Strict Fasting Guidelines: The 'Nothing by Mouth' Rule
One of the most critical instructions you will receive is related to eating and drinking. The medical term for this is 'nil per os,' or NPO, which means 'nothing by mouth.' This rule is in place for your safety during any procedure involving general anesthesia or deep sedation.
Why Fasting is a Non-Negotiable
When you are under anesthesia, your natural protective reflexes, such as your ability to cough and swallow, are temporarily suppressed. If there is food or liquid in your stomach, it could be regurgitated and then accidentally inhaled into your lungs. This serious and potentially life-threatening complication is known as aspiration pneumonia. Fasting ensures your stomach is empty, eliminating this risk.
Standard Fasting Timelines
While exact times can vary based on the procedure and your specific health needs, general guidelines typically include:
- Solid Foods and Non-Clear Liquids: Avoid eating solid foods, milk, or other non-clear liquids for at least 8 hours before your procedure.
- Clear Liquids: Many protocols allow clear liquids (water, apple juice, black coffee or tea without cream) up to 2 hours before your arrival time. However, always follow your doctor's specific instructions, as these may differ.
Disclosing and Managing Medications
Beyond food and drink, what you put into your body in the days and weeks leading up to your procedure is equally important. It is vital to have an open and honest conversation with your anesthesiologist about all substances you consume.
Medications to Stop (and When)
Certain medications can interfere with anesthesia or increase surgical risks, particularly the risk of bleeding. Your doctor may instruct you to temporarily stop taking some drugs, including:
- Blood Thinners: Prescription medications like warfarin, Eliquis, and Plavix, as well as over-the-counter NSAIDs like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).
- Herbal Supplements: Many people assume herbal remedies are harmless, but they can have significant effects. Supplements like garlic, ginkgo biloba, ginseng, St. John's Wort, and Vitamin E can increase bleeding risk or interfere with anesthetic drugs. Most doctors recommend stopping them 1-3 weeks before surgery.
- Certain Diabetes Medications: Your blood sugar management will be closely monitored, and your regimen may need adjustment on the day of surgery since you will be fasting.
Medications to Continue
On the other hand, some critical maintenance medications, such as those for blood pressure, thyroid conditions, or seizures, should often be taken on the morning of surgery with a small sip of water. The key is to follow your anesthesiologist's directions precisely. The American Society of Anesthesiologists provides detailed patient resources.
Avoiding Alcohol, Tobacco, and Other Substances
Alcohol, tobacco, and recreational drugs can significantly impact your anesthesia and recovery, and must be avoided before your procedure.
The Dangers of Alcohol
Drinking alcohol in the days leading up to surgery can affect your body in several ways:
- Interference with Anesthesia: It can affect how you respond to anesthetic agents, potentially requiring higher doses or leading to unexpected complications.
- Increased Bleeding: Alcohol thins the blood, increasing the risk of excessive bleeding during and after surgery.
- Slower Healing: It can compromise your immune system, slowing recovery and increasing the risk of infection.
The Impact of Smoking and Vaping
Smoking and vaping negatively affect your heart and lung health, making anesthesia riskier. Patients who smoke are more prone to respiratory complications, poorer wound healing, and a longer recovery period. Most medical professionals advise stopping at least 24 hours beforehand, with a longer period being ideal.
What Not to Wear and Bring on the Day of Surgery
Your preparation extends to what you wear and bring with you to the hospital or surgical center. Certain items can interfere with monitoring equipment or pose a safety risk.
The 'Do Not Wear' List
- Makeup and Nail Polish: Medical staff use the natural color of your nail beds and skin to monitor your circulation and oxygen levels. Makeup, lipstick, and colored nail polish can mask these vital signs.
- Jewelry and Piercings: Metal jewelry can pose a burn risk if electrosurgical tools are used. Rings can become a circulation problem if swelling occurs. All piercings, including tongue piercings, should be removed.
- Lotions and Deodorant: Some products can interfere with medical adhesives or electrical sensors. Follow specific instructions regarding skin preparation.
- Restrictive Clothing: Wear loose, comfortable clothing with short sleeves for easy access to your arms for IVs and blood pressure checks.
Comparison Table: Common Pre-Op Do's and Don'ts
| Action | Do | Don't |
|---|---|---|
| Eating | Eat a light, easily digestible meal the night before (if permitted). | Eat solid food, fatty foods, or milk products after your cutoff time. |
| Drinking | Drink clear liquids up to 2 hours before arrival (check with your doctor). | Drink alcohol or non-clear liquids (like milk, smoothies) within 8 hours. |
| Medications | Take approved meds with a small sip of water. Bring a complete list. | Take blood thinners, NSAIDs, or unapproved supplements without permission. |
| Hygiene | Shower or bathe as instructed. | Wear makeup, nail polish, or excessive lotion. |
| Accessories | Wear loose, comfortable clothing. | Wear jewelry, watches, or body piercings. |
| Other Substances | - | Smoke, vape, or use recreational drugs. |
Conclusion
By following these crucial guidelines on what you should not do before going under anesthesia, you play an active role in ensuring a smooth and safe procedure. From respecting fasting protocols to openly communicating about your medications and lifestyle, every detail contributes to a successful outcome. Always confirm instructions with your medical team, as specific health conditions and procedures may require tailored advice.
