Pre Operation

    NOTE: Material on this page does not constitute medical advice. Consult with your physician concerning specific medical conditions.
     

    Would it be expected practice of the anesthesiologist to listen to your heart and lungs before having ambulatory surgery? Would there be any exceptions?

    Ideally yes. Most anesthesiologists do listen to the heart and lungs of patients during their preoperative exam and interview. Exceptions? Perhaps if the patient had just been seen in the preanesthesia testing area the found to have a normal exam and no history of heart or lung disease some anesthesiologist might not see a need to reexamine the heart and lungs on the day of surgery.

    I am going to have knee surgery soon. I am taking atenolol 25 mg. daily for a problem where my heart beats too fast. Should I worry about interactions between my medication and anesthesia drugs?

    Atenolol is one of the current popular beta blockers used to slow the rate of heart contractions. In most cases, where the patient is placed on a beta blocker ,such as atenolol, for heart rate control, the anesthesiologist would want the drug continued right up to the time of surgery. Your anesthesiologists needs to know that you are taking atenolol and why you have been prescribed the drug. There is little to be concerned about as far as drug interactions between the drugs used for general anesthesia or regional anesthesia and atenolol.

    What are the concerns I should have with the taking of herbal compounds and vitamins with inpending surgery and anesthesia?

    Herbal supplements and vitamins are biologically active and can interact with medications and have an effect on surgery. These effects include increased bleeding, blood perssure changes, prolong sedation after anesthesia, fluid and electrolyte changes and alterations in blood sugar. The Americian Society of Anesthesiologists recommends that patients stop taking herbal medications and vitamin supplements at least two to three weeks prior to surgery. Always tell your anesthesiologist that you are taking herbal and vitamin supplements.

    I will be undergoing liposuction of the arms. I am concerned because my mother has angina and has had a bad reaction to anesthesia before. I believe angina can be hereditary. I sometimes have had chest pain, usually when I am stressed. Physicians have never found anything. They say Angina can be hard to confirm. Should I be concerned about general anesthesia?

    Patients with stable angina usually do quite well with general anesthesia. If you have been evaluated for angina and cleared by your physicians you can feel comfortable about undergoing a general anesthetic, especially if this evaluation included a stress test. You should discuss your concerns with your anesthesiologist and go over your options with him or her.

    For oral surgery, what blood pressure is too high to put someone under? 198/106 was my # b4.

    High blood pressure may make anesthesia and surgery hazardous. In patients whose blood pressure is very high before surgery, anesthesia tends to exaggerate both the highs and lows. These fluctuations can cause problems with the heart, brain and kidneys, leading in some cases to heart attacks or strokes.

    High blood pressure readings may be due to anxiety at the preop visit or related to true hypertension. We recommend that you see your primary MD and get your BP checked a few times before surgery. If you have hypertension, then you can be started on blood pressure medication and controlled prior to elective surgery.

    Although there is no exact level of blood pressure that divides acceptable blood pressure from blood pressure that is too high, most anesthesiologists would seriously consider canceling an elective operation if the diastolic (the lower number) was at or above 110, or the systolic (upper number) was above 200 - 220. The operation may need to be postponed to allow for proper diagnosis and treatment of the blood pressure to bring it down to acceptable levels.

    A blood pressure reading of 198/106 meets the criteria for severe hypertension, which puts a patient at risk for stroke, coronary events and kidney failure. While the data is skimpy, many physicians believe that hypertension should be brought under control slowly – over as much as six weeks – before considering elective anesthesia and surgery. The possibility of stroke, heart ischemia and the status of kidney function should be investigated before elective surgery.

    Is ambulatory surgery riskier if I smoke?

    In general, smoking very well may increase the risk of respiratory-related problems associated with the administration of anesthesia. For most ambulatory surgery procedures, though, the risk is still quite low. The overall risk, including the risk of death, while not impossible, is still quite low also. You may be able to eliminate smoking as a risk for your anesthetic care if your anesthesia can be provided with a regional technique, such as numbing the area of surgery, along with sedation, instead of general anesthesia. Very heavy smoking may also influence your operation through its effects on wound healing.

    I have a history of panic attacks and I need to undergo sinus surgery. Is it possible that this condition may cause problems during the anesthetic or that my panic attacks may worsen after anesthesia and surgery?

    Most patients who are about to have surgery experience at least some anxiety or nervousness beforehand. A person with a history of panic attacks is likely to have a more difficult time with this. Without knowing more about your exact condition and what triggers your attacks, we can offer only a few general suggestions that might help allay your anxiety and increase your chances of having a less stressful time:

    Ask for an interview, or at least a telephone call, with your anesthesiologist. Studies have shown that the best pre-surgery anxiety reliever is an interview with the anesthesiologist.

    Find out whether additional anti-anxiety medication can be prescribed for you to take the night before and/or the morning of surgery.

    Consult with your primary care physician to make sure that the current treatment for your panic attacks is optimal.

    Let other care-givers,including your surgeon, understand that you have a condition that may affect your ability to tolerate some routine things before and after surgery - e.g. application of oxygen masks and other medical devices.

    Would it be expected practice of the anesthesiologist to listen to your heart and lungs before having ambulatory surgery? Would there be any exceptions?

    Ideally yes. Most anesthesiologists do listen to the heart and lungs of patients during their preoperative exam and interview. Exceptions? Perhaps if the patient had just been seen in the preanesthesia testing area the found to have a normal exam and no history of heart or lung disease some anesthesiologist might not see a need to reexamine the heart and lungs on the day of surgery.

    What are the restrictions of food before ambulatory surgery?

    To decrease the risk of aspiration of gastric contents into the lung, patients are routinely asked not to eat or drink anything for at least 6-8 hours before surgery. Clear liquids may be allowed up to 3 hours before surgery. Coffee drinkers, if allowed to drink 3 hours before surgery, should drink their morning coffee at that time. Ask your anesthesiologist to be certain: the time limits for food or clear liquids before surgery can be institution and practioner specific.

    What actually goes on when I have an outpatient surgery procedure?

    The anesthesiologist will carefully assess your medical history and perform a directed physical examination during your preoperative assessment. He/she will then discuss with you the risks and benefits of your anesthetic options based on your medical status, the anticipated procedure, it's duration, and your surgeon. After informed consent, the anesthesiologist will then formulate your anesthetic plan, medicines, and monitoring. Throughout the anesthetic and surgery, your physical status will be monitored and treated to maintain your safety, and anesthetics will be delivered for analgesia. This same level of care will continue during your recovery, guided by your anesthesiologist.