術前
外来

手術を受けられる皆様へ

For patients scheduled for surgery

This pamphlet provides information to help you understand some
surgery-related complications and methods to prevent them.
Please be sure to bring this pamphlet with you when you areadmitted to the hospital.

順天堂大学医学部附属順天堂医院
Juntendo University Hospital

順天堂大学医学部附属順天堂医院
文書管理番号：1580012008-L 文書種別(大分類-中分類)：スキャン対象外

目次
Content
はじめに
Welcome
手術決定から入院まで ········································································· １
Getting ready for hospitalization(after deciding on surgery – before admission)
1. 手術をより安全に受けていただくための確認事項
Confirmation of safety measures for safer surgery
2. 禁煙について
Smoking cessation
3. 手術前の呼吸訓練について
Respiratory exercise before surgery
4. 口腔内の清潔について
Oral Hygiene
入院してから手術を受けるまで································································ 4
Hospital stay (after admission – before surgery)
1. 手術前の身の回りのご準備についてPreparation of what you need for your stay
2. 手術前日について
The day before your surgery
3. 手術当日について
The day of your surgery
4. 小児の日帰り手術あるいは当日入院手術の方へ
Pediatric day surgery and admission on the day of surgery
手術後から退院まで············································································ 7
Getting ready to be discharged (after surgery – going home)
1. 術後の経過について
Post-operative course
2. 術後に起こりやすい合併症
Post-operative complications that may occur

順天堂大学医学部附属順天堂医院
文書管理番号：1580012008-L 文書種別(大分類-中分類)：スキャン対象外

はじめに
WelcomeAt Juntendo University Hospital, our health care providers, including yourattending doctor, will work as a team to support you and your family sothat you have a worry-free experience during your surgical stay.
As part of this support, we have designed this pamphlet to answer some ofthe questions you might have. Please read the information carefully before
your surgery. If you have any questions or concerns, please do not hesitate
to consult with our staff.

順天堂大学医学部附属順天堂医院
文書管理番号：1580012008-L 文書種別(大分類-中分類)：スキャン対象外

手術が決定してから入院まで
Getting ready for hospitalization (after deciding on surgery –before admission)

1. 手術をより安全に受けていただくための確認事項
Confirmation of safety measures for safer surgery
Please be advised that the following information is important for your surgery andmay be asked repeatedly as needed.
1) Allergy
A variety of medical materials, instruments, and medications will be used insurgery. To prevent problems caused by allergies, please let us know if you
have experienced any skin symptoms (ex. hives and rashes) or nausea fromany of the following:
Medication, food (dairy products, eggs, soy proteins, fruits, etc.), rubber
products (latex), alcohol, medical tape, or other items.
2) Medication
Are you currently taking any medications? Some medications may need to be
adjusted (changed or stopped) for surgery.
3) Past medical history and history of surgery-

Have you or any blood relatives undergone general anesthesia or had any
medical problems with anesthesia? Also, have you ever received bloodtransfusions?

-If applicable, please bring your pacemaker or your ICD (Implantable
Cardioverter Defibrillator) identification book/card when being admitted tothe hospital.

4) Current health status-

Are you having any symptoms of fever, cold chills, vomiting, nausea, or
diarrhea?

-

Do you have any shortness of breath, heart palpitations, or trouble
breathing in your daily life?

-

Are there areas of your body where you have difficulty moving, or feel pain,
numbness, or weakness?

2. 禁煙について
Smoking cessation
During surgery under general anesthesia, artificial respiration and inhaledanesthetics may impair the cough reflex and increase secretions (phlegm),1
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文書管理番号：1580012008-L 文書種別(大分類-中分類)：スキャン対象外resulting in airway obstruction. Compared to non-smokers, those who smoke are
more likely to increase the amount of secretions from their lung and trachea. This
increases the risk of some respiratory complications such as atelectasis (partial
lung collapse) or pneumonia (lung infection) in which the bronchi are clogged withphlegm. Smoking also lowers immune system function in the lungs, which
increases the risk even more. For these reasons, you should stop smoking to clear
your lungs before surgery.
Smoking cessation is required for one month before the surgery. Please be warned
that failure to comply may result in postponement or cancellation of your surgery.
-

Atelectasis
Lung atelectasis is lung collapse due to the accumulation of pulmonary
secretions or blood in the bronchi. Reduced airway expansion can impair air
flow and can also predispose patients to pulmonary infections and othercomplications.

-

Pneumonia
Pneumonia is a condition in which infection occurs and inflames air sacs
(alveoli) in the lungs. Symptoms such as fever or trouble breathing can bephysically exhausting. In addition, if a course of antibiotics is needed, thismay prolong your hospital stay.

3. 手術前の呼吸訓練について
Respiratory exercise before surgery
Pre-operative breathing exercise can be effective to increase respiratory function,
which helps prevent post-operative respiratory complications. Please refer to the
instructions shown below.
-

Smoking cessation
As previously mentioned, the sooner you stop smoking, the better. The
longer you stop smoking for, the lower your risk of respiratorycomplications will be.

-

Aerobic exercise
Aerobic exercise can be beneficial by allowing adequate oxygen to be taken
in, improving lung function. However, exercise does not have to be
excessive to take in oxygen and enhance lung movement. You can improvelung function by taking a walk or doing calisthenics.

-

Pre-operative breathing exercise
Take a deep breath in through your nose and then exhale slowly throughyour mouth. When doing so, concentrate on abdominal breathing (breathe in
and out from the stomach). Keep in mind to expand your lungs as fully as
possible.

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4. 口腔内の清潔について
Oral Hygiene
When food and beverages are restricted before surgery, the proliferation of oral
bacteria may occur in the mouth. Also, in the perioperative period, patients may
not be able to brush their teeth adequately while recovering in bed. Thesesituations can cause poor hygiene and lead to the following complications:
Respiratory complications, such as pneumonia, can occur if oral bacteria enter thetrachea along with the breathing tube (inserted through the mouth) during generalanesthesia. Bacteria from the mouth carried into the bloodstream can cause
infections in the heart or surgical sites.
If you have a cavity, or a painful or loose tooth, there are risks of dental injuries
and other complications such as dental fracture (chip/crack); displacement ofteeth by an external force can lead to it getting caught in the throat or airway. If
examination of oral screening by a dentist or dental hygienist suggests that you
need treatment, we advise you to visit our dental department or your local dentist
for treatment as soon as possible.
-

Oral care
Oral care prior to surgery will help prevent the above complications. Be sure
to brush your teeth or keep dentures clean daily if applicable.

-

Precautions of brushing your teeth
Areas between the teeth, and the border between the teeth and the gums
are often left unbrushed. Move your toothbrush in short strokes andcarefully brush each tooth one by one.

-

Cleaning dentures
After you eat, wash your denture with water and use a special toothbrushmade for cleaning dentures. Please refrain from using regular toothpaste as
some contain abrasives that can damage dentures. The use of hot water canalso lead to deformity of denture, so please be careful.

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入院してから手術を受けるまで
Hospital stay (after admission – before surgery)

1. 手術前の身の回りのご準備についてPreparation of what you need for your stay
We would like you to prepare for a safe surgery. Please follow the list below andcheck the boxes ☑ as you prepare. For confirmation, please show these pages tothe ward nurse.

Things to do before admission□ Nails: Manicure (including colorless nail polish), extension nails, gel nails,
and nail arts must be removed, and nails are to be cut short and evenly
before surgery.
If your nails are long, you can injure yourself; medical equipment may not
function properly; and monitoring equipment may experience interference.
The natural color of your nails, an indicator of healthy blood circulation,
enables measurement of oxygen levels during surgery. Nail polish or otherfactors may interfere with accurate measurements.
□ Eyelashes: Please do not wear false eyelashes and have extensions
removed before hospitalization.
During surgery, medical tape will be placed on your eyelids for eye
protection. When the tape is removed after your surgery, false eyelashes orextensions may be torn off. There is also a risk of damage to the cornea due
to falling eyelashes, which can be dangerous to your eye health.

Things to check before heading to surgery□ Hair: Please remove hairpins or wigs. In the operating room, you will be
asked to wear a surgical cap.
Metal products (ex. hairclips) are dangerous when doctors are using
electrical equipment during surgery, as it can become heated quickly andcause serious burns. If you wish to remove anything after entering theoperating room, please inform your attending nurse. If your hair is long, you
may wear pigtails tied behind the ears on each side.
□ Teeth: Please take out removable teeth.
While undergoing anesthesia, a breathing tube is placed in your mouth
during intubation. This procedure can dislocate teeth due to externalpressure which may then enter the stomach or trachea and obstruct the
airway.

4
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文書管理番号：1580012008-L 文書種別(大分類-中分類)：スキャン対象外□ Beard: Depending on the surgery, you may need to shave. Please consult
with your doctor.
□ Contact lenses/eyeglasses/hearing aids must all be removed.
Contact lenses can damage the cornea if the lenses move during surgery.
Eyeglasses and hearing aids can be worn before undergoing anesthesia.
Please consult with the ward nurse if you wish to wear these to theoperating room.
□ Makeup: Please remove all makeup.
During the surgery, your doctors will use your natural skin color to help
monitor your health. If you wear makeup, medical equipment/tape may not
be adequately attached, or may be unable to reflect proper measurements.
Some makeup products may contain flammable ingredients.
□ Jewelry: All jewelry (such as necklace, rings, earrings/pierces, watch, etc.)
must be removed. Please notify the ward nurse or your doctor if you have
any tattoos or body art.
Metal products (ex. piercings) are dangerous when using electrocautery
during surgery, as they can quickly become heated and cause serious burns.
If you wear rings and your finger becomes swollen during surgery, the bloodflow to the fingertip can be blocked, and, in the worst cases, may need an
amputation. Like other metal products, iron powder contained in tattoos andbody art may be dangerous when using electrocautery during surgery.
If you are unable to remove any rings or have tattoos or non-removable
body art, please notify the ward nurse.
We ask that you take care of your personal belongings. Please note that we will not be
responsible for any loss or damage.

2. 手術前日について
The day before your surgery-

Please refer to the “Admission Guide” for information on what to prepare
for hospitalization and admission.

-

You may take a shower or have your body wiped clean.

-

Shaving and navel cleaning may be performed if necessary.

-

Please follow the instructions from your anesthesiologists regarding
food/beverage restrictions (fasting) prior to surgery.

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3. 手術当日について
The day of your surgery-

Please follow the instructions from your anesthesiologists regarding
food/beverage restrictions (fasting) prior to surgery.

-

Remove all removable items and let your nurse know about any nonremovable items.

-

Preparation for surgery by wearing your surgical gown and elastic
stockings.

-

After confirmation from the ward nurse, you will be guided to the operatingroom.
※Details regarding leaving the ward to go into surgery are explained in a
separate document.

4. 小児の日帰り手術あるいは当日入院手術の方へ
Pediatric day surgery and admission on the day of surgery

Surgery (MM/DD/Weekday):

/

(

)

1) The day before surgery
Children can eat until midnight (12:00 am) on the evening prior to surgery.
Clear fluids such as water, Japanese tea, and sports drinks are allowed.
2) The day of surgery
No eating!
Drinking (clear liquid only) is allowed untilam6
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手術後から退院まで
Getting ready to be discharged (after surgery – going home)
1.

術後の経過について
Post-operative course

Returning to the ward after surgery-

You will be transferred back to the ward by gurney or ward bed.

-

Parts of your body may feel numb due to anesthesia; your sensation will
return gradually.

-

An oxygen mask or intravenous lines may be placed on you after surgery.
Please do not pull or attempt to take these out yourself.

Physical examination-

Once you are transferred back to your wardroom, vital signs (blood pressure
and temperature) will be checked.

-

In some cases, electrocardiogram will be performed.

Bedrest after surgery-

After surgery, you will need to rest in bed until the anesthesia wears off.
Based on your surgical procedure, some patients may need prolonged bed
rest, which can cause bedsores or pressure ulcers. Ulcers can be prevented
by frequent or timed position changes in bed, and nurses will help you with
this.

-

Intravenous lines to deliver hydration and/or nourishment may be needed if
eating and drinking continues to be restricted.

-

Elastic stocking or use of pneumatic compression pumps on your limbs areused to prevent blood clots (deep vein thrombosis: DVT) during bedrest.

-

Please press the patient call button to let the nurse know if you needanything.

After release from bed rest-

Please call a nurse to observe and assist you when you get out of bed forthe first time after surgery.

-

Your attending doctor will examine your surgical wound and check yourpost-operative condition.

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2. 術後に起こりやすい合併症
Post-operative complications that may occur

術後せん妄
Post-operative delirium (POD)
Post-operative delirium is a condition in which cognitive function is impaired.
Fluctuating changes in mental status are characterized by reduced awareness ofthe environment and disturbance of attention (illusions, hallucinations, anddelusions). Environmental changes or stress from surgery may be a trigger. Afteran initial few days (1-2 postoperative days) of normal consciousness postoperatively, emotional instability may be manifested by irritability and anxiety;some patients may begin to speak incoherently. Although the occurrence of
postoperative delirium is most directly associated with surgery/anesthesia,
several other factors may be involved.

Factors associated with post-operative delirium(Pre-operative factors)
Age (elderly), decreased mobility, decreased comprehension, dementia, impaired
speech, use of sleeping medications(Surgical factors)
Highly invasive surgery, prolonged surgery, emergency surgery, anesthetics(Post-operative factors)
Pain, hypoxia, metabolic abnormalities, changes in the environment, changes incircadian (day/night) rhythm[What to do if you have post-operative delirium]-

Place a clock or calendar where you can see it.

-

Use familiar items that you would use on a daily basis.

-

Maintain your day and night rhythms. Opening the curtains in the daytime
to get some sunlight, watching television, or talking to friends and family
are some things that can stimulate the mind and prevent delirium.

-

Refrain from keeping hazardous objects around you for safety. Keeping
your bed low and having bed rails up will also help prevent falls andaccidents.

-

Support from family members will be essential. Having someone from thefamily by your side can provide comfort and ease, so ask someone to bewith you as much as possible. We ask family members to keep their loved

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one’s company; interact with them as naturally and normally as possible.
Please avoid conversing about inconsistent or abnormal behavior.
静脈血栓症
Deep vein thrombosis (DVT)
Resting in bed for a prolonged time during and after surgery may lead to poor
blood flow, which can result in blood clots in the vein. Symptoms of DVT
include swelling and pain in the area of the blood clot and skin color changes,
but it can also be asymptomatic.
When the blood clot breaks away from the vein, it can flow with thebloodstream and lodge in the vessels of the lungs. This can block blood flow to
the heart, resulting in a condition known as pulmonary embolism (PE, or socalled “Economy Class Syndrome”). PE can be life-threatening and is one of
the most severe complications after surgery. Symptoms of this condition
include dyspnea (difficulty breathing), sudden shortness of breath, chest pain,
cold sweats, and dizziness. In severe cases, there is a risk of cardiopulmonaryarrest. Therefore, it is crucial to take preventive measures prior to surgery andlet our staff know if you notice any of the above symptoms as early as possible.
[Precautionary measures]-

Elastic stockings
Depending on your risk level for venous thrombosis, you may be required towear elastic stockings before surgery. Do not let them sag and pull themfirmly as far as possible to the tops of your legs. Please let the staff know ifthey are loose or too large.

-

Intermittent pneumatic compression (ICP)
ICP devices are used during and after surgery to keep the blood flowing
smoothly. However, if you have been diagnosed with DVT in the past, yourrisk of pulmonary thromboembolism may be increased; decision to use ICP
devices will be made after consultation with your doctor.

褥瘡、皮膚異常Pressure ulcers, skin troubles
Pressure ulcers are commonly known as bedsores. Pressure ulcers can occur
when a person stays in the same position in contact with a foreign surface(even something as soft as a bed) for an extended period of time, leading topoor blood circulation. Symptoms of a pressure ulcer include redness of theskin, blisters, skin breakdown, and sores. The majority of pressure ulcers arelikely to form in places that cover bony areas such as buttocks and heels,
which are more susceptible to pressure and abrasion.

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[Precautionary measures]-

During surgery, a specialized mattress is used to prevent pressure going toa single area, instead dispersing the body’s weight. Periodic decompression(periodic removal of constant pressure on any single part of the body) is
also performed.

-

After surgery, if you are to have bed rest or are unable to move, nurses willassist you in changing positions periodically. If you can and are approved to
move, we advise you to move your body proactively, trying not to sit or lie
too long in the same position.

-

Skin condition and nutrition are important factors. Take care of your skinand eat a well-balanced diet to ensure that you are getting enoughnutrition.

接触性皮膚炎Contact dermatitis
Disinfectants such as povidone-iodine solution are used for skin preparation
during surgery. Prolonged exposure to large amounts can cause inflammation(redness of the skin). In severe cases, burn-like symptoms may appear.
To prevent skin troubles, excess solutions will be wiped off, and neutralizing
agents will be used on disinfected areas after the surgery.

神経障害
Post-operative neuropathies
Depending on your specific surgical procedure, different positioning of the
body may be required to facilitate surgical operations. Some positioning of the
body may cause pressure on the skin as well as the nerves. In rare cases,
numbness, muscle weakness, electric shock-like pain (i.e., stinging pain), andother neuropathic disorders may occur if decompression is not sufficiently
performed or if the same positioning continues for a prolonged time.
Excessive stretching of joints can also cause neuropathy. Currently, operatingtables and other surgical products that fix body positions firmly with minimalpressure are used. Periodic removal of pressure on the localized area is alsodone in order to prevent neuropathy during prolonged surgery.
If post-operative neuropathy occurs, most symptoms are likely to recover inabout a week, but the earlier you get out of bed and move your joints andmuscles, the better chance you have to improve symptoms faster.

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コンパートメント症候群
Compartment Syndrome
Areas with multiple muscles have a fibrous tissue-enclosed compartment foreach muscle. When the pressure within a muscle compartment increases due tobody positioning or other surgical factors, decreased blood supply may causemuscles, nerves, and blood vessel damage. This is called Compartment
Syndrome.
It most often occurs in the forearms, lower legs, and thighs, where fibrousbands of fascia surround the muscles. Symptoms include severe pain, swelling,
and numbness. Dangerously high pressure within the compartment may requirea fasciotomy (decompression surgery).
[High-risk factors]-

Obesity defined as Body Mass Index > 25 kg/m2-

Heavy musculature in the lower extremities, varicose veins, or obstructive
atherosclerosis-

Hypothermia, hypotension, diabetes, obesity, smoking, peripheral vasculardisorders, and decreased body fluid volume

If you have any concerns, please contact us at the Preoperative Clinic.

Explanatory date (MM/DD):

/

/

By:

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