Pre-operative

Pre-operative assessment

My practice manager will contact you and organise for a health questionnaire to be sent to you by email. It is important that you fill this out thoroughly as the information allows me to plan for the type of anaesthesia and pain relief for your specific circumstances. In some cases I will contact you by phone to discuss your health problems in more details and plan for your anaesthetic.

It would be helpful if you could let me know the results of any recent specialist appointments or investigations (ECG's, echocardiograms, stress tests, X-rays or blood tests) and bring the reports to hospital with you.

Medications

Please provide an up to date and thorough list of your medications and supplements. Most can be taken at their normal times on the day of surgery but may need tailoring post operatively.

Diabetes

Oral medication for diabetes will be withheld for morning procedures, but may be taken for afternoon operations. If you are on insulin, this will need to be discussed in advance.

Anticoagulants, antiplatelets, "blood thinners"

These will be withheld for a variable period prior to surgery, and should be discussed with myself and/or your surgeon. 

Fasting

Fasting reduces the risk of regurgitating and aspirating stomach contents under anaesthesia which, if it occurs, may lead to damage to the lungs from stomach acid.

You may have solid food until six hours before your procedure, with clear fluids up until two hours prior. Clear fluids include water, black coffee/tea and clear juice, but not milk, particulate containing fluids or chewing gum. A practical guide is to have two to three glasses of water up until an hour before your admission time. 

Morning procedures

Food until midnight, with clear fluids until 0600.

Afternoon procedures 

Breakfast prior to 0700 with fluids until 1100.

I appreciate this may differ from individual hospital recommendations; however, I would prefer that you follow these specific instructions. They will ensure you arrive for your procedure hydrated and comfortable.

Please note, the instructions for solid food will differ if you are having colonoscopy (refer to the instructions from your proceduralist); however, you should still follow the instructions above pertaining to clear fluids.

Smoking

Cigarette smoking before your surgery puts you at additional risk for adverse outcomes after surgery. These include, but are not limited to, wound infections (some requiring further surgery or prolonged intravenous antibiotics), chest infections, asthma during general anaesthesia and heart attacks. These complications can keep you in hospital longer, or necessitate another operation. The good news is that stopping smoking up to two weeks before surgery will reduce your risk of lung complications, while three to four weeks of abstinence will reduce the incidence of surgical site infection. There are also the long term beneficial effects of quitting, including reduced rates of cancer and heart disease and the financial benefits. 


We know that quitting cold turkey is ineffective: only one in eight people are able to quit this way. Adding nicotine replacement therapy increases your chances of long term abstinence to one in three per attempt. Combination NRT - a combination of a slow release (patch) and quick release (inhalator, spray, gum, lozenge) preparation - is the most effective method. The science tells us that this needs to be continued for at least three months to have the best chance of success. 


Other therapies I would recommend include hypnosis and Champix; these may be considered complimentary to NRT in some circumstances.  I would be more than happy to discuss these with you in advance or on the day of surgery.