1.1 Preoperative Care
The preoperative phase is the period between the decision to have surgery and the onset of the surgical procedure. This phase can be brief in the case of an emergency, or this phase can occur while testing, scheduling, education and screening takes place in a non-emergent case.
In all instances during the preoperative phase, a consultation must occur, a health history must be obtained, and financial and surgical consent must be given.
Duties of the CDA during the preoperative phase:
- Ensure that patient information, and health history are complete.
- Ensure that referral and radiographs are in consult room.
- Seat patient (remember to inform surgeon if the patient is a “patient of record”).
- Explain NPO and Pre Op Instructions (sedation).
- Following consult, take note of any special instructions prior to surgery date.
- Ensure that operatory set-up is planned/complete.
Examples of special instructions to confirm prior to surgery:
•Medically compromised patient (diabetic, cardiovascular disease)
• Allergies (latex, penicillin, etc)
• Pre-medication required
• Discontinuation of anti-coagulant
• Lab work: surgical guide, denture insertion
• Coordinate surgery with denturist or prosthodontist
Q: What is the absolute contraindication of any surgical procedure?
A: Patient refusal is the absolute contraindication for surgery.
Q: What is the purpose of the interview for preoperative patients?
A: The purpose of the preoperative interview is to obtain patient’s health information, provide information on the surgical experience (entire perioperative period), and facilitate an environment for the patient or caregiver to ask questions.
Q: In addition to prescription medications, why is it important to ask the patient about over-the-counter (OTC), herbal, and recreational drug use during the preoperative interview?
A: OTC, herbal, and recreational drug use may complicate surgical procedures.
alcohol – cardiac issues during surgery, and postop infection
aspirin and garlic – bleeding
tobacco and marijuana – respiratory issues
Q: What type of patient is at highest risk for adverse effects of surgery?
A: The diabetic patient is at highest risk of adverse effects due to: intraoperative blood glucose control, and postoperative wound infection.
Q: What are the two most common catastrophic events that can occur in the intraoperative phase? (Why is is so important to obtain a complete health history?)
A: Anaphylaxis and Malignant Hyperthermia are the two most catastrophic events that can occur during surgery. Anaphylaxis: a severe, potentially life threatening allergic reaction.
Malignant Hyperthermia: a disease that causes a fast rise in body temperature and severe muscle contractions when someone with the disease receives general anesthesia.
It is not the CDAs role to diagnose or treat the above mentioned complications or contraindications for surgery. The role of the CDA during the preoperative period is to ensure that the patient has provided all the necessary information to the Surgical Team so that their surgery can occur. The CDA must ensure that:
• Patient information and health history is complete
• NPO status is confirmed (sedation)
• Financial consent is given
• Surgical consent is given
• Patient is accompanied by a responsible adult to take them to and from their surgery, and to remain with them (for the day) following surgery (sedation)