Brain/Skull Surgery Preoperative Instructions

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1. NOTHING TO EAT OR DRINK AFTER MIDNIGHT PRIOR TO ADMISSION.

2. Shampoo your hair and scrub your scalp gently with the ANTISEPTIC SOAP HIBICLENS which you will get from the hospital before admission. Use this soap in the shower and WASH ALL OVER with it.

3. Please provide a good contact number to my office staff since this will be given to the anaesthesiologist who will call you the night before surgery. Please be available and feel free to ask any questions regarding this important service.

4. Patients who are the first on the operating schedule must be at the hospital at 6:15 AM. You will be advised by my staff exactly where to report. All other patients will be advised regarding the time and place to present to the hospital.

5. You will be given long white elastic stockings. This is to keep blood from clotting in your legs while you are asleep. Put them on just before you go to the Operating Room.

6. You will be given some preoperative medication to assist in helping you to relax. Accompanying family members/friends may go to the operating area with you. They will be shown the way to the Surgical Waiting Room. I will talk with them as soon as I have completed the operation and I am satisfied that you are comfortable in the Recovery Room. You will be here for about one (1) hour.

7. Following my discussion with your guests I want them to go to the Intensive Care waiting room and await your arrival. They will have their first opportunity to visit with you after you are settled into the Neurosurgical ICU.

8. PAIN MEDICINE will be provided to you after surgery. Injectable narcotics are generally avoided since they will put you to sleep rendering you difficult to examine neurologically and less able to deep breath. This could result in pathologically increased intracranial pressure. Brain surgery is usually not painful and mild analgesics are usually sufficient. We do not want you to experience intolerable pain. If you have questions about this, feel free to ask.

9. For most patients, I will want you to be awake immediately following the completion of the operation. This permits us to conduct a very important initial post-operative neurological examination.

10. Once we are satisfied that you are sufficiently awake and responsive, we will determine if you can begin taking oral nourishment. Oftentimes this is within hours of having been introduced to your new surroundings in the Neurosurgical ICU. At first you will be offered ice chips to be followed by sips of water and then clear fluids. Determinations concerning your ability to take oral medications and food are made over the next few hours and days.

11. You may anticipate that there will be one or more intravenous (IV) lines providing you with IV fluids and medications. Many patients will also have an arterial pressure line inserted in the Operating Room after they are asleep. In a similar way, a bladder catheter is inserted since we want to know about all the fluids entering your body and all that are coming out.

12. In some unusual circumstances where controlling intracranial pressure is anticipated to be a significant problem, we may choose to leave the endotracheal tube (the breathing tube that is inserted by the anesthesiologist through which the anesthetic medication is delivered) in place post-operatively. In these cases, the patient will be sedated and breathing controlled by a special "ventilator" device that is beside the ICU bed. The Intensive Care specialist will be responsible for managing this aspect of your care. This is usually discussed with the patient in advance of surgery.