The day of the operation

Tuesday 1 April, 2014

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On this page: Di's story | Anaesthesia | The operating theatre | Unknown factors | Surgical wound | Key points

Although each person’s situation is different, this section provides general information about what may happen on the day of the operation.

You should arrive at the allocated admission time. Arriving early doesn’t mean you’ll be admitted early. When you’re admitted, you might not know the exact time of the surgery, but you’ll probably know if it will be in the morning or the afternoon. There are sometimes unexpected delays, depending on other patients or emergencies – the receptionists and nurses will keep you informed.

You will change into a surgical gown and put your personal possessions in a bag for storage (or your support person can keep them). If the surgery affects part of your body with hair, it will be shaved.

You may also have pre-tests or scans (e.g. a urine test, x-ray or heart scan). Some people have ‘pre-medication’, such as an injection or tablet to help them feel relaxed.

Your medical team can give you information about the operation, but there may also be some ‘unknowns’. For instance, they may not know how many stitches you will need, or if you will need a blood transfusion, until the operation.

"I had a wire lumpectomy on my breast. It was a day procedure. My son and his partner stayed in the waiting room, then took me home in the afternoon." – Deanna   

Di’s story

"I was admitted for breast reconstruction surgery. While lying in the pre-theatre area, my plastic surgeon informed me that my implant hadn’t yet arrived. He expected me to agree straightaway to having a different, bigger implant.

"I declined having this implant, despite feeling extremely pressured. Consequently, the surgery had to be rescheduled. I had the procedure I wanted, and I’m glad I stuck to my original decision.

"My case shows that there can be unforeseen problems or major changes to the proposed surgery after you’re admitted. My advice is to manage your stress and have a support person available. If something comes up, discuss the options and decide if you still want to proceed."

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Your medical team will give you drugs to temporarily block any pain or discomfort you feel (anaesthesia or anaesthetics). An anaesthetist will prescribe these drugs and monitor you, if necessary.

General anaesthesia

Puts you into an unconscious state and keeps you there for a certain period of time. Although this is sometimes described as being ‘put to sleep’, it’s not the same thing.

You may experience some side effects when you wake up from general anaesthesia. Most of these side effects are temporary and are easily managed by your medical team – see below.

Local anaesthesia

Involves numbing part of the body, usually using drops, sprays, ointments or injections into the tissue. You are still awake and aware of what’s happening. The numbness typically lasts for several hours to a day.

Regional anaesthesia (regional block)

A local anaesthetic is injected through a needle placed close to nerves. This may include a nerve block, spinal or epidural anaesthetic. Local anaesthetic is also applied to the skin beforehand so the needle prick doesn’t hurt.

Before you receive anaesthesia, the team will talk to you about your medical history. You should also tell them about your current condition – for example, when and what you last ate and drank, or if you think you have a cold or the flu.

"The doctor used local anaesthetic on the skin on my arm, then cut off the mole. I saw what was happening but I didn’t feel any pain. The numbness wore off in a few hours." – Craig 

Risks of anaesthesia

It’s uncommon to have an allergic reaction to anaesthetic. Your medical team, including the anaesthetist, will review your medical records and general health to determine if you are at risk of having an adverse reaction (e.g. low blood pressure, hives, swelling or breathing problems). Anaesthetists are trained to recognise the signs of allergic reactions and they will give you medication to reverse any complications. Your medical team will go over specific risks when you consent to the operation (see planning and preparation).

How will I feel after general anaesthesia?

The following side effects may occur:

Nausea and vomiting: About 20–30% of patients feel nauseated or vomit within 24 hours of surgery, but there are medications to control this. It’s common to vomit after eating your first meal. Sometimes vomiting makes you feel better. Some people feel nauseated during the first few days after discharge from hospital, but this eases.

Chills and dizziness: Your body may cool down after surgery, which can cause you to feel cold/shiver. Some people feel dizzy. You will be monitored to make sure that you aren’t getting an infection. During the operation and recovery, your temperature will be maintained, usually with warming blankets.

Mental effects: You may feel confused, groggy or ‘fuzzy’ in the minutes or hours after you wake up. Some people don’t remember why they had surgery. Most people make a full recovery and remember what has happened within a few days. Confusion is more common for elderly people and those who had memory problems before the operation. Rarely, people have ongoing effects (such as some memory loss or fogginess) a week or several months later. This is called post-operative cognitive dysfunction (POCD). The reasons why POCD occurs aren’t fully known.

Agitation: You might cry or feel restless and anxious when you wake up. Some people feel like their arms or legs are twitchy. This is a normal reaction.

Tell your medical team if any of these side effects get worse. 

"The doctor told me to count to 10 when he put the mask over my face. I got to three then all I remember is waking up. I don’t remember the operation at all." – Gillian

The operating theatre

You will lie on a hospital bed that is wheeled into the operating theatre. This is a clean (sterile) room where the operation occurs. The surgical team will wear caps, masks and gowns to prevent infection.

If you are having general anaesthetic, it will be given by injection or by inhaling gas through a mask. Sometimes both methods are used. You might feel a burning or stinging sensation, but once the drugs take effect, you usually won’t be aware of what’s happening. Some people say it feels like a deep, dreamless sleep.

During surgery, a machine called a ventilator breathes for you. The anaesthetist constantly monitors you to make sure your pain is controlled until the procedure is completed. They will check your vital signs (e.g. heart rate, temperature and blood oxygen levels) using tools like a pulse oximeter.

When the operation is done, the anaesthetic will begin to wear off slowly or you will be given more drugs to reverse the effects. At this time, you’ll be taken to a recovery room and your vital signs will be monitored until you are fully awake. You may experience side effects from the anaesthesia – see above.

Unknown factors

There are some things that the medical team may not know until the operation is in progress:

Needing a transfusion

If you lose a lot of blood, some blood or blood products can be transferred into your body (transfusion). Someone else’s blood is usually used. There are strict screening and safety measures in place, so this is generally very safe.

If you’re concerned about receiving someone else’s blood products, you might be able to bank some of your blood before the surgery, so it can be transfused back. Ask your doctor for more information.

Taking a different approach

The surgeon may plan for laparascopic (keyhole) surgery but revert to open surgery due to complications or difficulties.

Removing extra tissue

If the cancer is found in other places, your doctor may remove extra tissue. It may be difficult to tell you exactly what will be removed before the operation, as scans don’t always detect all of the cancer. The surgeon will remove as much cancer as possible during the operation.

Involving another surgeon

Another surgeon may be called into the theatre to assist your surgeon. This is standard practice, as the extra support or advice can help achieve the best outcome for you. For example, a gynaecological surgeon may get assistance from a colorectal surgeon if the bowel is affected.

Creating a stoma

The medical team will talk to you beforehand about the possibility of creating an opening in the body. This is called a stoma, and it may be temporary or permanent. An example of a stoma is when parts of the bowel are connected to the skin (e.g. a colostomy).

Your medical team – including a stomal therapy nurse – will give you specialised information and support if this relates to you. Call Cancer Council 13 11 20 for more information or to arrange to speak with someone who has a stoma.

Surgical wound

Your surgeon can choose how to close up the incision created during the surgery. They might need to close up several layers of tissue (e.g. muscle and skin).

The surgeon’s approach will depend on the part of your body affected and what kind of surgery you have (e.g. open/large cuts or keyhole/small cuts). Common methods of closing a surgical wound include:

  • sutures or stitches – sewing the wound closed using a strong, thread-like material that can sometimes dissolve
  • staples – small metal clips • glue (e.g. Dermabond™) – transparent liquid or paste used to seal minor wounds (up to 5cm), or applied on top of sutures
  • adhesive strips (e.g. Steri-Strips™) – pieces of tape placed across the wound to hold the ends together, which may be used with sutures. 

Sometimes skin is taken from another part of the body and placed on top of the wound to help it heal. This is called grafting.

The wound will usually be covered with surgical dressings to keep it dry and clean (sterile). This will be in place for a couple of days, then changed regularly. The nurses can look at the wound to see if it’s healing and check for bleeding or signs of infection. If you have a shower, the dressing will be taken off and reapplied afterwards.

The wound may feel itchy or irritating after surgery. Tell the nurses if this happens – it could be a sign it’s healing, but it may also be a problem. For example, some people are allergic to certain types of adhesive tape and dressings.

Sutures or staples may need to be removed in 7–10 days. See recovery after surgery for information about follow-up appointments. 

Key points

  • On the day of the operation, you should arrive at your allocated admission time. Arriving early doesn’t mean you’ll be admitted early. You may not know the exact time of the surgery, but you’ll probably know if it is scheduled in the morning or afternoon.
  • You may also have pre-tests or scans (e.g. a urine test, x-ray or heart scan). Some people have ‘pre-medication’, which may be an injection or tablet that makes you feel relaxed.
  • Your medical team will give you some drugs to temporarily block any pain or discomfort you feel (anaesthesia or anaesthetics).
  • General anaesthesia puts you into an unconscious state; local and regional anaesthesia numb parts of the body while you are still awake and aware of what is happening.
  • It’s rare to have a bad (allergic) reaction to anaesthesia. If it occurs, the anaesthetists will give you medication to reverse any complications.
  • After general anaesthesia, you may experience some side effects, including nausea, chills, dizziness or agitation. Side effects usually go away within hours. Some people feel groggy or fuzzy for a few days. Tell your medical team how you are feeling.
  • There may be unknown factors about the operation. For instance, another surgeon may be called in to assist, or extra cancer tissue may be removed. Your doctor will discuss the possibilities with you before the operation.
  • Surgical wounds can be closed up using sutures, stitches, staples, glue or adhesive strips. 

Reviewed by: Dr Bronwyn Avard, Deputy Director, Intensive Care Unit, The Canberra Hospital and Senior Lecturer, ANU Medical School, ACT; Kylie Foley, Registered Nurse, Urological, Gynaecological and Vascular Surgery, Royal North Shore Hospital, and Practice Nurse, Hills Family General Practice, NSW; Di Holt, Consumer; Shelly Hunter, Physiotherapist, Brisbane Private Hospital Rehabilitation Unit, QLD; Lorraine Kealley, Registered Nurse, Medical Oncology Ward, Royal Perth Hospital, WA; Shomik Sengupta, Urologist, Sengupta Urology, VIC; Dr BP Wheatley, Retired Generalist Obstetrician and Gynaecologist, SA; Carmen Heathcote, Yvonne Howlett and Amy Parker, Helpline Operators, Cancer Council Queensland.
Updated: 01 Apr, 2014