GENERAL INFORMATION:
PRE-OPERATIVE GUIDELINES
What should I do before my surgery?
Before being admitted to hospital for surgery it is important to ensure that there are no medical conditions or other factors which may put you at unnecessary risk from the procedure, or cause your operation to be delayed or cancelled. On admission you will be assessed firstly on your medical history and later by the Anaesthesiologist; it is crucial for your safety that you give accurate information about your pre-existing medical conditions, your medications, whether or not you are a smoker and how long since you last ate or had something to drink. If your surgery is urgent then while there may not be time to implement the suggestions below, it remains important for the Anaesthesiologist to have the information needed.
Existing medical conditions:
Respiratory (lung) disease
Asthma: If you have severe asthma this may be life-threatening without proper preoperative preparation.
Chronic lung conditions such as emphysema or bronchiectasis:
Cardiac disease
Neurological disease, epilepsy and muscle diseases:
All of these may have profound implications for the anaesthetic; you should check with us well before your surgery whether an assessment is needed. A report from your specialist about your condition will be very helpful. Do not stop your anti-epileptics; anaesthesia and surgery may interfere with your anticonvulsant regimen, leading to seizures and loss of your driver status, and should be planned for ahead of time.
Genetic diseases:
Porphyria, Malignant Hyperthermia tendency and Sickle Cell anaemia are diseases which require special precautions and therefore prior notice . Please contact us early if you have concerns.
Psychological or psychiatric treatment:
If you are on treatment for depression or schizophrenia we need to be informed two weeks early as certain drugs may be dangerous when combined with anaesthetics.
Metabolic disease:
If you suffer from Diabetes it is very important that you are assessed by the Anaesthesiologist prior to your admission if you are having anything other than minor day-case surgery. Some diabetic drugs may need to be changed or omitted before surgery.
New medical conditions:
Current illnesses such as colds, flu, bronchitis and pneumonia may markedly increase your risk of complications under anaesthesia, and you should not undergo elective surgery while you have an active infection. Please be sure to attend your regular physician or check with us if you are unsure.
Smoking:
Smokers are at increased risk of complications following anaesthesia and surgery. These result from both the short-term effects (airway irritability, decreased ability to clear sputum from the chest) and the long-term effects (lung tissue destruction, emphysema and heart disease). You can reduce the risk of complications by stopping smoking. Even twenty-four hours of not smoking will reduce your risk of hypoxic (low blood oxygen) events; however you need to stop 6 to 8 weeks before surgery for the benefits to be substantial. Also you do not want to be suffering symptoms of enforced withdrawal at the same time as you are recovering from major surgery.
Starvation guidelines:
You will be warned by your Surgeon not to eat or drink before your surgery. This is important! It is extremely dangerous to disregard this or to conceal from your Anaesthesiologist that you have eaten. Why is this? Anaesthesia relaxes the functional valve system preventing regurgitation of stomach contents into the throat; if there is food residue in your stomach this may enter your lungs leading to major damage and even death. The following guidelines should only be disregarded in the case of emergency surgery:
Adults:
Do not eat within 6 hours of your anaesthetic. It is preferable not to eat on the day of your surgery even when this is scheduled for the afternoon unless you have been given specific permission to do so.
Note: This does not mean that you cannot take your medications.
If you are taking medication for blood pressure, chest pain or epilepsy, these should be taken with a small amount of water (25 ml) 2 hours before your surgery.
If your surgery is scheduled later you may drink water or clear fluids (apple juice, black tea or coffee, coke etc) up to two hours before the anaesthetic.
Children:
Children become distressed when hungry or thirsty and should not be starved unnecessarily. The following are safe but should not be reduced:
• No food within 6 hours of surgery
• No formula feed within 6 hours of surgery
• No breast milk within 4 hours of surgery
• Clear fluids (water, apple juice, cordials without fruit cells) may be given up to two hours before surgery.
Please remember that the order of the surgical slate may be changed, so that the times above should be taken as starting from the beginning of the slate, usually 07h30 in the morning or 13h00 in the afternoon.
Before being admitted to hospital for surgery it is important to ensure that there are no medical conditions or other factors which may put you at unnecessary risk from the procedure, or cause your operation to be delayed or cancelled. On admission you will be assessed firstly on your medical history and later by the Anaesthesiologist; it is crucial for your safety that you give accurate information about your pre-existing medical conditions, your medications, whether or not you are a smoker and how long since you last ate or had something to drink. If your surgery is urgent then while there may not be time to implement the suggestions below, it remains important for the Anaesthesiologist to have the information needed.
Existing medical conditions:
Respiratory (lung) disease
Asthma: If you have severe asthma this may be life-threatening without proper preoperative preparation.
- You should be taking your medications regularly
- You should not undergo anaesthesia and surgery if you are presently having an asthmatic attack, even if mild.
- A cold or flu will markedly increase your risk of complications; if you have contracted flu you should postpone your operation for at least two weeks.
Chronic lung conditions such as emphysema or bronchiectasis:
- Your lung condition should be optimised. Does your regular physician know of your impending surgery and is he satisfied with your chest condition? Have you been taking your medication? Has your condition recently deteriorated or do you have a chest infection?
- If you have a severe chronic lung condition you may need to be admitted days before your surgery for preparation. Please contact us at least a week before admission to discuss this.
Cardiac disease
- Hypertension (high blood pressure)
- It is extremely important your blood pressure is controlled. Untreated hypertension may lead to cancellation of your surgery or post-operative complications such as stroke or heart attack.
- Blood pressure medications may have severe effects when combined with anaesthetic drugs. Do not stop taking your medications because you are not allowed to eat before surgery. Rather check with us by phone or visit to plan which medicines should be continued and which omitted on the day of surgery.
- Angina, previous heart attack or cardiac surgery, cardiac rhythm disturbances, venous thrombosis and lung embolism; previous cardiac failure:
- Does your cardiologist know of your impending surgery? Is he satisfied with your cardiac status?
- Medications for chest pain and blood thinning need careful planning. Please contact us or your regular medical attendant at least a week before admission.
- Drugs: Check with us beforehand which medicines you should take up to the time of surgery.
- Antihypertensives should be taken on the day of surgery, particularly b-blockers (Ziak, Concor, Inderal etc), as should anti-anginal drugs and cardiac failure medications.
- Anticoagulants (Warfarin) on the other hand should generally be stopped at least five days before surgery. It is very important to clear this with your doctor
Neurological disease, epilepsy and muscle diseases:
All of these may have profound implications for the anaesthetic; you should check with us well before your surgery whether an assessment is needed. A report from your specialist about your condition will be very helpful. Do not stop your anti-epileptics; anaesthesia and surgery may interfere with your anticonvulsant regimen, leading to seizures and loss of your driver status, and should be planned for ahead of time.
Genetic diseases:
Porphyria, Malignant Hyperthermia tendency and Sickle Cell anaemia are diseases which require special precautions and therefore prior notice . Please contact us early if you have concerns.
Psychological or psychiatric treatment:
If you are on treatment for depression or schizophrenia we need to be informed two weeks early as certain drugs may be dangerous when combined with anaesthetics.
Metabolic disease:
If you suffer from Diabetes it is very important that you are assessed by the Anaesthesiologist prior to your admission if you are having anything other than minor day-case surgery. Some diabetic drugs may need to be changed or omitted before surgery.
New medical conditions:
Current illnesses such as colds, flu, bronchitis and pneumonia may markedly increase your risk of complications under anaesthesia, and you should not undergo elective surgery while you have an active infection. Please be sure to attend your regular physician or check with us if you are unsure.
Smoking:
Smokers are at increased risk of complications following anaesthesia and surgery. These result from both the short-term effects (airway irritability, decreased ability to clear sputum from the chest) and the long-term effects (lung tissue destruction, emphysema and heart disease). You can reduce the risk of complications by stopping smoking. Even twenty-four hours of not smoking will reduce your risk of hypoxic (low blood oxygen) events; however you need to stop 6 to 8 weeks before surgery for the benefits to be substantial. Also you do not want to be suffering symptoms of enforced withdrawal at the same time as you are recovering from major surgery.
Starvation guidelines:
You will be warned by your Surgeon not to eat or drink before your surgery. This is important! It is extremely dangerous to disregard this or to conceal from your Anaesthesiologist that you have eaten. Why is this? Anaesthesia relaxes the functional valve system preventing regurgitation of stomach contents into the throat; if there is food residue in your stomach this may enter your lungs leading to major damage and even death. The following guidelines should only be disregarded in the case of emergency surgery:
Adults:
Do not eat within 6 hours of your anaesthetic. It is preferable not to eat on the day of your surgery even when this is scheduled for the afternoon unless you have been given specific permission to do so.
Note: This does not mean that you cannot take your medications.
If you are taking medication for blood pressure, chest pain or epilepsy, these should be taken with a small amount of water (25 ml) 2 hours before your surgery.
If your surgery is scheduled later you may drink water or clear fluids (apple juice, black tea or coffee, coke etc) up to two hours before the anaesthetic.
Children:
Children become distressed when hungry or thirsty and should not be starved unnecessarily. The following are safe but should not be reduced:
• No food within 6 hours of surgery
• No formula feed within 6 hours of surgery
• No breast milk within 4 hours of surgery
• Clear fluids (water, apple juice, cordials without fruit cells) may be given up to two hours before surgery.
Please remember that the order of the surgical slate may be changed, so that the times above should be taken as starting from the beginning of the slate, usually 07h30 in the morning or 13h00 in the afternoon.
This information was reproduced from the South African Society of Anaesthesiologists (SASA) website Patient Corner page with permission from the webmaster (http://www.sasaweb.com)