Patient journey

All patients undergoing day surgery or general surgery will normally be offered an appointment for a preoperative assessment before surgery either on the same day as their gynaecology clinic appointment or certainly soon after. At this appointment, we assess your suitability for surgery. You will also be asked to complete a Health Screening Questionnaire.

Our specially trained preoperative nurse practitioners will discuss any health issues that may affect your anaesthetic and operation and will provide you with information regarding aspects of your care. The Royal College of Anaesthetics provides lots of detailed and useful information about anaesthetics for patients and visitors.

All patients undergoing any type of surgery will first attend what is known as the forward waiting area. Depending on a patient’s personal circumstances, they can either walk to this area or can be collected and taken to this area by one of our Theatre Porters. In the forward waiting area, you will be checked in by a member of the reception team. Thorough checks are completed ahead of your surgery to ensure we have all the necessary information - signed consent, fasting confirmation, correct imaging and results of investigations. We also ensure that all women are looked after by at least one female member of staff at all times.

The Liverpool Women’s now has a newly built Day Surgery Unit. Patients who attend the day surgery unit are selected to be surgically, socially and medically fit for discharge within hours of surgery.

Surgical fitness

Day surgery is suitable for operations that do not require prolonged observation or bed rest and where pain control does not require injectable medication for prolonged periods. Such operations include procedures such as hysteroscopy, cystoscopy, diagnostic laparoscopy and laparoscopic tubal occlusion.

Social fitness

All patients must have a responsible adult, able and willing to care for the patient at home for at least the first 24 hours after they come home. Patients and their carers should have easy access to a telephone. The patient’s home must be suitable with adequate kitchen, bathroom and toilet facilities.

Medical fitness

Patients should either be fully fit or have well controlled chronic disease such as diabetes, asthma or hypertension. This will be assessed by the preoperative assessment clinic. Patients with complicated medical or anaesthetic problems might be discharged on the same day but they will need to prepare for an overnight stay and should be admitted to the gynaecology wards.

Role of the anaesthetist in day surgery

The anaesthetist will meet you on the day ward before surgery and will use their skill and expertise to ensure that your recovery from anaesthesia allows you to go home soon after surgery.

Waking up promptly: Short acting anaesthetic drugs are used that will wear off as quickly as possible to help reduce the time to discharge from hospital.

Pain control: Drugs such as paracetamol and anti-inflammatory drugs are used to provide pain relief and reduce the need and dose of sedative drugs such as morphine.

Nausea and vomiting: all patients will have their risk assessed and will be given appropriate drugs to prevent the risk of nausea and vomiting.

Hydration: it is important to remain well hydrated before surgery by drinking still water until 2 hours before the operation as this enhances your recovery. Your anaesthetist may also give you intravenous fluids to ensure that you are not dehydrated.

Patients whose surgery, social or medical fitness does not allow day surgery will be admitted to the general gynaecology wards.

The same principles of anaesthesia apply. We aim to ensure that patients are fully awake promptly after surgery and comfortable with controlled nausea and vomiting. However, admission to the ward allows us to use additional techniques to control pain:

Patient controlled analgesia

Patient controlled analgesia, or PCA, is a method of pain control that allows you to give yourself some pain relief as and when you need it.

Regional local anaesthetics

Transversus Abdominis Plane (TAP) block is a local anaesthetic block and is given by the anaesthetist when you are asleep and will help numb the nerves supplying sensation to the front of the abdomen. This works with other pain medication to control pain after abdominal surgery such as hysterectomy or laparotomy.

Epidural analgesia

Epidural analgesia benefits patients with medical conditions such as respiratory or cardiac disease following major surgery. For safety reasons, the epidurals are inserted when the patient is awake, in the anaesthetic room and then tested before a general anaesthetic or sedation is given.

The operating department

The operating department includes a reception waiting area, anaesthetic rooms, operating theatres and a recovery room. It looks and feels quite different from other hospital departments. Operating theatres are brightly lit and are purposely quite cool in temperature. As it is important for you to keep warm, a blanket will help if you feel cold.

The staff

Theatre staff normally wear coloured 'pyjamas' and paper hats. Because of this, they all look much the same, but you will probably recognise your anaesthetist having met him or her already.

Reception

If you have walked to theatre, you will now need to get onto a theatre trolley for your anaesthetic. This is narrower and higher than a hospital bed and may feel quite cold and hard. A member of staff will help you climb onto it. Theatre staff will check your identification bracelet, your name and date of birth and will ask you about other details in your medical records as a final check.

The anaesthetic room

You will then be taken into the anaesthetic room or, sometimes, into the operating theatre. Several people will be there, including your anaesthetist and the anaesthetic assistant. There may also be an anaesthetist in training, a nurse and a student doctor or nurse. All the checks you have just been through will be repeated once again. If you are having a general anaesthetic, you will probably now need to remove your glasses, hearing aids and dentures to keep them safe. If you would prefer to leave your dentures in place, ask your anaesthetist if this would be alright. During your operation, your anaesthetist will attach you to machines to monitor:

• Your heart: sticky patches will be placed on your chest (electrocardiogram or ECG)
• Your blood pressure: a blood-pressure cuff will be placed on your arm
• The oxygen level in your blood: a clip will be placed on your finger (pulse oximeter).

More monitoring may be needed for major operations. 

The High Dependency Unit allows patients with complicated medical or surgical conditions to receive specialist nursing care from highly trained nurse practitioners using advanced monitoring equipment. This is provided in a bay where one nurse looks after a maximum of two patients. Medical cover is provided by anaesthetic and surgical staff. They do regular ward rounds throughout the day and night.

Admission to the HDU is usually planned by the surgical, anaesthetic and nursing team before the patient comes for surgery. However, these facilities are also of major benefit to patients who come to the hospital requiring emergency surgery or who develop a complication following routine surgery. The facilities available in the High Dependency Unit allow us to perform major surgery on patients whose medical conditions would have previously meant they were unfit for surgery.

After surgery, you will wake up in the recovery ward where the nurses will care for you and ensure your comfort before you are ready to return to the ward.

• BMI Clinic Leaflet
• Caesarean Section Information Card for General Anaesthetic
• Caesarean Section Information Cards Regional Anaesthetic
• Epidural Information Card - Epidurals for labour
• For further information concerning anaesthesia and analgesia for your delivery go to the Labour Pains website.