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	Decision Points focus on key medical care decisions that are important to many health problems.
	Blood Transfusions: Should I Bank Blood Before Surgery?

Before Surgery

Preoperative care

Most surgery centers and hospitals have a before-surgery (preoperative) form for you to fill out. This form usually includes questions about your medical history and current health. This information helps the surgical team prepare for your surgery. They are trained to provide you with safe care during your surgery.

• Talk to your surgeon about what kinds of surgery you have had. Describe your recovery period, and be sure to mention any problems you may have had.
• Describe any health problems you have, such as:
  • Diabetes.
  • Heart problems. Also tell your doctor if you have a pacemaker.
  • Lung problems, such as COPD (chronic obstructive pulmonary disease).
  • Sleep apnea.
  • Asthma.
  • Any allergies to foods or any substance, including latex, tape, adhesives, anesthetics, or other medicines. You may also be asked whether any family members have had reactions to anesthetics.
  • Any bleeding problems or use of blood-thinning medicine, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• Tell your surgeon if you currently have a cold, flu, or fever or have had one recently.
• It is important for you to be honest with your doctor and tell him or her about any tobacco, alcohol, illegal drugs, or medicines you use. This includes over-the-counter medicines, vitamins, and supplements, such as St. John's wort and diet aids. Your use of substances or medicines may affect your reaction to anesthesia or pain medicines.
• Talk about any physical restrictions you have, such as an artificial joint or limited range of motion of your neck, arms, or legs.
• Let your doctor know if you have any metal implants or fragments in your body.
• Tell your surgeon if you are or might be pregnant.

You most likely will complete the preoperative form 1 to 3 days before your surgery. Before surgery, your surgeon may also ask you to see your regular doctor for an exam and possibly for tests. A surgeon may ask this to make sure that surgery is not likely to be too hard on you. Your regular doctor or your surgeon may order certain tests—such as blood tests, urine tests, and blood clotting tests—to help determine your overall health. You may also be scheduled for other tests, such as X-rays or an electrocardiogram (EKG), if your surgeon thinks they are needed before your surgery.

Your surgeon may include other doctors in your care, depending on your other medical conditions. For example, if you have heart problems, your surgeon may discuss your care with a cardiologist. If you have many medical problems, your regular doctor may do your physical exam before surgery. To help make sure that no problems are missed, it can be helpful to have a doctor who knows you well do this exam and your medical history.

If you will need blood during your surgery, you may wish to donate your own blood. This is called autologous donation. It will have to be arranged several weeks before your surgery. To qualify for autologous donation, you must not be anemic.

Blood Transfusions: Should I Bank Blood Before Surgery?

Many hospitals or surgery centers have a nurse who will meet with you or call you at home a few days before your surgery. This nurse makes sure all your forms and tests are complete before your scheduled surgery. The nurse also:

• Makes sure the date and time of your surgery are correct.
• Talks about when you should stop eating and drinking before surgery.
• Answers any questions you may have.

Minor surgeries that can be done in your doctor's office or at a same-day surgery center usually take less than 2 hours, and you can recover at home after the surgery. For these, you most likely will need only oral pain medicines after your procedure. Examples of these types of surgeries are:

• Cataract removal.
• Laparoscopy, such as surgery to repair a hernia or remove the gallbladder.
• Breast biopsy.
• Dilation and curettage (D&C).
• Hemorrhoid removal.
• Minor bone or joint procedures, such as arthroscopy or hand surgery.

For more major surgery or emergency surgery, you will probably stay in the hospital.

Before your surgery, your surgeon or nurse will remind you to do the following:

• Bring any X-rays or other tests that you may have.
• Follow the instructions exactly about when to stop eating and drinking. If your doctor has told you to take medicines on the day of surgery, do so using only a sip of water.
• Do not use aspirin or other nonsteroidal anti-inflammatory medicines (NSAIDs) for 1 week before your surgery.
• Leave all valuables, such as money and jewelry, at home.
• Bring what you will need after surgery, such as your inhaler if you have asthma or a cane if you use one. Also bring your insurance information.
• If you are having same-day surgery, arrange for someone to take you home. And make sure you have someone stay with you for the first 24 hours.
• Shower the morning of surgery, but do not use any perfumes, colognes, or body lotion.
• Remove all nail polish and body jewelry, such as piercings.

In the preoperative area

When you arrive for your surgery, your nurse will:

• Check your name, your birth date, and your signed consent for surgery. Your nurse will also check the correct body area for your surgery. If you have any last-minute questions, ask to discuss them with your surgeon.
• Measure your vital signs (temperature, heart rate, blood pressure, respiratory rate, and oxygen level).
• Measure or ask about your height and weight.
• Make sure you have not had anything to eat or drink for the length of time your surgeon told you.
• Check your medical chart for any allergies you have and any medicines you take.
• Answer any questions you or your family members have about your surgery. Tell the nurse who should be contacted right after your surgery to talk about how the surgery went and whether anything was found.
• Make sure you have a ride home.
• Explain to you what will happen and reassure you to help you remain calm. The nurse may go over the pain scale that is used to help see how you are doing after surgery.
• Ask you to urinate and change into a hospital gown.
• Ask you to remove any dental work, such as dentures or plates.
• Ask you to remove any hearing or visual aids, such as hearing aids or contact lenses.
• Give you the medicines ordered by the anesthesiologist during his or her visit with you before surgery. These medicines will help you relax.
• Give you antibiotics, if ordered by your surgeon.
• Give your family or friends instructions on how long you will be in surgery and in the recovery area. The nurse will also let your family or friends know where they can wait during your surgery.
• Start an intravenous (IV) line in your arm or hand, if ordered by your surgeon or anesthesiologist, for fluids and medicines before, during, and after your surgery.

Your surgeon or the surgical team may also give you some information on what will happen after surgery, such as whether you will have special equipment, like another IV, a urinary catheter, or wound drains.