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The normal instructions with preparing for anesthesia are to let the patients know not to eat or drink anything after midnight before surgery. If you have surgery first thing in the morning, then these guidelines are not hard to comply with. But for surgeries later in the day for diabetic patients – then dangerous dehydration from lack of drinking water or low blood sugar from not eating can result.



                                       Anesthesiologist with patient

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There are now new guidelines by the American Society of Anesthesiologists:

  • Solid food should be avoided for 6 hours

  • Clear fluids for up to 4 hours before anesthesia

  • Always follow your own physician’s instruction on preparation for surgery

  • Patients are normally encouraged to take their regularly scheduled medications up to and including the morning of surgery. If anything should be avoided, your surgeon will give you orders on what to take. Taking your medication should be done with only a swallow of water if your surgery is early in the morning.



Exceptions with taking medications include the following:






Insulin and the diabetic patient increases the incidence of peri-operative complication. The risks are infection, metabolic derangements, renal and cardiac complications. The major peri-operative complications in diabetic patients are infection and impaired wound healing. Infection contributes up to 2/3 of post-operative complications. Hyperglycemia affects greatly to wound healing and susceptibility of infection.




Diuretics, commonly known as "water pills" are used to treat not only high blood pressure but are also given to patients with heart failure, or to treat swelling of the legs (edema). Theses medications when taken the day of a surgical procedure can cause two problems for the patient.  Diuretic cause the patient to lose any retained fluid, so going long distances without a restroom nearby can sometimes be problematic.


Diuretics cause a decrease in blood volume called "hypovolemia", which can be detrimental during and after a surgical procedure. Many anesthesiologists will tell their patients not to take the diuretic the morning of surgery, however; every patient is different in their needs and will be consulted on what is right for them.





There are many people who actively use Herbal Medications. Many patients can be reluctant to admit they take these herbal supplements however; it is very important to make sure you tell your plastic surgeon and anesthesiologist before your surgery. Acute and chronic hepatic or renal toxicity is possible with these agents. 


Other adverse effects that may complicate the surgical and anesthetic include excessive bleeding, heart and blood pressure effects and sedation. Most surgeons and anesthesiologist recommend discontinuing use of herbal medications for at least one to two weeks before surgery.




Some of the most common herbal products are the following:

  • Echinacea - Immune suppression and liver inflammation

  • Black Cohosh - Blood pressure decreases might cause bleeding

  • Feverfew - Migraine, anxiety, insomnia, joint stiffness; risk of prolonged bleeding

  • Garlic - Blood pressure changes; risk of prolonged bleeding

  • Ginger - Sedative effects, risk of bleeding; especially when taken with aspirin and Ginkgo

  • Ginkgo Biloba - May increase bleeding

  • Ginseng - Insomnia and irritability; risk of cardiac effects

  • Hoodia - Changes in blood sugar; possible arrhythmias

  • Kava - Sedative effects; potential liver toxicity; risk of additive effect of medications

  • St. John's Wort - Sedation; blood pressure changes; drug interactions with medication that prolong effects of anesthesia

  • Valerian - Increased sedative effects




Vitamin E should be discontinued completely for at least two weeks before your surgical procedure. Vitamin E can cause prolonged bleeding. Its antioxidant effect reduces thrombin formation and thus helps decrease blood clotting, and it also appears to minimize platelet (blood-clotting component) aggregation and stickiness. Blood clotting time is important when you are expecting to have a surgical procedure.




Discontinue all diet pills, prescription and over the counter; as they can cause cardiovascular problems with anesthesia. Flenfluamine and Phetermine (are two diet aids) should not be stopped abruptly. These two drugs need to be stopped slowly and titrated down in dosage. Mazindol (Mazanor and Sanarex), Dexfenfluramine (Redux), Dextroamphetamine (Dexadrine) and all over the counter diet aids need to be stopped two weeks before surgery.




Medications that contain aspirin or ibuprofen can cause bleeding problems during and after surgery. These medications can interfere with normal blood clotting. Most surgeons and anesthesiologists suggest stopping all medications that contain aspirin or ibuprofen at least two weeks prior to your surgery. Tylenol should be used instead.



Medications that contain Aspirin or Ibuprofen that should be avoided:

  • Alka-Seltzer

  • Anacin

  • Bufferin

  • Children's Aspirin

  • Midol

  • Motrin

  • Advil

  • Aleve

  • Naproxen

  • Naprosyn

  • Excedrin

  • Excedrin Migraine

  • Emprin

  • Dristan

  • Aspirin Ascription

  • Darvon

  • Percodan


                                                       Anesthesiologist assisting patient

                                                Licensed image for





There are many drugs that interact with anesthesia and include toxic levels, increased bleeding and other dangerous interactions. ALWAYS tell your surgeon and anesthesiologist everything you are taking, prescription and over the counter, so he or she can adjust your anesthesia with the levels of medication you might have in your bloodstream.

Do not ever stop taking a prescription medication without first discussing this with your surgeon, anesthesiologist, or internist (at your pre operative check-up).


                                 medication that could interfere with anesthesia

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The following is a list of symptoms you might have that you are taking medication for that could cause potential complications with anesthesia:


  • Blood Clots – greatly increases bleeding risks


  • Infection – Erythromycin, Tetracycline and Flagyl


  • Ulcers – Tagamet


  • Depression – (any SSRI serotonin serum reuptake inhibitor) Paxil, Prozac, Zoloft, Luvox, Celexa, lexapro, Elavil, Pamelor, Sinequan, Celexa, Wellbutrin, Effexor, Cymbalta, and any MAOI’s


  • Pain Relief – Vicodin, Lortab, Norco, Oxycontin, Percocet, Percodan, Oxycodone – the liver will metabolize the anesthesia faster and will require the anesthesiologist to give you more medication sooner.


  • Insomnia – Ambien and Halcion


  • High Blood Pressure – any beta blockers like Inderal or calcium channel blockers like Procardia.  These drugs interfere with the normal regulation of the cardiovascular system during anesthesia.


  • Immunosuppression – Cyclosporin and any steroid anti-inflammatories


  • Diabetes – Metformin has been known to cause serious metabolic problems with general anesthesia.


  • Arthritis – anti-inflammatories, such as ibuprofen, any NSAIDs may increase bleeding.


  • Thyrhoid  Problem - thyrhoid medication or Synthyroid needs to be stopped before surgery, as it can cause the heart to beat too rapidly.


  • Irregular Heart Beat


  • Epilepsy


  • Tuberculosis


  • Fungal Infections




Anesthesia can be hard on the human body.  It is even harder on patients who smoke.  Because of the fact that smokers have a tendency to develop coughs and an elevated heart rate, makes the odds higher for problems with anesthesia.  


Smoking causes the following symptoms:

  • Decreases lung capacity

  • Lowers the body immune system with trying to fight off an infection

  • Higher incidence of blood clots

  • Reduces oxygenation in the red blood cells

  • Constricts the blood vessels

  • Delayed wound healing

  • Elevate heart rate

  • Elevate blood pressure

Read more about smoking and cosmetic surgery












If you have received minimal sedation only, you may be able to go home once the procedure is finished. If you have received moderate or deep sedation, you will probably require more time to recover. Often this may be within an hour. In the recovery room, you will be monitored until the effects of the medication wear off.


Any after-effects of the medication must be minimal or gone before you will be discharged from the facility to go home. You will not be allowed to drive yourself, so arrangements should be made for a responsible adult to provide you with transportation. If you think you may need some assistance, you might consider having someone stay with you on the day of surgery.


If you have had anesthesia combined in any kind of form of sedation (oral or intravenous), you will need someone responsible to drive you home after surgery.




Standard post anesthesia instructions for 24 hours after leaving the hospital or surgery center include:

  • do not use alcohol

  • do not drive a car or operate heavy machinery

  • do not sign any legal documents

  • do not make any important decisions


Your own Plastic Surgeon will have his or her own specific post operative instructions that you need to make sure you adhere to.






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