Recently I watched a romantic comedy Korean drama. Incidentally, there was an episode where the main cast (the male and the female cast) underwent breast cancer surgery. Yes, the hero also has breast cancer, and both had the surgery at the same hospital on the same day.

I was amazed to see the pre-operation (before surgery), intra-operation (during surgery) and post-operation (after surgery) scenes. Each of them was portrayed precisely like an actual medical scenario. None of the scenes was made in a slipshod manner. And this was just a comedy-drama, not a medical drama.

The episode showed patients were being prepared for surgery, what happened during the surgery, post-surgical care and until they were discharged home.

In one scene, the actors were positioned semi-recumbent as soon as they arrived in the ward. Nurses did four-hourly positioning for them. Once they recovered from anaesthesia, the nurses instructed them to do breathing exercises via incentive spirometry.

Facts about surgery under anaesthesia:

PRE-OPERATION (pre-surgery)

When you go for surgery, the anaesthesiologist in charge of your anaesthesia will see you a day before your surgery. Most of the time, you must go to the Anaesthesia Preoperative Clinic for a preoperative assessment weeks before your scheduled surgery. In the clinic, the doctor will screen for medical risks and try to optimise them so you can go under anaesthesia. Bring all your medication and any medical reports available to you; blood tests result, x-rays etc. 

Sometimes, you need to be referred to a specialist from another discipline to get your medical problems under control. For example, if you are found to have heart failure, you will then be referred to a cardiologist for further workup. The anesthesiologist would want to prepare your organ function to an optimum state so you can survive the surgery unscathed.

Once you get the green light from the anaesthesiologist, you may go for surgery as planned. 

You should fast for at least 6 hours but are allowed to drink only clear fluid for up to 2 hours before the surgery. It is dangerous to withhold information about your fasting duration. If the fasting time is inadequate and the anaesthesiologist does not know about it, no precaution will be taken. The stomach acid can be aspirated into the lungs causing the lung tissues to burn and inflamed during the anaesthesia. This can be fatal as burnt lung tissues cannot exchange oxygen effectively. 

Patients should also stop smoking 7 weeks before surgery so the lungs can generally function throughout anaesthesia, especially after surgery. The impaired lung function can severely affect your recovery in general and may result in a prolonged hospital stay.

Make sure you understand the surgery. Only sign the consent form after understanding the procedure, the anaesthesia involved and its risk. It is best to discuss surgery with the surgeon who will perform it, not just any surgeon.

Do discuss the best anaesthesia method for you with your anesthesiologist. Ensure you understand anaesthesia's side effects, especially if you have many co-morbidities. The more co-morbidities you have, the higher possibility of you may have peri-operative complications. Sometimes your anaesthesiologist may recommend an additional procedure (epidural or regional anaesthesia) to ensure you can manage pain after surgery.

Take off your makeup, nail colour, dentures and jewellery before going to the operating theatre. Not only will you feel comfortable, but your care will also be pleasant to everyone. It is best to shower before surgery because you will be stuck in bed for a few days after surgery.

Remove the glasses and dentures but take them to the surgical board. You may need glasses for authorisation of consent. Do inform us if you have any loose teeth or crown/bridge teeth made. We will take extra precautions with your expensive dentures.

INTRA-OPERATION (during surgery)

The moment you enter the operation theatre (OT), the scrub nurse will verify your personal information (name, IC number), the site, and the name of your procedure/surgery. Again you will be asked the same question when brought inside the operation room (OR). Don't be angry if a similar question is asked several times (at least 3 times). It is just a safety procedure to ensure the right patient, correct procedure and right side for your own sake.

Do calm down before being anaesthetised. You may say a prayer or meditate. Just trust the Lord and pray that everything will go smoothly.

You will be given a concoction of anaesthetic drugs through your intravenous line. While you are being anaesthetised, the ventilator will take over your breathing, and your physiological changes will be monitored and cared for by the anesthesiologist. You will be drifted into a different state of unconsciousness.

POST-OPERATION (after surgery)

The anesthesiologist will wake you up once the surgery is over. We will bring you back from the deep state of anaesthesia using a special method, including certain drugs. Open your eyes and stay calm when you hear your name being called. Do not panic if there is a big tube inside your mouth. Just follow our instructions by opening your mouth and allowing us to suction your phlegm before taking out the breathing tube.

You will be monitored at the recovery bay for a while. It is ubiquitous to feel dizzy and lethargic. Some may feel nauseous and even vomit up to a few hours after anaesthesia. Ask for pain relief medication if you still have pain.

As soon as you are brought back to the wad, the nurse will check your vital signs and change your clothes. They will also ask about your pain score and check if you still feel nauseous. They will let you rest and put you in a semi-recumbent position. You can eat and drink once you no longer feel nauseous. Some types of surgery may require you to be kept fast for longer.

For surgery involving the abdominal, chest or any surgery of long duration, you will be taught to use incentive spirometry (IS) after the surgery. An incentive spirometer is a device which helps expand and strengthen the lungs after surgery. You will be asked to take deep inspiration, pause using the device, and see how much your lung can expand. You must use the device every hour until your lung is fully expanded. Lung zones that collapse after the surgery (atelectasis) cannot partake in good gas exchange and are prone to develop infection (pneumonia). These may cause poor recovery.

Often tight stocking and anti-clotting drugs such as heparin will be given to a specific category of patients to prevent fatal blood clots from forming in the lungs and the heart. 

You will be encouraged to ambulate as quickly as possible to restore good lung ventilation and blood flow. Don't just lie in bed, refusing to move out of fear of having pain. We will give you adequate pain medication in many forms to assist your post-surgical ambulation move quickly. The faster you move, the better the recovery.

Let the surgical wound recover on its own. Eat well and do not take unnecessary supplements to speed up wound healing. Of course, recovery will take time, as the human body is complex and intricate.

Dr Hana Hadzrami.