The pre-operative period of surgery is considered to be the time just prior to a surgical procedure beginning when the first preparations take place. Depending on the urgency of the surgery, much of the desired preparation may turn into an unrealistic luxury. Neurological emergencies cross a wide diapason. It is important that quick and appropriate assessments are made with thorough neurological evaluation, as many of these conditions require expeditious initiation of treatment [1].

During this pre-operative time, the focus from the health care team is centered around learning the patient, assessing the patient and educating the patient and family. It is important to learn the patient’s nutritional state, medical, surgical and social history, allergies, current medications, and personal habits that may affect his/her health and recovery. It is equally important to assess the patient’s physical state, noting any handicaps and/or abnormality, signs of infection, overall general health and appearance, mental state, blood pressure, heart rate, height and weight. Blood and urine may be taken to check specific lab tests. In case a blood transfusion is necessary during or after the procedure, the patient’s blood type will be checked. Often a chest X-ray, electrocardiogram, X-ray, CT and/or MRI scans of the head, neck or spine may be needed. Due to the nature of neurosurgical conditions, a lumbar puncture to check spinal fluid may be necessary.

The patient’s and his/her family’s understanding of the neurosurgical condition, possible treatments, potential outcomes and prognosis is ascertained. Each of the above is explained in a timely manner to expedite treatment. Oftentimes, the patient is unable to participate in his/her decision-making requiring a family member to be responsible for making decisions and signing consent forms for treatment.

If time permits the patient will need to fast for a short period prior to surgery, typically beginning at midnight the night before. An intravenous will be required to provide fluid during this time if the patient is an inpatient. A bowel preparation may be necessary, as well. Prior to surgery, specific areas of the patient’s body will be cleansed with an antibacterial soap. Intravenous access will be gained, which will allow for medications to be given and blood to be drawn quickly and easily. Most likely, a urinary catheter will be placed, and/or a nasogastric tube may be needed, though they are often placed with the patient under sedation or anesthesia for elective procedures.

When patients and families are carefully explained the nature of the condition, planned procedure and potential outcomes, less anxiety is encountered. Family’s knowledge of the patient can save a tremendous amount of time, allowing the provider to assess the patient using brief exams.

The perioperative period of surgery begins from the start of surgery until the day of discharge. It is during this period that care, concerns and treatment becomes more focused on the underlying condition. As each individual situation dictates, knowing what to watch for can help identify neurological/post-operative complications, which may require immediate attention.