false teeth, and contact lenses or eyeglasses and puts on a hospital gown. The person is taken to a designated room (called the holding area) or to the operating room itself for final preparations before surgery. The skin that will be cut (operative site) is scrubbed with an antiseptic, which minimizes the number of bacteria and helps to prevent infection. A health care practitioner may remove hair from the operative site with clippers or with hair-removing liquids or creams. Sometimes a plastic tube (catheter) is inserted into the bladder to collect urine during surgery. A catheter is inserted in one of the veins of the hand or arm. Fluids and drugs are given through the catheter. A drug may be given by vein (intravenously) for sedation. If an operation involves the mouth, intestinal tract, lungs or respiratory tract, or genitourinary tract, people are given one or more antibiotics within 1 hour before the operative site is cut to prevent infection (prophylaxis). Antibiotics are given by mouth or vein depending on the operation and are usually discontinued within 24 hours after surgery. This therapy also applies to people undergoing some other operations in which infections are particularly problematic (for example, joint or heart valve replacement). On the day of surgery, people who useinsulinto treat their diabetes are typically given one third of their usualinsulindose in the morning. People who take drugs by mouth to treat their diabetes are given half of their usual dose. If possible, surgery is done early in the day. The anesthesiologist monitors the blood sugar (glucose) level during surgery and gives additionalinsulinor glucose as needed. People do not resume their usual at-homeinsulinregimen until they resume their regular diet. Before a breathing tube is inserted in the windpipe, dentures must be removed. Ideally, before people are moved from the holding area, they should give their dentures to a family member. People who have takenprednisoneor another corticosteroid for more than 3 weeks within the past year before surgery may need corticosteroids during surgery. Corticosteroids are not given during minor surgical procedures. 