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Prior to your admission you will have made arrangements at Macquarie Neurosurgery office or received a phone call from the Admissions Office at Dalcross Hospital confirming your date for admission and the time for arrival at Dalcross Hospital. At the time of this call you will also be informed of any payments due for your hospital stay as determined by the Health Fund (i.e. any excess due under the terms of your cover).
In preparation for your hospital stay it is advisable to pack a small bag with your personal effects such as toiletries, sleepwear, dressing gown, slippers etc. It is also essential to bring with you your medicare care card, health fund card plus your medications.
Arrival at Hospital:
On arrival at the hospital you are to head directly to Reception where you will be met by the Admissions Clerk. He/she will check the paperwork with you and answer any queries you have. Once this is completed you will be escorted to the ward and taken to your room.
Admission to the Ward:
The nursing staff will be notified of your arrival and will undertake your clinical admission. During the course of this process the nurse will check you have with your medications and xrays/scans.
You will also be visited by the resident medical officer for the hospital who will do a complete medical admission including your history, the family history (as related to medical conditions), current symptoms and check your current observations (blood pressure, temperature etc.). He/she will also order a number of blood tests as required prior to the surgery and at some stage after this you will be visited by the Pathology technician who will take the required blood samples. A chest x-ray will usually be ordered and performed prior to the pre-operative visit by the anaesthetist: this may be essential to check the condition of your lungs and airway prior to administration of an anaesthetic. Any other pre-operation diagnostic tests/investigations such as MRI, CT scan, cerebral angiogram will be organised at this time.
The anaesthetist will visit you on the eve or morning of your surgery for a consultation with you regarding the anaesthetic and immediate post-operative period. This will give you a chance to ask any questions about the anaesthetic and time in surgery. The anaesthetist may also order some form of sedation for the night prior to surgery to encourage a good night’s sleep.
A member of the surgical team will visit you before the surgery at which time you will be given the opportunity to ask further questions and/or have the procedure explained in detail.
Your family is more than welcome to stay with you during the course of these events and then will be directed to the waiting room during the medical admission, examination by the anaesthetist and radiological investigations etc.
You will be placed on nil by mouth at midnight (unless your surgery is in the afternoon in which case fasting will commence early in the morning).
Day of Surgery:
On the morning of the surgery you will not be permitted any food or drink apart from a sip of water with your morning medications. At the appropriate time, the operating room will send an orderly to collect you for transfer to the operating room. The nursing staff in the ward will ask a series of questions related to a routine checklist on departing the ward. On arrival in the operating rooms you will be met by an anaesthetic nurse/technician who will again go through the checklist with you. At this point you will be placed in the holding bay to wait for the anaesthetist.
Prior to leaving the ward (timing dependent on the order of the list) the nursing staff may administer a pre-medication which will sedate you and make you sleepy but is not part of the full anaesthetic. Your family may visit prior to your leaving the ward but will be encouraged to leave the hospital while you are in the operating room. Their contact details will be obtained so they can be notified of the time to return to the hospital in time to meet with the surgeon at the end of the procedure.
On arrival in the operating room area you will be met by the anaesthetic nurse who will again ask a series of questions related to the operation. You will be instructed by the nursing staff as to what will take place during the anaesthetic. The anaesthetist will proceed to insert a needle into a vein to commence an intravenous infusion and the drugs to put you off to sleep. He will then insert various other tubes as required. Also at this time a urinary catheter may be inserted which will remain in place post-operatively until such time as it is deemed no longer necessary.
Once all the monitoring has been connected and anaesthetist has completed the commencement of anaesthetic, the surgical team will then prepare the operation site for surgery. This will include shaving of the operative site, preparation of the scalp and draping of the operative site.
The surgery will then be performed by the surgeon with assistance of members of the surgical team.
Following the Operation:
On completion of the operation by the surgical team, the anaesthetic team will end the anaesthetic and wake you up again. Once you are stabilised you will be transferred to the Intensive Care Unit (ICU) for your post-operative care. On arrival in ICU the medical and nursing staff will connect you to various monitoring machines, check your observations, infuse appropriate medications, and ensure your reasonable comfort before allowing your immediate family to visit you. After most surgery will be awake but very drowsy and although you might be able to answer their questions etc you will have no memory of their presence at this stage. For certain surgery there is a medical necessity to leave you sedated, intubated and ventilated. This will usually be anticipated prior to surgery but is occasionally made necessary during the course of the surgery (example being for strict blood pressure control). If this is necessary, you will not be aware of the intubation and be kept comfortably asleep. The surgical team will also meet with your relatives at this time to inform them of how the surgery went, the findings, and their expectations during the early post-operative period.
Your length of stay in ICU will be dependent on the complexity of the surgery, your rate of recovery and your requirement for monitoring and medications. On the morning following the surgery you will usually undergo a CT scan to check for any complications at the surgery site e.g. swelling of the brain and collection of fluid. This is a routine procedure for all post-operative brain surgery cases and is not something to be alarmed by. Depending on the surgery you have had, it may be necessary for you to undergo a repeat cerebral angiogram to check completeness of the surgery and again to eliminate any post-operative complications with the blood vessels.
When the surgical team and ICU team are happy with your progress in the recovery phase, you will be discharged from ICU and transferred to the ward where you will stay until such time you are ready for discharge either to a rehabilitation unit or home (again, depending on the type and complexity of the surgery performed). During the entire post-operative period, both in the ICU and the ward and up until the day of discharge, you will be visited by a member of the surgical team on a daily basis (not always on Sunday). The timing of this daily visit is not set as the surgeons can be held up in consulting rooms, operating rooms, education etc. However, a member of the team will visit.
During your entire post-operative phase whilst in hospital you will be visited by the physiotherapists who will assist you with deep breathing and mobilisation following the surgery. You will be surprised how quickly you are encouraged to get out of bed to sit in a chair (this will commence whilst in ICU) and gradually walk further distances as you build up your strength. When you are managing well and feeling stronger you will be discharged from hospital usually 7-14 days following surgery. Before discharge you must be comfortable, be afebrile, have opened your bowels, and have a normal white cell count. This varies from individual to individual. For some cases where a prolonged stay is required in ICU to manage vasospasm 21 days is the usual length of stay. Your sutures will be removed at day 14 but you will not be able to wash your hair for a further 14 days after the sutures have been removed.
What to expect once you have left hospital:
When you first leave hospital you can expect to feel not quite as strong and confident as you did in hospital. This is a normal feeling and is usually due to the fact that you are no longer surrounded by all the medical support. This does not mean to say that you will necessarily be unable to manage as well but is essentially a related to your confidence and will soon pass – usually once you get back into your normal sleeping pattern.
During the six week period between leaving hospital and your post-operative visit to the surgeon in the consulting rooms you will experience some different symptoms which might worry you at the time but are all part of the normal healing process. These include:
• Pain over the operation site – this can develop any time from 2 weeks from surgery to three months and is the ‘waking up’ and repair of the nerve endings in the scalp which have been cut at the time of surgery.
• Swollen closed eye – again this is as a result of the opening of the skull and gaining access to the brain which takes place very near to the eye socket. The swelling will go down and the eye will open shortly following the surgery. When the eye first opens you may experience some double vision but again this will be expected to resolve.
• Low back pain and pain in legs – this is called ‘arachnoiditis’ and is a result of blood (albeit small amounts) travelling through the CSF (fluid around the brain and spine tissue) to the base of the spinal column. This leads to irritation of the nerves to the buttock and legs. This will resolve with time.
• Fatigue – this is a multifactorial result of the magnitude of surgery that you have undergone. It is your body telling you that you are doing too much and that rest is an important part of the recovery period. To build up your strength you should increase your activity daily but stop for short periods when you feel tired.
Post op consultation:
You will be asked to make an appointment with the surgeon for six weeks following the date of discharge from hospital. Often this appointment will be made for you by the ward staff (but not if you are discharged on the weekend). If you do not have this appointment before you leave hospital you should ring the rooms (+6129223 6500) to make this appointment. This visit to the surgeon is very important as he/she needs to check the surgical wound/s, your physical state and neurocognitive state as part of the full assessment. Depending on the results of this visit you will be instructed as to when you next follow-up appointment should be and is made by the secretarial staff before your departure from that appointment. There is no fee for this appointment as it is covered by the surgery fees.
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