If you have an upcoming surgery or procedure that requires anesthesia, and aren't sure what to expect or how to prepare, here are some tips from your friendly board-certified anesthesiologist:
Fasting: yes, everyone's favorite... the reason I put this first is because it's vitally important that you follow the recommended fasting guidelines in order to decrease your risk of complications, and avoid having your procedure cancelled. We learned many decades ago that if a patient undergoes anesthesia with food in their stomach, they are at risk of aspiration, which means vomiting and having the stomach contents go into their lungs. Aspiration can lead to mild to severe respiratory distress, and even in the worst cases, death. The general guideline has been to have nothing to eat or drink for 8 hours before your planned procedure. To make this simple, most hospitals or surgery centers will tell you to have nothing orally after midnight the night before the procedure. In recent years we've realized that for those scheduled in the afternoon, a prolonged fasting period is both unpleasant for the patient, and may cause them to be dehydrated and do less well. For this reason, make sure you get detailed information on this topic in your preop information packet. If you haven't gotten detailed instructions from the hospital, surgeon's office, or the surgery center, it's best to call them to ask so you won't encounter problems the next day. If you're having a colonoscopy, you'll be given a bowel preop solution to drink that day before your procedure, and should be given detailed instructions on when and how to consume it (as well as when to stop drinking liquids).
Medications: you should be given detailed instructions on which medications you should take or not take on the morning of your procedure. Even though you will be fasting for a short time before your procedure, some medications are ok to take with sips of water only, and in fact, some medications are recommended/encouraged to be taken on the day of the procedure (i.e. not to be skipped) in order to improve your outcome. Examples of such medications are: certain blood pressure medications such as those in the class called "beta blockers" (names like metoprolol, propranolol, bisoprolol), anti-seizure medications, acid-reducing medications (like protonix, pepcid, and others), anti-arrhythmic drugs (used to treat heart rhythm problems like Afib), and some of the medications used to treat congestive heart failure, and COPD or asthma (inhalers). The bottom line is that you shouldn't have to guess what to take or not take, so make sure this is explained to you well in your preop instructions. It can make a difference in how well you do both during and after your procedure.
A note about blood thinners: if you're taking a blood thinner, it's extremely important that the person who prescribes the blood thinner is aware that you're having a procedure and they give you instructions about if and when to stop it and restart it. This is a complicated issue because some blood thinners remain in your system for days, while others are short-acting; there is no rule that applies to all blood thinners because of this.
If you have a pacemaker or pacemaker/defibrillator: Make sure your cardiologist sees you before your planned procedure, and if you're due to have your device checked, that it is done in time to ensure that everything is working as it should (i.e. the battery) to reduce your risk of problems during and after your procedure. Know what brand of device you have (such as Boston Scientific, Medtronic, St. Jude etc.), and the contact phone number of your heart doctor, in case there are any questions on the day of the procedure.
Tell your anesthesiologist about any problems you've had in the past during surgery and anesthesia: for example, if you're ever been told that you have a "difficult airway", in other words, there was difficulty putting in a breathing tube, this is crucial information. Or, if you or a family member has had a condition called "malignant hyperthermia", it's essential to tell your anesthesiologist this so that they can make special preparations to avoid complications. If you have a history of postoperative nausea and vomiting, be sure to mention this too. Today we've gotten much better at preventing this, especially if we know ahead of time that you've experienced this.
If you have obstructive sleep apnea (or OSA): make sure this is listed on your medical history, use your CPAP machine every night if you have one, and be prepared to bring your CPAP machine with you to the hospital, particularly if an overnight stay is planned.
Drink plenty of fluids the day before your procedure up until you are to begin fasting, unless you are normally on a fluid-restricted diet. This will help to make your intravenous line placement go more smoothly, and decreases your chances of having postoperative nausea/vomiting.
During the days and weeks leading up to your procedure: stay on schedule with your regular medications. We know that optimizing the management of any chronic medical conditions helps improve patient outcomes. If you smoke, try to quit, or at least reduce your smoking. Smokers are at higher risk of respiratory complications, as well as poor wound healing and wound infections. Even if you abstain from tobacco use for 48 hours before the procedure, this can help your blood oxygen levels improve.
If you've recently had a respiratory infection (including Covid-19): elective procedures should be postponed until you have fully recovered. Some institutions recommend waiting at least 4 to 6 weeks depending on the severity of your illness before you undergo an elective procedure.
General anesthesia, sedation, and regional anesthesia: you don't always have to go to sleep for a procedure, as some can be done with sedation, and some can be done with regional anesthesia which involves numbing the area of the body which is being operated on. Nerve blocks which numb part of the body are often performed before the start of surgery to aid in pain management. Your anesthesiologist will discuss with you the plan and go over any possible side effects. They are there not only to give you anesthesia, but also to monitor you closely throughout the entire procedure. We have made great strides in providing a safe, comfortable anesthesia experience for patients. You can play a role in ensuring you have a good outcome.
I hope this information is helpful!
Cheers,
Dr. B
#anesthesia #surgery #patientsafety #themoreyouknow #nerveblocks #sedation #saferprocedures #healthandwellness #vigilance
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