Coronary Artery Bypass Grafting (CABG) Pre-Surgery Preparation: stop smoking, not allowed to consume any food or drink at least six hours before the operation, medication, after surgery, physiotherapy, wound care

Coronary Artery Bypass Grafting (CABG) - Preparing for surgery

Our Patient Journey

Learn more on what to expect on the actual day of your coronary artery bypass graft (CABG) surgery at NHCS: [Same Day Admission – SDA]

Patient journey for Coronary Artery Bypass Graft (CABG)

Preparation before coronary artery bypass grafting surgery

You are usually admitted to the hospital one or two days before surgery to allow the doctor to assess your general condition and conduct some pre-operative tests. Some patients are suitable for same day admission (SDA).

Medication

Please remember to bring your medication to the hospital when you are admitted. This allows the medical team to perform medication reconciliation.

No Smoking

You are strongly advised to stop smoking before your operation. Smoking makes it difficult for you to clear your secretions after surgery and is dangerous to your health and recovery. Smoking also decreases the durability of bypass grafts.

Physiotherapy

Preoperative physiotherapy training is essential for you because of the potential post-operative chest complications. Your co-operation is much needed.

The physiotherapist will assess your breathing and teach you techniques such as slow, deep breathing, limb exercises and supported coughing with a small pillow. These will help you after your surgery.

Consent for Surgery

The surgeon will explain to you and your family members the nature of heart problems and the type of operation you are undergoing. He will tell you the date of your surgery and the approximate duration of the operation. He will also obtain your written consent for the surgery. You should feel free to discuss your concerns with the doctors.

Pre-medication (for elective admissions, non-SDA)

The anaesthesiologist will see you on the evening before your surgery. He will explain to you how you will be anaesthetised during the operation. Sedation may be ordered to help you sleep better before the operation.

Bowel Preparation

A laxative (suppository) will be given on the evening before your operation to clear your bowels.

No Food Consumption

You are not allowed to consume any food or drink at least six hours before surgery. This is to prevent any vomiting and subsequent inhaling of the vomitus into your lungs during surgery, which can be life threatening.

Personal Items & Valuables

Personal items such as spectacles, dentures, watches and other valuables should be given to your family members for safekeeping.

Day of coronary artery bypass grafting surgery

Skin Preparation

On the morning of surgery, you will need to shower with an antibacterial solution to minimise the risk of infection. Talcum powder and body sprays are not allowed after your bath.

Before you are sent to the operating theatre, the nurse will inform you to do the following:

Empty your bladder
Remove any personal items e.g. dentures, spectacles, watch.
Change into a gown

Pre-medication

An injection will be given just before you are taken to the operating theatre. The medication will cause dryness in your mouth, make you sleepy and less anxious. You are advised to remain in your bed after the injection.

Family Visit

Your family may visit you before you are wheeled to the operating theatre.

Transfer to Operating Theatre

The ward nurse will accompany you to the operating theatre on a trolley.

In the Operating Theatre

Once you have arrived at the operating theatre, the nurse will countercheck your identity and the type of surgery you are scheduled for. You will then be transferred to the operating theatre. The anaesthesiologist will administer medication to induce sleep and eliminate pain during the operation.

After a coronary artery bypass grafting surgery

Once the operation is completed, you will be transferred to the post-anaesthesia care unit (PACU) or Intensive Care Unit (ICU) where you will be monitored closely. You will regain consciousness after the anaesthesia wears off. There will be a number of tubes and small electrodes that will be taped to your chest to monitor your heart rate and rhythm.

A breathing tube will be inserted through the mouth into the windpipe. It will be connected to a breathing machine, which will assist you to breathe. From time to time, the nurse will remove the secretions from your mouth.

While this tube is in place, you will not be able to talk since the tube passes through your voice box. The nurses are specially trained and will be able to anticipate your needs.

The breathing tube will be removed when you do not require breathing assistance. You will receive oxygen through a face mask or nasal cannula for the next few days.

A flexible plastic tube is passed through your nose into the stomach, to drain out any fluid or air. It is usually removed after a few days or when the breathing tube is taken out. You will not be able to drink orally because of the danger of water entering your lungs and causing you to choke. However, your mouth will be cleansed frequently and your lips moistened to prevent dryness.

In addition, you will have several small tubes in your veins to administer fluid, blood and medication. There will be a small tube inserted in your wrist artery to measure blood pressure and/or for withdrawing blood samples. A urinary catheter will drain urine from your bladder continuously and enable the nurse to keep an accurate record of your urine output.

You will also find drainage tubes inserted in the lower end of your chest incision. These tubes are for draining fluid that may accumulate during and after the operation. These tubes may be uncomfortable but will be taken out as soon as possible, usually a few days after surgery.

After your breathing tube is removed and depending on your condition, you may be able to drink a small amount of water, progressing from liquids, to a soft diet, depending on your tolerance.

The physiotherapist will continue to see you through your progress. If necessary, you will need to practise frequently on the incentive spirometer to help you in your lung expansion.

We recommend early ambulation to prevent complications. You will be propped up in bed and turned from side to side to facilitate chest drainage.

While you are in the PACU/ICU, it is important that you receive plenty of rest. As such, visitors will be limited. Please refer to our latest Visitor Policy here (https://www.nhcs.com.sg/covid-19-visitor-policy).

The use of handphones may interfere with the functioning of some electrical equipment. Hence, visitors are advised not to bring it into the ICU or to switch off the handphone before entering the ICU.

The average stay in the ICU for most patients is two to three days, though this will vary with individuals. Your surgeon will explain to you the need for any extended stay.

Transfer to the ward

When your condition is stable, you will be transferred to the Intermediate Care Area (ICA) or High Dependency (HD) unit for further convalescence. You may be nursed in the HD area for one to two days, depending on the progress of your recovery. Your doctor will decide when to transfer you to the general ward.

In the HD area, you will see some monitoring equipment by your bedside. These are used to monitor your heart, blood pressure, pulse and respiratory rate.

Ambulation

From the second or third day after surgery, you may be assisted from your bed to an armchair. Your activity level will slowly be increased; from taking short walks in the room to walking around the ward, then progressing to longer walks and stairs climbing, in preparation for discharge.

Physiotherapy

The physiotherapist will continue to see you through your progress. If necessary, you will need to practise frequently on the incentive spirometer to assist in deep breathing and lung expansion. The physiotherapist will assist you in coughing techniques during the day.

Deep breathing and coughing exercises will help clear your secretions. The coughing exercises will not harm your incision but may cause some pain and discomfort. Taking pain medication and holding a small pillow against your chest to splint your chest incision will make you more comfortable when you cough. Limb exercises help to promote and improve blood circulation and strengthen muscles.

Relief of Post-operative Pain

You will experience some pain after surgery. The severity of pain varies from one person to another and depends on the extent of the surgery. Pain medications will be given orally or by injections to relieve your pain.

Wound Care

The nurses will clean and check your incision wound. Once the wound is dry, it will not be covered with dressing unless ordered by your doctor. It will be exposed to air, which allows it to become dry. The wound can be cleansed with a mild soap. Do not apply any talcum powder, lotion or ointment onto your wound.