normal instructions with preparing for anesthesia are to let the patients know
not to eat or drink anything after midnight before surgery. If you have surgery
first thing in the morning, then these guidelines are not hard to comply with. But for surgeries later in the day for diabetic patients – then dangerous
dehydration from lack of drinking water or low blood sugar from not eating can
There are now new guidelines by the American Society of Anesthesiologists:
Solid food should be avoided for 6 hours
Clear fluids for up to 4 hours before anesthesia
Always follow your own physician’s instruction on preparation for surgery
Patients are normally encouraged to take their regularly scheduled
medications up to and including the morning of surgery. If anything should
be avoided, your surgeon will give you orders on what to take. Taking your
medication should be done with only a swallow of water if your surgery is
early in the morning.
Exceptions with taking medications include the following:
Insulin and the diabetic patient
increases the incidence of peri-operative complication. The risks are
infection, metabolic derangements, renal and cardiac complications. The
major peri-operative complications in diabetic patients are infection and
impaired wound healing. Infection contributes up to 2/3 of post-operative
complications. Hyperglycemia affects greatly to wound healing and
susceptibility of infection.
Diuretics, commonly known as
"water pills" are used to treat not only high blood pressure but are also given
to patients with heart failure, or to treat swelling of the legs (edema). Theses medications when taken the day of a surgical procedure can cause two
problems for the patient. Diuretic cause the patient to lose any retained
fluid, so going long distances without a restroom nearby can sometimes be
Diuretics cause a decrease in
blood volume called "hypovolemia", which can be detrimental during and after a
surgical procedure. Many anesthesiologists will tell their patients not to
take the diuretic the morning of surgery, however; every patient is different in
their needs and will be consulted on what is right for them.
There are many people who actively
use Herbal Medications. Many patients can be reluctant to admit they take these herbal supplements
however; it is very important to make sure you tell your plastic surgeon and
anesthesiologist before your surgery. Acute and chronic hepatic or renal
toxicity is possible with these agents.
Other adverse effects that may
complicate the surgical and anesthetic include excessive bleeding, heart and
blood pressure effects and sedation. Most surgeons and anesthesiologist
recommend discontinuing use of herbal medications for at least one to two weeks
Some of the most common herbal
products are the following:
- Immune suppression and liver inflammation
- Blood pressure decreases might cause bleeding
Vitamin E should be discontinued
completely for at least two weeks before your surgical procedure. Vitamin
E can cause prolonged bleeding. Its
antioxidant effect reduces thrombin formation and thus helps decrease blood
clotting, and it also appears to minimize platelet (blood-clotting component)
aggregation and stickiness. Blood clotting time is important when you are
expecting to have a surgical procedure.
all diet pills, prescription and over the counter; as they can cause
cardiovascular problems with anesthesia. Flenfluamine and Phetermine (are
two diet aids) should not be stopped abruptly. These two drugs need to be
stopped slowly and titrated down in dosage. Mazindol (Mazanor and Sanarex),
Dexfenfluramine (Redux), Dextroamphetamine (Dexadrine) and all over the counter
diet aids need to be stopped two weeks before surgery.
Medications that contain aspirin
or ibuprofen can cause bleeding problems during and after surgery. These
medications can interfere with normal blood clotting. Most surgeons and
anesthesiologists suggest stopping all medications that contain aspirin or
ibuprofen at least two weeks prior to your surgery. Tylenol should be used
Medications that contain Aspirin
or Ibuprofen that should be avoided:
There are many drugs that interact with anesthesia and include toxic levels,
increased bleeding and other dangerous interactions. ALWAYS tell your surgeon
and anesthesiologist everything you are taking, prescription and over the
counter, so he or she can adjust your anesthesia with the levels of medication
you might have in your bloodstream.
Do not ever stop taking a
prescription medication without first discussing this with your surgeon,
anesthesiologist, or internist (at your pre operative check-up).
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The following is a list of
symptoms you might have that you are taking medication for that could cause
potential complications with anesthesia:
– Vicodin, Lortab, Norco, Oxycontin,
Percocet, Percodan, Oxycodone – the liver
will metabolize the anesthesia faster and will require the anesthesiologist to
give you more medication sooner.
– Ambien and Halcion
High Blood Pressure
– any beta blockers like Inderal or calcium channel blockers like Procardia.
interfere with the normal regulation of the cardiovascular system during
– Cyclosporin and any
– Metformin has been known
to cause serious metabolic problems with general anesthesia.
such as ibuprofen, any NSAIDs may increase bleeding.
Problem - thyrhoid medication or
Synthyroid needs to be stopped before surgery, as it can cause the heart to beat
Anesthesia can be
hard on the human body. It is even harder on patients who smoke.
Because of the fact that smokers have a tendency to develop coughs and an
elevated heart rate, makes the odds higher for problems with anesthesia.
Smoking causes the
Lowers the body
immune system with trying to fight off an infection
you have received minimal sedation only, you may be able to go home once the
procedure is finished. If you have received moderate or
deep sedation, you will
probably require more time to recover. Often this may be within an hour. In the
recovery room, you will be monitored until the effects of the medication wear
after-effects of the medication must be minimal or gone before you will be
discharged from the facility to go home. You will not be allowed to drive
yourself, so arrangements should be made for a responsible adult to provide you
with transportation. If you think you may need some assistance, you might
consider having someone stay with you on the day of surgery.
you have had anesthesia combined in any kind of form of sedation (oral or
intravenous), you will need someone responsible to drive you home after surgery.
Standard post anesthesia
instructions for 24 hours after leaving the hospital or surgery center include:
not use alcohol
not drive a car or operate heavy machinery
not sign any legal documents
not make any important decisions
Plastic Surgeon will have his or her own specific post operative instructions
that you need to make sure you adhere to.