What to Expect the Day of Surgery

Can I eat or drink on the day of surgery?

You may not eat anything on the day of your surgery; no solid food after midnight. However, depending on the time of your surgery, you may be able to have something to drink. You are allowed unlimited amounts of clear fluid up to four hours before your surgery time. For instance if your surgery is at noon, you may have a clear liquid before 0800 am. Examples of clear liquids include water, black coffee (with or without sugar), tea, Gatorade and all soft drinks. Liquids that have “substance” to them, such as orange juice and milk, are NOT clear liquids, and should be avoided after midnight

SPECIAL DIRECTIONS FOR YOUR INFANT: If your infant (less than one year of age) is having surgery, you may give him or her a clear liquid up to 2 hours before surgery, or breast milk up to 6 hours before surgery. Feeding with formula or solid food must be completed at least 8 hours before surgery.
 

Will I be nauseated after surgery?

It is possible that you may have nausea and/or vomiting following anesthesia. Patients who are at an increased risk for developing postoperative nausea/vomiting include women, non-smokers, people who experience motion sickness, and patients who have experienced nausea or vomiting after anesthesia previously. Please share this information about your medical history with your anesthesiologist during your interview.

Certain types of anesthesia increase your risk for nausea/vomiting. Regional anesthesia, such as spinal or epidural anesthesia and nerve blocks, and light sedation lower your risk of nausea/vomiting by avoiding a deep general anesthetic. Your anesthesiologist will discuss your anesthetic options with you.

Some types of surgery increase your risk for nausea/vomiting. For instance, ENT surgery, plastic surgery, and abdominal surgery all have an increased incidence of postoperative nausea/vomiting, while orthopedic surgery has a lower incidence. We realize that nausea after surgery in not a pleasant experience, so we routinely administer oral and intravenous medication to minimize your risk. The higher your risk (based on the particular surgery and your risk factors), the more aggressive our approach. We may even use a sea-sickness patch (scopolamine patch) to minimize nausea, since most postoperative nausea is movement-related. We don’t use the scopolamine patch as prophylaxis on all patients because of possible side effects, including sedation, dry mouth, dizziness, and urinary retention. Of course, if in spite of our efforts you still experience nausea in the recovery room, we will use your IV to treat your discomfort.

Should I take my medications on the day of surgery?

For the most part, medications that you take at home should be continued, including your usual morning medications on the day of your procedure. Your family doctor or internist has placed you on your medications to treat certain conditions, and we do not want these to present a problem during or after surgery. There are, however, a few exceptions. The following is a list of medications which should not be taken on the day of surgery:

• Diuretics (water pills)
• Diabetes medications (insulin or pills for diabetes)
• Coumadin (your surgeon should advise you when to discontinue this)
• NSAIDs (medications such as ibuprofen or naproxen)

Certain blood thinners such as aspirin and plavix require special consideration. If you are on aspirin and/or plavix because you have had a stroke or have coronary disease (especially if you have a coronary artery stent), you must notify both your surgeon and your cardiologist about the need for surgery. Discontinuing aspirin and plavix in these instances is potentially dangerous, and must be considered carefully after a discussion among your treating physicians.

Will I wake up during surgery?

The problem of "awareness" under anesthesia, or the concern that a patient may be awake during surgery has garnered a lot of public attention recently. To put your mind at ease, it is helpful for you to understand under what circumstances this may occur, and just how great your risk is for "awareness".

First, only a portion of operations are performed under "general anesthesia", the deep anesthetic which eliminates consciousness and movement. Many surgeries are done with nerve blocks such as spinal anesthesia, or even local anesthesia alone. In cases where a block or local anesthesia is used, sedation is provided through an IV with the patient breathing on his own. The sedation is a sort of "twilight" state from which the patient may easily arouse. The overwhelming majority of patients who tell us "I woke up during surgery" were simply in and out of this twilight state during an uneventful surgery using a nerve block.

Under general anesthesia it is very rare for a patient to experience any awareness during surgery. There are a few conditions that will increase the risk of awareness, including:

• Emergency surgery
• Cardiac surgery
• Surgery for major trauma
• General anesthesia for cesarean section
• Anesthesia given exclusively through the IV
• Patients with alcoholism or other drug abuse
• Patients with chronic pain on high dose narcotics
• Patients with a history of awareness under general anesthesia
• Patients who are critically ill

Our anesthesiologists are aware of patients who may be at increased risk, and we always take special precautions to prevent awareness. Our documented incidence of awareness under anesthesia is less than 1 in 50,000 patients. Although this complication can occur, it certainly does not warrant great concern on your part.

Will I have pain after surgery?

Your anesthesiologist is a specialist in Perioperative Medicine, and part of that expertise is directed toward preventing and treating postoperative pain. There are several ways we address the problem of pain after surgery.

1. Prophylaxis. Pain medications given just prior to surgery can be very effective in preventing postoperative pain. We often administer non-steroidal anti-inflammatory medications and opioids before incision to achieve this effect.
2. During surgery. Several classes of anesthetic drugs act to relieve pain, and one or more is always administered during surgery to ameliorate pain upon awakening.
3. Nerve blocks. "Numbing" of the surgery site is very effective in preventing postoperative pain, and can take one of several forms. We may administer pain medications through a spinal or epidural block, often leaving a catheter in place to give repeat doses over hours or days. We may provide a nerve block which numbs a specific extremity, again sometimes leaving a catheter in place for continued use. Finally, your surgeon may inject local anesthesia aroung the incision to numb the area locally.
4. In the recovery room. Each of our patients who comes to the recovery room has orders written for the management of pain. We understand that every patient responds differently to pain medications, so we are always immediately available to order additional medications or try different strategies to control your pain.

Our excellent recovery room nurses are all specialists in postoperative care, and will continually assess your level of pain and administer necessary treatment. You will never feel as if you are alone with your pain while you are under our care!