Assessment for Surgery
The physician can do this alone or together with a specialist nurse. It is a duty to explain all the elements of the procedure that the patient or their legal guardian cannot be expected to know. The discussion should include the following:
- The problem to be treated.
- Likely outcome, complications, e.g. infection, nerve palsy.
- The nature of the scar and where it will lie.
- Alternative treatments and their merits.
- The consequences of doing nothing.
- The operation will take place in an operating theatre. The patient may need to change from their outdoor clothes into theatre clothes.
- The operation will take place under local anaesthesia and not general anaesthesia. The patient will therefore be awake throughout the operation.
A consent form should then be signed and a note made in the patient records. A handout may be helpful.
This need not be as detailed as for a patient having a general anaesthetic, but the medical history should seek information about the following:-
|Relevant History||Reason and Action|
|Diabetes||Timing of operation in relation to meals. The insulin dependent diabetic has to time their food intake carefully.|
|Epilepsy||May limit the dose of Lignocaine or other cerebral stimulants used.|
|Bleeding Tendency||Genetic: Aspirin, Warfarin and prostaglandin inhibitors may be important, as well as vaso-dilators, such as alcohol.|
|Pace Maker||Consider the type of diathermy used, Unipolar v Bipolar.|
|Myocardial Infarction||Operation best deferred until at least six months after a myocardial infarction.|
|Renal or Liver Failure||May affect excretion of drugs.|
|Excessive Anxiety||May require pre-medication.|
|Hepatitis B or HIV||Extra protection needed for staff. Only essential operations should be considered.|
|Pregnancy||First trimester of pregnancy, non-essential intervention should be avoided.|
|Hypertension||May increase superficial oozing and bleeding.|
|Keloid Scars||Discuss likelihood of formation of further hypertrophic or keloid scars.|
|Allergies||Check whether allergic to systemic medicaments, e.g. Penicillin and local anaesthetics or topicals, e.g. Povidone Iodine or colophony in plasters.|