Going to theatre can be unpleasant. It may be a degrading and scary experience. Knowing what awaits you is very important. Being a patient strips you of your identity and makes a mere number out of you. Healthcare workers can be quite insensitive to your position as they deal with many patients every day and the impact of your position becomes dulled and they can become quite out of touch with your fears and uncertainties.

The sterile enviroment of a theatre complex, out of neccesity, is not a welcoming and warm place. For your safety the walls are bare and unnessary funiture is not allowed beyond what is neede to perform your procedure. Hospital theatre equipment is designed with functionality in mind and are not known for their esthetical qualities.

Healtcare workers dressed in sterile clothes appear drab and unfriendly and caps to keep hair covered and face masks contribute to make them appear unfriendly and forbidding.

Surgeons and theatre staff are however used to these surroundings and to them it is a welcoming, well-known area in which they make their daily living and they see past the drab surrounds.

It is important to realise that the drab and seemingly severe surrounds are merely a function of neccesity for your safety and well-being and the healthcare workers despite their enviroment are just ordinary people going about their daily task.

Knowing what the different pieces of equipment are in theatre and how they are going to ensure that you have a safe and successful procedure is vey important. It is also very importnat to understand the routine in theatre and what process is followed. This will remove anxiety and uncertainty from your mind and make it an interesting and informative experience rather than a scary one.

It is important to visit the hospital prior to your procedure to see the ward, the theatre and the recovery area as well as enquire as to what will happen excactly on the day of your operation. Most hospital employ a PRO excactly for this kind of situation.

The following will try and illustrate a typical routine visit to a hospital for an elective procedure and will attempt to show some of the equipment that will be utilised during your procedure.

ADMISSION

Admissions desk

It is typical that if your operation is scheduled in the morning that you would be admitted to the hospital very early in the morning. It is important therefore to have the household well prepared for this. Your spouse, friend or family member would ordinarily accompany you to the hospital and this will obviously mean that work related matters as well as childcare matters are arranged timeously. It is quite normal to be admitted at six o’clock in the morning.

The first port of call will be the admissions desk where certain paperwork will have to be filled in. This is usually to administer the hospital account and you need to ensure that you check beforehand what documentation would be required. This would typically include identity documents, proof of medical insurance, agreement to co-payments, guarantee of payment and may even include a cash deposit. Keep in mind that hospital are run by business men and are financial institutions and can be and most certainly will be extremely hard nosed about outstanding accounts.

Mostinstitutions have pre-admission facilities where this acn be dealt with during ordinary business hours before the admission date making the admission process so much easier on the day of your procedure.

The ward

You will be taken to the ward and your bed space will allocated to you. A member of staff will take your blood pressure, temperature and weight . You will also be asked specific questions about your health, possible allergies to medication, previous anasthetic complications and whether you fully understand your planned procedure. Many of these functions will also be performed at a pre-admission clinic, once again making your admission so much easier as well as the task of the usually overworked staff. You will be given hospital clothes to wear which will typically be a gown that fastens behind your back and is mostly not very flattering, but specifically designed to be functional.

Your valuables will be taken and locked away for safe keeping. You will be informed of your approximate time for theatre but have to be aware that this may not be accurate and may even be out with several hours as theatre lists can be prolonged by many technical factors as well as emergencies.

Theatre

You will be fetched by a porter and brought to theatre on your bed. It can be quite disconcerting to see the passage lights pass overhead and most people become quite anxious at this stage. To help with anxiety a light sedative is frequently in the ward prior to this.

At the theatre doors, you will be handed over to theatre personnel and they will verify with the ward staff that you are the correct patient and that you have been booked for the correct procedure. They will also ask some basic questions and verify that all false teeth, jewelery and aids have been removed. You will then be placed in a waiting area.

When your turn arrives, you will be taken to theatre. In theatre you will be asked to move onto the theatre table. An anaesthetic nurse will connect an oximetre, a soft rubber hood which is placed on your finger and measures the oxygen concentration in your blood.

The nurse will also connect a blood pressure cuff to monitor your blood pressure and ECG stickers on your chest that will monitor your heartbeat throughout the procedure. The anaethetist will place a drip needle into one of your veins and start an infusion (drip) and you will be put to sleep. You may be asked to count to ten and will remember very little about this part of the procedure.

A breathing tube will be inserted into your trachea through your mouth if you are going to have a full anaesthetic and a ventilator will breathe for you for the duration of the procedure. Once asleep care will be taken to protect your eyes and any bit of your body that may have pressure placed on it for a prolonged period. This would for instance mean that soft cushions will be placed under your heels so that you do not develop pressure sores from not moving your feet.

There are several pieces of equipment that may be used by the surgeon and anaethetist during your procedure.

Equipment used in theatre

The anaesthetic machine

This machine has a supply of different gases including oxygen and mixes anaesthetic gases into the flow of oxygen and air mixture that is driven into and out of your lungs by the ventilator. The machine also removes the carbon dioxide that you exhale.
The machine has a large monitoring function to perform and measures the amount of the different gases that enter and exit your body, the concentration of oxygen in your blood, your heart rate and your blood pressure. It has several alarms and fail-safe mechanisms to keep you safe.

The C-arm or mobile fluoroscopic X-ray machine

This mobile X-ray machine is used extensively to confirm the anatomy and position of the bony structures of the spine as well as confirming that the level of surgery performed is the intended level. It is also used to confirm that spinal instrumentation is properly inserted and fixed if there is any instrumentation required for your procedure..

The operating microscope

Many operations to the spine require that the tissues are magnified so that the surgeon can discern the nerves from the other tissues. Some surgeons use operating loupes, which are special glasses that have telescope like lenses that magnify the tissue. Other surgeons use an operating microscope which is a large machine that both illuminates the tissue and can also manify the tissue much more than an operating loupe.

The theatre table

Most full time spinal surgeons will use a specially designed theatre table made out of carbon fibre that is designed to allow the surgeon to use the C-arm to see the bones of the spine and any instrumentation used withot interference from the metal of an ordinary operation table. There are movable pads for the patient to lie on so that they do not develop pressure sores.

The table is also adjustable at different angles and height to assist the surgeon to see the tissues of the spine better and to operate in a comfortable position.

The diathermy machine

The diathermy machine is used to coagulate bleeding blood vessels and is used to dissect tissues with. It uses an electrical current and can generate enormous amounts of heat at the tip of the working probe.

The cell saver

In long and complicated spinal procedures a cell-saver may be used. This is a device that is connected to the suction unit and all the blood that is sucked up during the procedure is washed inside the machine in a saline solution and impurities are removed. The blood can then be given straight back to the patient through the drip.

Spinal nerve monitoring

In some procedures and especially in scoliosis surgery this tecnology may be used. Scoliosis is where the spine is bent and has to be straightened with rods and screws. This may place the nerves under stress and this system will warn the surgeon that the nerves are being compromised and will allow the surgfeon to modify the rocedure to be able to protect the nerves.

Neuronavigation

Some surgeons use a computer that helps them identify the different structures and is useful in placing screws in the correct position away from the fragile nerves. These computers use a system of known reference points to calculate where the surgeons instrument is in relation to the tissue.

During your procedure your skin will be prepared with solutions that kill the bacteria growing on your skin. Your surgeon and scrub sister will do the same by streilising their hands with solutions that kill bacteria and washing their hands thorouhly. They will then donn theatre gowns and wear masks. The operation site and the rest of your body will be carefully draped with speacial sheets to vover the areas that have not been prepared. Your operation will be performed under the strictest sterile conditions possible.

At the end of the operation a drain will be placed in the wound to drain away any excess blood and body fluid so that the wound can heal properly and the skin edges closed with sutures, metal surgical clips or even glue.

You will be moved over to your bed with a roller board and taken to the recovery room where you will be kept till fully awake. You will be transferred to the high care unit or the ward. If you spend the night in the high care unit, you willbe transferred to the ward the following morning.