If you’re going to have surgery, it’s good to be prepared. You should find out about what your surgery will involve, your medicines, what you need to do before the surgery, how to get to and from the hospital, and your care when you go home after your surgery.
The days leading up to your surgery
Make sure you know exactly what your operation is for, what it is expected to do for you and the risks involved.
You might have a general anaesthetic, a local anaesthetic or light sedation. Be sure you know what your doctors plan to do and what you need to do to prepare. Ask your doctor about the anaesthetic — you might not meet the anaesthetist until the day of the operation.
If you take medicines regularly, discuss them with your doctor. It’s important to know whether or not you should take them as usual or delay them.
Tell your doctor about all the medicines you take, including over-the-counter and complementary or alternative medicines. You may need to stop taking some medicines, such as anti-inflammatory medicines and aspirin, before surgery. Discuss this with your doctor.
If you have diabetes, you need to develop a good plan with your doctors that involves what medicines to take and when to eat.
If you smoke, quit if possible. Quitting will help your recovery and reduce your risk of problems with anaesthetic. Even quitting for a short period is helpful.
If you drink alcohol every day, drink less before surgery. It will help with your healing and your recovery.
The day before surgery
If you’re having a general anaesthetic, you’ll need to avoid eating and drinking for some hours beforehand. Your anaesthetist will tell you when to stop eating and drinking before surgery.
You should be able to take most medicines with a sip of water right up until surgery. However, it’s very important to tell your anaesthetist if you are taking antidepressants, anticoagulants including aspirin, or medications for diabetes, as you will need special instructions for taking these before surgery.
You should plan how you’re going to get to hospital and get home. It’s best to ask family or a friend to help you get home and to help you at home afterwards.
After surgery
Ask your doctor how long you’ll be expected to stay in hospital after the operation. Some people need only a few hours before they can go home while others will be in for a few days or more. A few will be told they’ll wake up after surgery in an intensive care unit. It depends on the type of surgery, the type of anaesthetic, and your health.
Pain can be a significant problem after surgery. Don’t be a hero. Tell your doctors and nurses if you have pain.
Some people will need rehabilitation after surgery, either to get their strength back or to help with the particular problem that the surgery has dealt with. You can have rehabilitation treatment at home or in a rehabilitation unit. Talk to your doctor.
Depending on the type of surgery, there might be some things you can’t do for a while. You might not be allowed to drive, you might find it hard to work, you might find it hard to look after yourself. It’s good to talk these things through with your doctor before the surgery so you can plan to solve problems in advance.
Getting back to normal life can take time. You might be more tired than you expect. Go easy on yourself and accept help that’s offered.
More information
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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 hypoglycemic (diabetes pills) should NOT be taken.
Anesthesia is the use of medicine to prevent discomfort during surgery or medical procedures. Most people do well with anesthesia (pronounced: an-ess-THEE-zhuh) and have no problems afterward.
How Does Anesthesia Work?
Anesthesia works by blocking signals in the nervous system. The nervous system is made up of the brain, spinal cord, and nerves. Messages from the body travel through the nerves and spinal cord to the brain. Anesthesia blocks pain messages from getting to the brain.
What Are the Different Types of Anesthesia?
There are three types of anesthesia: general, regional, and local. Sometimes, a patient gets more than one type of anesthesia. The type(s) of anesthesia used depends on the surgery or procedure being done and the age and medical conditions of the patient.
General anesthesia: A patient who gets general anesthesia is completely unconscious (or "asleep"). They can’t feel any pain, are not aware of the surgery as it happens, and don’t remember anything from when they are “asleep.” Patients can get general anesthesia through an IV (into a vein) or inhale it through their nose and mouth. A tube placed in their throat helps the person breathe while they are under general anesthesia.
Regional anesthesia: This type of anesthesia is injected near a cluster of nerves in the spine. This makes a large area of the body numb and unable to feel pain. Common types of regional anesthesia include epidurals (often used in childbirth), spinal blocks, and peripheral nerve blocks (when the medicine is injected near a nerve or group of nerves to block feelings of pain in a specific area of the body).
Local anesthesia: Local anesthesia numbs a small part of the body (for example, a hand or patch of skin). It can be given as a shot, spray, or ointment. It may be used for dental work, stitches, or to lessen the pain of getting a needle.
How Is Anesthesia Given?
If you'll be getting anesthesia, doctors and nurses will work with you and your parents (or caregivers) to ease any fears. Sometimes, a patient gets sedation before the IV is placed or anesthesia is given. This medicine, given by mouth or as a nasal spray, helps them relax and feel sleepy. If you get sedation, a parent usually can stay with you until the sedative starts to work.
Then, you'll get the anesthesia from either an or a CRNA (certified registered nurse anesthetist). Depending on the anesthesia type, it may be given through a mask, breathing tube, or IV.
During anesthesia, the doctor or nurse will closely watch your breathing, heart rate and rhythm, body temperature, blood pressure, and blood oxygen levels.
After general anesthesia, you'll go to the post-anesthesia care unit (PACU) or recovery room. Your parents can join you here and be with you while you wake up. Patients often go home the same day, but some stay in the hospital.
What Are the Side Effects of Anesthesia?
For regional and local anesthesia, someone may feel sore where the needle was given.
For general anesthesia, someone may feel groggy and a little confused when waking up after surgery. Other common side effects can include nausea or vomiting, chills or shakiness, or a dry throat (from the breathing tube).
These side effects usually aren’t dangerous and go away quickly.
What Are the Risks of Anesthesia?
For most people, anesthesia is very safe. In very rare cases, anesthesia can lead to problems such as abnormal heart rhythms, breathing problems, allergic reactions to the medicines used, and even death. The risks depend on the kind of surgery or procedure, the condition of the patient, and the type of anesthesia used.
Your health care provider will talk to you and your parents about any possible risks.
What Else Should I Know?
Most people don’t have any problems with anesthesia.
Before you get anesthesia, the doctors and nurses will ask you about:
- your current and past health, including any breathing problems like asthma and whether you snore
- any medicines (prescription and over-the-counter), supplements, or herbal remedies you take
- any allergies (especially to medicines, foods, or latex)
- whether you smoke, drink alcohol, or use any drugs
- any past reactions you or any family member has had to anesthesia
Follow the doctor's and nurse’s recommendations about what to do before anesthesia, such as:
- when you need to stop eating or drinking
- whether you need to stop any medicines or herbal supplements before surgery
If you have cold symptoms (a cough and/or runny nose) or breathing problem in the days before the surgery, it is very important to let the doctor and care team know.
Most medications should be taken on the patient’s usual schedule the day before the scheduled procedure. We recommend that patients not take most oral medications within 8 hours of their scheduled arrival time, because many medications can cause stomach irritation or nausea if taken without food. Many medications are available in IV form, and can be given during or after anesthesia when necessary. This question becomes more complicated for antihypertensive medications, anticoagulants, antiplatelet therapy, and pain medications. Nearly all the medications commonly used for general anesthesia and sedation have the effect of lowering blood pressure and reducing sympathetic tone; some of them depress cardiac function as well. Common medications include propofol, fentanyl, midazolam, and the inhaled fluorinated ethers such as sevoflurane and desflurane. For this reason, caution should be used in telling patients to take all antihypertensive medications on the morning of surgery, as significant hypotension may result during anesthesia. The surgeon or the physician performing the procedure often requests that anticoagulants or antiplatelet therapy be discontinued for several days to a week in advance of surgery. If you feel that it is not in your patient’s best interest to hold these medications, it is best to discuss this with the surgeon in advance. Often, low-dose aspirin can be continued throughout the perioperative period without increasing the risk of bleeding for many routine procedures, and it may protect the patency of drug-eluting coronary stents. However, in some circumstances such as intracranial surgery, the risk of bleeding may be unacceptable. In a 2016 update on dual antiplatelet therapy, ACC/AHA guidelines advise: “Decisions about the timing of surgery and whether to discontinue DAPT after coronary stent implantation are best individualized. Such decisions involve weighing the particular surgical procedure and the risks of delaying the procedure, the risks of ischemia and stent thrombosis, and the risk and consequences of bleeding. Given the complexity of these considerations, decisions are best determined by a consensus of the surgeon, anesthesiologist, cardiologist, and patient.” Patients who are on opioid treatment for acute or chronic pain may be advised to take their medications with a sip of water up to two hours before the time of surgery. Fentanyl patches may be used per the patient's routine; it is helpful for the patient or family to make a note of the time and date of placement, and inform the anesthesia team. Patients with severe opioid dependence, especially those who are taking Suboxone (buprenorphine and naloxone) or methadone as maintenance therapy, should be referred for a Pre-surgical Pain Medicine consultation, as postoperative pain management in these patients presents special challenges. Antihypertensive medications
Anticoagulants and antiplatelet therapy
Pain medications