Hershey Outpatient Preoperative Evaluation (HOPE) Center

If you’re planning to have surgery at the Penn State Milton S. Hershey Medical Center, and are not already a patient in the hospital, you or your surgeon may wish to schedule a preoperative visit in the Outpatient Preoperative Evaluation Center. This appointment will prepare you for your surgery, and make your time both before and after surgery, less hurried, and more pleasant.

Appointments may be scheduled by calling your surgeon’s office or calling the preoperative appointment schedulers directly at 717-531-8855. The clinic is open Monday through Friday from 8:00 a.m. to 5:30 p.m.

The following information will answer many of your questions regarding your preparation for surgery, and the preoperative evaluation visit. Should you need more information, or have questions about your specific surgical or medical problems, please don’t hesitate to call us at 717-531-1626 or 717-531-6886. 

Why should I have a preoperative visit?

Anesthesia and surgery affect your entire body, so it is very important for your surgeon and anesthesiologist, the two physicians who will care for you before and during surgery, to know as much about you as possible.  During your preoperative visit, an anesthesiologist, along with a nurse practitioner or physician assistant, will carefully evaluate your medical problems, obtain any additional information that may be needed from your family doctor or other hospitals where you may have been cared for, and order any necessary consultations or laboratory studies.  At this time, your anesthesiologist will also discuss with you, your options for anesthesia during surgery, as well as pain relief following your procedure.  He or she will also discuss with you any changes in your medications which may be required by anesthesia or surgery, and may order some new medications to help prepare you for the day of surgery. 

What do I need to bring to my visit to the preoperative evaluation center?

It is important to get as complete a picture of your medical history as possible.  Therefore, in order to save you time during your visit, please bring all the information you have about the following:

  1. All of your medications, including their names, dosages, and the frequency with which you take them.  It may be simplest to bring all of your medications in their original bottles.  Please be sure to include ALL over-the-counter and herbal medications!
     
  2. The names and phone numbers of your family doctor, and any specialists you have seen recently or see on a regular basis.
     
  3. The results of any laboratory studies, particularly major heart or lung tests, such as cardiac catheterization, stress tests, echocardiogram, pulmonary function tests, or CT scans, that you have had recently. 
     
  4. The types, dates, and locations of any prior surgery, particularly surgical procedures in which you have any some sort of complication.
     
  5. A description of any devices, such as pacemakers or automatic internal cardioverters/defibrillators that you may have in your body, including the card issued with the device. 

What will be done at the preoperative evaluation visit?

  • History and physical examination, usually performed by a nurse practitioner or physician assistant, to gather the information most relevant to your surgery.

  • Blood tests, if they are required.

  • Electrocardiogram, for most patients over age 45.

  • Chest x-ray for patients with respiratory or chest disorders, or those having surgery in the chest region.

  • Visit with an anesthesiologist.

  • Hospital preoperative registration for the surgical procedure.

Completion of all these services usually requires 1½ to 2 hours.

Do I need an appointment for a preoperative evaluation?

Yes.  In order to avoid very long waits that occur when many patients come at the same time, the center sees patients by appointment.  That appointment may often be scheduled by your surgeon’s office.  However, if it is not, please feel free to call our clinic directly at the number above, for an appointment time.  You may have other appointments on the same day at Hershey Medical Center.  If so, please inform the secretary, at these appointments, of the time of your visit in the preoperative evaluation center, so they know you will have to be free at that time.   

If another appointment would cause you to be late for your preoperative visit, please call us so your visit may be rescheduled.   

What type of anesthesia will I have?

The basic purpose of anesthesia is to take away the pain associated with a surgical or medical procedure.  Painful sensations travel from the site of surgery, to your brain through a network composed of thousands of nerve cells.  These nerve cells may start any where in your body, and usually travel first to the spinal cord and then on to the brain, where they are processed into emotions, sensations, thoughts, and movements.   

There are four different types of anesthesia, which can interrupt the painful sensations at different points:

  • Local Anesthesia
    Local anesthesia often called “novocaine” can be injected near the surgical site, to deaden the nerve endings and remove pain before it starts. This type of anesthesia is usually associated with numbness at the surgical site, and sometimes difficulty in moving an extremity, but few other effects.
     

  • Regional anesthesia
    Local anesthetic, or “novocaine,” is injected near one of the major nerves that provide sensation to usually an arm, leg, or other larger area of your body. This type of anesthesia prevents the movement of the painful impulses for up to several hours. It often leads to numbness and weakness of an entire arm or leg, until it wears off.
     

  • Spinal, epidural, or caudal anesthesia
    This type of anesthesia numbs the major nerves in and around the spinal cord. It can be in the form of an injection at almost any level, from the “tailbone” to the upper back. It numbs a large area of the body, often the entire body below the waist. This type of anesthesia usually lasts for several hours, but may be injected continuously through a small plastic tube, to provide pain relief for up to several days. It is often associated with numbness and weakness of the legs, and lower body.
     

  • General anesthesia
    This type of anesthesia interrupts the transmission of nerve impulses in the brain, by making you unconscious so that your brain does not receive or interpret any pain signals from the rest of the body. General anesthesia also interrupts other functions of the brain such as the control of movement and breathing. Therefore, during general anesthesia, your anesthesiologist must perform many of these functions, including breathing, for you.
     

  • Sedation, “twilight sleep” or “monitored anesthesia care”
    This type of anesthesia, which is becoming much more widely used with the development of new medications, is often used for procedures which are uncomfortable, though not really painful, or along with local or regional anesthesia. The administration of medications into the vein, by an experienced anesthesiologist, can provide pain relief and an extreme calming effect, so that in many cases you can “sleep” naturally through a procedure, while still maintaining the ability to breath for yourself, and awakening quickly at the end of the procedure.

What role does my anesthesiologist play in my operation?

Anesthesiologists are responsible for administering potent medications to relieve pain and manage vital life functions, including breathing, heart rhythm, blood pressure, and brain and kidney function during surgery.  As doctors, they manage and treat any medical problems which may be present before surgery, and may be detected as part of the preoperative visit.  In addition, they manage medical conditions which develop during or immediately after surgery.  During surgery, advanced technology is used to monitor the body’s functions.  Anesthesiologists must interpret these monitors in order to properly diagnosis, regulate, and treat the body’s organ systems while a very delicate balance of anesthetic and other medications are administered.  At Hershey Medical Center, resident physicians and nurse anesthetists may assist anesthesiologists with the management of anesthesia.  However, it is the anesthesiologist who will be finally responsible for the interpretation of the monitoring devices and the management of your medical condition during and after surgery.  Anesthesiologists may also be responsible for providing pain relief for you in the postoperative period. 

Can I choose my anesthesiologist?

There are approximately 50 anesthesiologists on the faculty Penn State Milton S. Hershey Medical Center.  Many of these anesthesiologists have special skills, and concentrate on the management of specific types of patients, such as pediatric patients, or patients who have specific types of surgery, such as cardiac surgery, neurosurgery, or outpatient surgery.   

At Penn State Milton S. Hershey Medical Center, we would encourage you to choose an anesthesiologist who you may know, who has been recommended to you, or who may have specific skills appropriate to your particular surgery.  Though we cannot promise the availability of one specific anesthesiologist on any particular day, we will do our best to arrange for a specific anesthesiologist to care for you, and work with your surgeon to choose a date for surgery on which they both are available. 

In order to choose a specific anesthesiologist, you may either:

  1. Discuss your request directly with your chosen anesthesiologist,

  2. Discuss your request with the anesthesiologist who visits you in the preoperative evaluation center, or

  3. Call the department scheduling office at 717-531-6619.

When can I meet with my anesthesiologist before my surgery?

If you have chosen a specific anesthesiologist to care for you, you may call them directly to arrange a time, before your surgery, to meet or to discuss your anesthesia on the telephone.  If not, the anesthesiologist who will care for you will be scheduled the day before surgery.  If you have special concerns, you may call the Department of Anesthesiology at 717-531-8202 or 717-531-6619, to ask this physician to call you before surgery.  If not, you may expect to see your anesthesiologist when you arrive in the hospital for your surgical procedure.   

If you happen to be a patient in the hospital before surgery, your anesthesiologist or resident physician in anesthesiology will visit you in the hospital, the evening before surgery.   

What should I have to eat and drink before surgery?

Under most circumstances, you should have nothing to eat or drink after midnight the night before surgery, except for essential medications.  However, there are many circumstances under which you may be able to have clear liquids, such as apple juice, black coffee, tea, or water, up until 3 hours before surgery.  You should receive specific instructions to from your surgeon or anesthesiologist regarding what to eat and drink before surgery.  If you have not, or have any questions, please call the preoperative evaluation center at 717-531-6886.

Should I take my usual medications before surgery?

It is beneficial to take some medications immediately before surgery, while not taking most others. Therefore, it is important to receive specific instructions from your surgeon or anesthesiologist regarding which medications to take, and which not to take, the morning of surgery.   

Unless otherwise instructed by your surgeon or anesthesiologist, stop all aspirin and aspirin-containing products such as Anacin, Bufferin, and Alka-Seltzer, one week before surgery.   You may continue to use Tylenol as needed up until the day of surgery. 

Unless instructed otherwise, stop all non-steroidal anti-inflammatory drugs such as Ibuprofen, Advil, Motrin, and Aleve, 4 days before surgery.

Will herbal medications and dietary supplements affect my anesthesia and surgery?

There are some commonly used herbal medications, which may affect your anesthesia and surgery.  Therefore, it is probably best to discontinue the use of these medications several days before surgery, as directed by your surgeon or anesthesiologist. 

 

Brand Name Scientific Name Common Names Common Uses Possible Side Effects & Drug Interactions
Echinacea

Echinacea purpurea

Purple Cone Flower

 

Common colds, bronchitis, coughs, wounds and burns, urinary tract infections

 

1. May cause liver toxicity, especially when used with other liver toxic drugs, i.e., anabolic steroids or methotrexate.

2. May also see decreased effectiveness of corticosteroids.

Ephedra

 

Ephedra sinica

Ma-Huang

Ephedrine

Chinese Joint Fir

Over-the-counter diet aids

Bacteriostatic

Antitussive

Potential Drug Interactions:

1. Heart glycosides or halothane: arrhythmias.

2. Guanethidine; Monoamine Oxidase inhibitor (MAOI), Oxytocin - high blood pressure or fast heart rate

Feverfew Tanacetum parthenium

Feverfew

Feather few

Midsummer Daisy

Migraine prophylactic

Antipyretic

1. Can reduce platelet activity and increase bleeding; especially along with warfarin or other anticoagulants.

2. Headache with suddenly stopping drug.

3. 5-15% of users develop mouth ulcers or gastrointestinal tract irritation.

GBL, BD and GHB

Gamma-butyrolactone; Butyrolactone gamma; 1,4 butanediol; Gamma hydroxybutyrate

GBL, BD, GHB (abbreviations for 3 drugs, not approved by FDA

Bodybuilding, weight loss aid,
sleep aid

1. Death

2.  Seizures

3. Unconsciousness

4. Bradycardia

5. Slowed respirations that my require intubation

Garlic

Allium sativum

Clove Garlic

Ajo

Lipid and blood pressure lowering. Has antiplatelet, antioxidant and anti thrombolytic qualities

1. May increase warfarin effect; will see increased INR (PT).

2. May decrease effect of some HIV drugs.

Ginger

Zingiber officinale

Black Ginger

African Ginger

Reduces nausea

Reduces spasms

1. May increase bleeding

2. Use with caution when taking warfarin.

Ginkgo

Gingko biloba

Maidenhair Tree

Fossil Tree

Circulatory stimulant

May enhance bleeding in patients on anticoagulant or antithrombotic therapy, i.e., aspirin, NSAIDSs, warfarin or heparin.

Ginseng

Panax ginseng

American Ginseng

Chinese Ginseng

Korean Ginseng

Adaptogenic

Energy level enhancer in athletes

Antioxidant

1. Ginseng Abuse Syndrome (.15g per day): sleepiness, muscle spasm, fluid retention

2. Avoid use with other stimulants; may cause high blood pressure or fast heart rate

3. May cause mania in patients on phenelzine.

4. Decrease effectiveness of platelets; increase bleeding, especially with anticoagulants.

Goldenseal

Hydrastis canadensis

Orange Root

Yellow Root

Ground Raspberry

Turmeric Root

Eye Root

Diuretic

Anti-inflammatory

Laxative

Hemostatic

1. Increase Uterine contractions

2. Overdose may cause paralysis.

3. Increases water excretion by the kidneys

4. May worsen fluid retention and/or high blood pressure.

Kava-Kava

Piper methysticum

Ava

Kawa

Ava Pepper

Anxiety reduction

1. Increases effect of barbiturates, benzodiazepines, and alcohol and can cause serious liver damage.

2. Increased suicide risk in patients with depression.

Licorice

Glycyrrhiza glabra

Licorice Root

Sweet Root

Gastric and duodenal ulcers

Gastritis, Cough/bronchitis

1. May cause high blood pressure, low potassium and fluid retention.

2. Dangerous in many chronic liver conditions, and renal insufficiency.

Saw palmetto

Serenoa repens

Sabal

Cabbage Palm

Benign prostatic hypertrophy

Antiandrogenic, Antiexudative

May also see additive effects with other hormone therapies, i.e., birth control pills or estrogen replacement therapy

St. John’s Wort

Hypericum perforatum

    Hardhay

Amber

Goatweed

Treatment for depression and anxiety

1.May decrease effectiveness of anti HIV drugs

2. Possible interaction with digoxin

3. May prolong effects of anesthesia.

Valerian

Valeriana officinalis

All-heal

Setwall

Vandal Root

Mild sedative

Mild anxiety reduction

1. Will likely increase barbiturate effect.

2. May decrease symptoms of benzodiazepine withdrawal.

Vitamin E

Vitamin E

Vitamin E

To slow aging process, prevention of stroke and pulmonary emboli, prevention against atherosclerosis, promotion of wound healing, effective against fibrocystic breast syndrome

1. May increase bleeding, particularly in conjunction with other anticoagulants and antithrombotic drugs.

2. May affect thyroid function in otherwise healthy patients.

3. May enhance hypertension in hypertensive patients in dose >400 IU per day

Based on “What You Should Know About Your Patients’ Use of Herbal Medicines and Other Dietary Supplements”, published in 2003 by the American Society of Anesthesiologists.  A copy of the full text can be obtained from ASA, 520 North Northwest Highway, Park Ridge, IL 60068-2573   (06/27/03)