• You will be told that you may not eat or drink for several hours before surgery. The exception is some (but not all) medications. The purpose of this is to ensure that your stomach is empty, minimizing the chance of your vomiting. You may hear us talk about being NPO - from the latin phrase non per ora, “nothing by mouth.” Unless you have specific orders from your surgeon, you may eat your regular foods until the time we tell you to stop.
  
  
• Caution: Eating too close to your scheduled surgery (i.e., after the time you are told to stop) may require rescheduling of your surgery.
  
  

• Various tests may be required before your have surgery. These may include blood work, heart testing (EKG) or x-rays.
  
  
• Many patients will go to the O’Connor Hospital Pre-Op Clinic.
  
  

• Anticoagulants (blood thinners) usually need to be stopped several days before surgery. Oral medications may need to be replaced with injected or intravenous (IV) medications. It is extremely important that both your surgeon and your physician (who has ordered the anticoagulants) discuss the optimum timing for stopping these medicines. Please be aware that many drugs and herbal products may be anticoagulants (blood thinners) although they are not used for that purpose.
  
  
• Prescription anticoagulants include:
  
  • warfarin (Coumadin)
  • enoxaparin (Lovenox)
  • clopidogrel (Plavix)
  • ticlopidine (Ticlid)
  • aspirin (in many versions)
  • non-steroidal anti-inflammatories (NSAIDs) (in many versions)
  • dipyridamole (Persantine)
  • aledronate (Fosamax)
  
  
  
• Non-prescription (over-the-counter or herbal) anticoagulants include:
  
  • aspirin (in many versions)
  • non-steroidal anti-inflammatorys (NSAIDs) (in many versions)
  • Vitamin E
  • garlic
  • ginger
  • ginkgo biloba
  
  
  
• Monoamine Oxidase Inhibitors (MAOIs)
  
  • Drugs in this group include some anti-depressants and most anti-Parkinson drugs.
    
    
  • MAOIs can interfere with many of the medications used during anesthesia. If the medication needs to be stopped, it should be done one to two weeks (7-14 days) before surgery because it takes that long for the drug to be out of your system. You should discuss this with your surgeon and primary physician as early as possible.
    
    
  • MAOIs include:
    
    • tranylcypromine (Parnate, Sicoton)
    • phenelzine (Nardil, Nardelzine)
    • isocarbonazid (Marplan)
    • rasagiline (Azilect)
    • selegiline (Eldepryl, Deprenyl)
    • linezolid (Zyvox) (an antibiotic)
    • St. John’s Wort
    
    
    

• In general, blood pressure (heart) medications, anti-seizure medications and acetaminophen-containing pain medications (no aspirin or NSAIDs) should be taken the morning of surgery with a sip of water.
  
  
• Insulin may be given in a reduced dose. Discuss this with your anesthesiologist. Oral hypoglycemics (diabetes pills) should NOT be taken.
  
  

• Make sure that your inform your surgeon and anesthesiologist that you have the device.
  
  
• Make sure that you have the information card from your device (brand & model, company contact info). Each device responds differently to the devices we use in the operating room. We may need to have the device interrogated (tested) before or after your surgery.
  
  

• O’Connor Hospital - Pre-Op Clinic
  408-947-2593
  www.oconnorhospital.org
  
  
• South Bay Surgery Center
  408-779-3697
  www.southbaysurgerycenter.com
  
  

• We are happy to accomodate requests as we are able. However, not every physician is available every day.
  
  
• Please contact our scheduler at 408-298-3218 to make your request. Have your scheduled surgery date/time, planned procedure and surgeon’s name available.
  
  

General anesthesia is a state of total unconsciousness resulting from the administration of medications, which may be given intravenously or inhaled. The patient with a general anesthetic typically requires a mask or tube in the throat not only to administer oxygen and inhalational anesthetic agents, but also to facilitate their breathing.

• Regional anesthesia is anesthesia affecting a portion of the body, such as an arm or leg. It may involve a single injection or placement of a catheter near an appropriate nerve in an arm, leg or along the spine through which medicine may be given over a period of time. This type of anesthesia may produced complete numbness along with muscle weakness, or produce selective pain relief, depending on the types of medications used. The duration of the effect depends on the amount and type of medication used.
  
  
• Local anesthesia is a subset of regional anesthesia. It refers to anesthesia of a small part of the body, such as a tooth or an area of skin. Often the surgeon will inject local anesthetic close to the operative area to make it numb.
  
  
• The patient may be fully awake during the procedure, or may receive sedation in addition to the regional anesthetic.
  
  
• Regional techniques may be used to provide post-operative pain relief, using catheters and continuous-flow pumps.

Sedation (MAC) provides the patient with medicines that alleviate anxiety (anxiolysis), reduce pain (analgesia) and facilitate relaxation. Sometimes the sedation needs to be deeper during parts of the procedure, and at other times it may be light enough that the patient can communicate.

A good analogy is a dimmer switch on a lamp -- the light can be fully on, fully off, or somewhere in between. The anesthesiologist will tailor your level of sedation based upon your needs and response to the medications during the procedure.

• General and Regional techniques may be combined, particularly if the primary goal of the regional technique is to provide post-operative pain relief.
  
  
• Regional and Sedation techniques are frequently combined, so that the regional technique provides the pain relief, and the sedation provides the anxiety relief.