Jill Zafar, MD
Jill Zafar, MD, assistant professor of anesthesiology at Yale University and medical director of presurgical evaluation at Yale New Haven Hospital in Connecticut.
Bottom Line: Make your major or minor surgery a success with this advice from inside the operating suite.
It’s official, you need surgery. You understand its importance for your health, but there’s no denying that your nerves are on edge. First, take a deep breath to take any panic out of the equation. Then start to prepare for it, just as you would any goal you want to accomplish. To show you how, we turned to Jill Zafar, MD, medical director of presurgical evaluation at Yale New Haven Hospital in Connecticut.
Why an anesthesiologist? Often an unsung hero in the operating room, this is the doctor who not only maps out your anesthesia plan but also keeps you comfortable and safe during surgery and helps with pain control afterward. Dr. Zafar’s insider view on surgery-suite prep will help you get through your procedure with flying colors.
“Train” the way you would for a fitness event: You wouldn’t think of running a 5K race without preparing for it, says Dr. Zafar, who suggests you look at surgery the same way. In fact, an operation can stress your body as much as running that race would. If you have the luxury of time before your procedure, go into it in the best shape possible through exercise and a nutritious diet…with guidelines from your doctor or surgeon that take into account your general health. Doing so may make your recovery quicker and more comfortable. Make sure you eat enough protein, take any regular medications and continue to exercise. Cut back on alcohol.
Surprising tip: Some hospitals have formal surgery wellness programs designed to help patients sail into surgery in the best shape possible. Ask whether your hospital or surgery center has such a program, and get on board if it does.
Stop smoking: If you still haven’t kicked the habit, let surgery provide the impetus to finally quit. Dr. Zafar says that’s the case for a good number of people. Take advantage! Your lungs and heart don’t work as well when you smoke, and this may make you more likely to develop breathing problems during or after surgery. You’re also at higher risk of getting pneumonia. Smoking slows down blood flow, so your incision may heal more slowly or become infected.
Surprising tip: You should quit smoking now, of course. But even quitting the day before your procedure can reduce your risk for complications.
Get the most out of your pre-op appointment: Although you may have met your surgeon already, you’ll likely have a specific pre-op meeting (and possibly one with your anesthesiologist) in the days or weeks leading up to the procedure. Together, you’ll review all your medical conditions and make sure that you’re healthy enough for the procedure. Use this time to go over any medications, herbs and supplements you take. If you take any daily, ask which ones you’re able to take on the morning of your surgery. Some drugs may need to be stopped a week or so before surgery—certain ones interact with anesthesia and can trigger low blood pressure, while others can cause bleeding complications. If you’ll be spending at least one night in the hospital, confirm that your surgeon will give a list of your meds to the hospital so that you’ll be given those drugs during your stay.
Expect your doctor to ask about lifestyle habits that could interfere with anesthesia such as drinking alcohol and using recreational drugs as well as smoking. And be honest about everything—your doctors are not there to judge you but to protect you.
Important: Don’t forget to mention if you have or think you have sleep apnea. Anesthesia is riskier for people with this breathing problem, so special precautions are necessary.
You might need certain tests if you haven’t had them recently…
Depending on your unique health profile and any chronic conditions you have, you may need other tests or need to see other specialists.
Most people won’t meet their anesthesiologists until the day of surgery. So early on, ask your surgeon about what kind of anesthesia is most commonly used for your procedure.
There are four main types:
You may get a sedative along with local or regional anesthesia to make you more comfortable.
Share your concerns: If you’ve ever had a bad reaction to anesthesia, tell your surgeon or reach out directly to the anesthesia department in advance of your procedure to discuss it. Based on this history, your anesthesiologist might alter your anesthesia plan or add a medication such as something to prevent vomiting if that’s the problem you had.
Something more serious: It’s rare, but some people have a severe reaction under anesthesia called malignant hyperthermia (MH). It causes high fever and other problems and can be life-threatening. You’re more susceptible to having such a reaction if you have a certain genetic mutation passed down to you by a parent. If you know that someone in your family developed MH during surgery, your anesthesiologist will likely treat you as if you have it, too, as a precaution. There is a blood test that can look for the gene mutations most commonly associated with MH, but the only way to truly confirm or rule out susceptibility is with a muscle biopsy, a test done at only certain centers around the country. You can find out more at MHAUS.org.
Don’t be afraid of anesthesia: Some people, even those who have had anesthesia with no problems in the past, fear going under more than the surgery itself. You may even be worried about waking up from general anesthesia during surgery. That can happen in high-risk procedures such as open heart or emergency surgery if the anesthesiologist has to err on the side of keeping you alive versus giving you enough anesthesia to keep you fully unconscious. But it’s very rare, and even if you have some awareness, it’s unlikely you’ll feel pain.
Follow pre-op instructions: Typically, you won’t be able to eat past midnight the day before surgery. That’s because if there’s anything in your stomach, you could regurgitate it, inhale it into your lungs and end up with pneumonia. So follow the eating and drinking directions you’re given to the letter.
Surprising tip: Studies have found that a carbohydrate pre-op drink (think of a liquid version of the carbo-loading that marathon runners do the night before their race) can lead to better outcomes. A prolonged starvation period can itself produce stress and dehydration, explains Dr. Zafar. It turns out that the carb drink can lead to more stable blood sugar when you’re in recovery. Do not do this on your own, however, because it may not be safe for everyone. Ask your doctor whether this drink is an option for you and, if so, where to get it and when exactly to drink it.
What happens when you get to the hospital: The surgery center or clinic is a lot like the airport—there’s a lot to do before you get where you’re going. Pack your patience—it takes time to safely prepare you for your surgery. During this busy time…
If you’re having general anesthesia, the anesthesiologist may place a breathing tube in your throat to keep your airway open after you’re unconscious. If it’s needed, it will likely be removed before you wake up.
During surgery, the anesthesiologist will continually monitor your anesthesia levels and your vital body functions to make sure that you’re handling the surgery well.
In the recovery room, you’ll probably feel groggy and maybe briefly confused. You may have side effects such as nausea or vomiting or, if you had a breathing tube, a sore throat. If you had local or regional anesthesia, the injection site may be sore.
You’ll be in some pain: The amount will depend on the surgery you had. The anesthesia team can give you pain medications or a nerve block to make you more comfortable.
The majority of surgeries today take place at outpatient facilities. If you’re going home the same day of your operation…
Have someone there to take you home: You won’t be able to drive yourself home, but don’t attempt to take a bus or even a cab if you can help it. You need someone not only to help you in and out of the car but also to stay with you and see to your needs for at least a few hours as the anesthesia works its way out of your system.
Make sure that you understand post-op instructions: Your medical staff will give you instructions specific to your surgery. You’ll also learn about the signs of risky post-op complications and what to do if any develop. Ask the person who will drive or accompany you home to listen to any verbal instructions and take notes because you still may be a little fuzzy from the anesthesia.
Take these precautions: For 24 hours after surgery, even if your surgery doesn’t limit your activities, respect the fact that you had anesthesia and don’t drink alcohol, make any important decisions or use potentially dangerous machinery—many people scoff at this last one, but the advice isn’t limited to forklifts or bandsaws. Snowblowers and lawn mowers fall into this category, too. Your body needs time to recover its strength even if your head feels clear.
Take your pain medication as prescribed: Most people are sent home with opioid pain medications after surgery. The opioid abuse crisis has made some people afraid of taking them, but if you’re in so much pain that you can’t move around, you could develop complications such as pneumonia or blood clots. Your doctor may also prescribe ibuprofen or acetaminophen-based pills to cut back on the need for opioids, but in some cases, opioids are simply the most effective option.
If you’re concerned about them, talk to your doctor about exactly how to safely take them before you leave the hospital, and don’t hesitate to call your surgeon’s office about this or any other aspect of aftercare as you recover.
