Preoperative preparation

There is a long list of tablet medications that act as blood thinners. This list includes the following common drugs but there are others as well:

• Apixaban (Eliquis)
• Aspirin (Astrix, Cartia, Cardiprin, Dispirin, Solprin)
• Clopidogrel (Clovix, Coplavix, Duocover, Iscover, Piax, Plavicor, Plavix)
• Dabigatran (Pradaxa)
• Dipyridamole (Asasantin, Persantin)
• Prasugrel (Effient)
• Rivaroxaban (Xarelto)
• Ticagrelor (Brilinta)
• Ticlopidine (Tilodene)
• Warfarin (Coumadin, Marevan)

In many situations, your anticoagulants may need to be changed or ceased prior to surgery. This will depend upon your reason for being on that drug and the type of procedure you are having performed. Clear advice will be given to you about what to do with any of these types of medications when you are booked in for surgery. If there is any doubt, always contact my rooms regarding this.

Prior to any elective surgery, it is a requirement that you fast for at least 6 hours beforehand. This is a way of making sure your stomach is empty at the time of anaesthetic. Having an anaesthetic or sedation with food or liquid in the stomach increases your risk of regurgitating or vomiting during anaesthetic, and a condition called “aspiration pneumonitis” which is where the gastric contents are breathed into the lungs. This can be a very serious problem and by fasting appropriately, this risk is made as low as possible. Sometimes, you may be advised to have certain types of liquids or specific medications within this timeframe but generally you are asked to be “nil by mouth” for 6 hours before. This includes not eating or drinking anything including water or even using chewing gum. Unless you are advised to do otherwise by myself or my anaesthetist, please follow these instructions strictly.

For specific bowel procedures such as colonoscopy and some types of bowel surgery, cleaning the bowel out with a bowel preparation is necessary. If it is required, I will advise you of this and provide you with the information required to complete it properly.

If you have had a particular scan or X-ray prior to your operation, you will need to bring this to hospital with you on the day of your surgery. This includes the following types of imaging:

• CT Scan
• MRI
• Nuclear Medicine Scan
• Ultrasound
• X-ray

If you are not sure, it is always much easier to bring a scan, just in case it is needed on the day.

Apart from the general health risks associated with smoking, there are some higher risks that can occur if you are smoking at the time of surgery.

Smoking in the lead up to an operation clearly increases your risk of lung problems with a general anaesthetic or sedation. This type of problem can be severe and on some occasions, if the anaesthetist deems your risk to be too high, your operation may be postponed.

After an operation, it is well known that smokers have a higher risk of problems such as pneumonia, infection, hernia in wounds and blood clots (known as deep venous thrombosis).

The full benefits of smoking cessation prior to an operation are at their highest when you stop smoking at least 4 to 6 weeks before surgery. If you need assistance with this, your GP is the best place to start. Alternatively, Dr Betros is happy to discuss this with you at the time of your consultation.

It is very common that patients can develop a problem such as a cough or cold prior to surgery. If this happens, please contact my rooms to discuss this, especially if you are still sick as late as a week before your planned operation. It may mean your surgery is safer to be delayed if needed.

In addition, other problems such as bacterial infections (eg urinary tract infection or cellulitis) are very important and any other major change in your health. Specifically, if you are diagnosed with any heart, lung or kidney problem after you have booked in for your surgery, I will need to be notified.

If this is not done, it may be possible, your surgery is cancelled on the day until your new problem is sorted out and it is at the safest circumstances to proceed.