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Sizing Up Surgery

Routine Tests

The practice of ordering routine laboratory tests before admission for surgery is commonplace in most hospitals. Many doctors believe that urinalysis, chest x-rays, or complete blood counts, for example, can identify potential problems that might complicate the surgery if not detected and treated early. Some tests commonly performed before surgery and the symptoms that prompt doctors to order them are:

  • chest x-ray-- shortness of breath, chest pain, cough, fever without other source, abnormal sounds
  • electrocardiogram (EKG)-- chest pain, palpitations, arrhythmia, murmur, distant heart sound
  • urinalysis-- frequency, hesitancy, discharge, side pain, kidney disease, diabetes, use of drugs known to cause kidney disease
  • white blood count-- fever, suspicion of infection, use of drugs known to affect white blood cell counts
  • platelet count-- blood loss, easy bruising, alcoholism, use of drugs known to affect platelet count
  • glucose-- excessive sweating with tremor or anxiety, muscle weakness, diabetes, pancreatitis, cystic fibrosis, altered mental status, alcoholism
  • potassium-- vomiting, diarrhea, congestive heart failure, kidney failure, muscle weakness, tissue damage, hypertension, diabetes, use of drugs known to affect potassium levels
  • sodium-- vomiting, diarrhea, excessive sweating, thirst or fluid intake, pulmonary disease, central nervous system disease, congestive heart failure, cirrhosis.

Patients facing surgery need to discuss with their doctors the necessity of having certain tests performed prior to surgery, says Mary Pat Couig, R.N., Associate Director for Nursing Affairs at the Food and Drug Administration.

'Going Under'

Anesthesia is the art and science of relieving pain and keeping patients safe and stable during surgery. But for patients already nervous about their impending surgery, the idea of being unconscious may not be a comforting thought, especially if it's coupled with the fear of not regaining consciousness.

According to L. Melvin Elting, former Chief of Surgery at Riverdell Hospital in New Jersey, and Seymour Isenberg of the Kansas City College of Osteopathy and Surgery, authors of The Consumer's Guide to Successful Surgery, although many people associate anesthesia with regular sleeping, slumber is only a side effect. If you were to go to sleep and surgery began, you'd wake up in a hurry. While sleep involves a dousing of the highest brain recognition centers derived from the senses, it would take only a mild stimulus to peak them to alarm.

The unconsciousness or "deep sleep" required for surgery is another matter. The deep sleep that is required for loss of sensation of pain occurs in stages, beginning with a gradual dozing off to an eventual drifting into paralysis so that the nerve responses are dampened. Unconsciousness must then be maintained during surgery so that patients are not aware of their surroundings and do not experience pain.

Problems traditionally associated with anesthesia such as drug hangover, nausea, and awareness have been lessened over the years by better drugs, improved monitoring, and specialized training.

WebMD Public Information from the FDA

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