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Dr. John M. Keggi JOHN M. KEGGI
M.D
Dr. ROBERT EDWARD "TED" KENNON ROBERT EDWARD "TED" KENNON
M.D
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Most patients arrive on the morning of surgery at the hospital. Years ago, patients were admitted the day or two before surgery for preoperative testing, but in modern practice most of the testing is performed as an outpatient well before admission.

Preadmission testing also has the advantage of identifying any potential problems - such as a clotting disorder or cardiac arrhythmia - long before the patient has to actually reach the hospital, and consequently, if any minor issues are found they can often be corrected before the scheduled surgery without delaying or canceling it.

There are a few things to remember before the hospital admission, though.

Stopping Medications Before Surgery

Certain medications have to be discontinued prior to admission to the hospital. The most common of these are nonsteroidal anti-inflammatory medications, such as ibuprofen or naprosyn. These medications can thin the blood and should be discontinued at least 3 days before surgery.

Aspirin or any drugs that contain aspirin (Anacin, Percodan, etc.) should be stopped 7 days prior to surgery. These drugs inhibit platelet function so that bleeding is more likely.

Drugs taken expressly as "blood thinners" should be stopped before surgery, but this needs to be checked during the preoperative medical clearance visit. Some of these cannot be stopped (depending on why they are being taken - for example, patients with some cardiac arrhythmias or mechanical heart valves cannot simply stop anticoagulation), and special arrangements may need to be made for admission to the hospital several days before surgery for conversion to a heparin I.V. that can be shut off a few hours before surgery. Warfarin and other "blood thinners" such as clopodigrel (e.g., Plavix) should be stopped 7 days before surgery if this is cleared with your internist.

Another class of drugs that can cause problems with anesthesia are oral hypoglycemic drugs taken by non-insulin dependent diabetics (such as glucophage or metformin). These should not be taken the day of surgery.

Herbal Medications

Many patients today are taking a number of herbal and nonpharmaceutical remedies for everything from prostate problems to depression. Because these are herbal preparations and not prescribed, many patients may not think to list them when reporting medications to their doctors. However, some of these have potent effects on blood pressure and the nervous system, and can cause potentially serious interactions with some of the anesthetic drugs used. If you are taking any of these preparations, be sure to mention them to all of the physicians involved in your care, including your surgeon, primary care provider performing the presurgical medical clearance visit, and particularly the anesthesiologist.

The Night Before Surgery

Most patients are understandably somewhat anxious the night before surgery. However, it may help to reflect that this is the last night living with that arthritic joint, and after the planned surgery you can begin getting back to life with improved mobility.

Many of our patients may be coming from far away, and it is not uncommon to stay in a local hotel the night prior to surgery. It does, however, necessitate an early checkout.

It is important not to eat or drink anything after midnight the evening before surgery. This ensures that the stomach is empty by the time of surgery. Even for patients just having regional or spinal anesthesia, it is still important that the stomach be empty just in case general anesthesia is needed.

The exception to this is some regular medications you may take such as blood pressure medication. Your internist may recommend taking these medications on the morning of surgery. In this case, it is acceptable to take the medications with just a sip of water, as this is a very small volume.

Do not smoke or drink alcohol 48 hours before surgery, as this can cause problems with anesthesia.

What to Bring To The Hospital

Most patients pack a small overnight bag to take with them to the hospital. This is checked in the preoperative area and sent up to the hospital room, along with clothing and other belongings, so that it is waiting for you when you get upstairs after surgery.

The hospital will provide a (admittedly not-sostylish) hospital gown, which you need to wear for surgery, but you certainly can take along a comfortable gown for after surgery. Pajamas are usually difficult to get in and out of for the first few days after surgery, and most patients find the hospital gowns are more comfortable.

The hospital provides non-skid booties, but a good pair of bedroom slippers are usually helpful to have. You may also want to bring along your own pillow.

The hospital also will provide toiletries, but as with staying at a hotel, you probably will prefer to have your own. Women may want to take a make-up kit, but it is advisable not to wear make-up, jewelry, or nail polish (which interferes with oxygen sensors clipped to the fingers) on the day of surgery.

Reading material and portable music players are fine to bring to the hospital. Most patients also bring a cell phone, which in non-ICU areas is usually allowable, and many patients bring lap-top computers also.

If you have already been given crutches or a walker, bring them to the hospital. Some insurance plans deliver these items to patients' homes prior to surgery. If not, the physical therapist will outfit you with the necessary equipment during your hospital stay.

Be sure to take along any forms and papers given to you by your doctors prior to surgery, especially any consent forms and lists of medications and dosages. You should also bring along a current insurance card(s) in case the hospital needs it.

In general, do not bring your own medications, however. It can cause confusion, and the hospital generally provides all medications. On rare occasions, there are some uncommon medications that your internist may recommend you take with you, however, because they may be nonformulary medications (rarely used and not available through the hospital pharmacy). In this case, take the medication bottles (with their labels) in a plastic bag, so that they can be tagged and kept with the other post-operative medications. You will get them back, but it allows the nurses to keep track of exactly what medications (and potential interactions) you are taking.

Also, it is generally not advisable to take valuables, large quantities of cash, or credit cards to the hospital. If you normally wear contacts, plan on using your glasses for a few days instead. It is also advisable to remove all rings (including wedding bands) before going to the hospital, as there can sometimes be swelling from an I.V. or fluid retention that can cause problems with rings.

Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.