Fasting Rules: Why 'Nothing by Mouth' is Non-Negotiable
One of the most critical instructions before any surgery involving anesthesia is the 'nothing by mouth' (NPO) rule. Anesthesia can relax your protective airway reflexes, such as your gag and cough. If you have food or liquid in your stomach, there is a risk it could come back up and be inhaled into your lungs. This is known as pulmonary aspiration and can lead to dangerous, life-threatening pneumonia.
What to Avoid the Night Before
- Solid foods: No matter how small the portion, solid food, including candy and gum, is strictly forbidden after the specified time, typically midnight.
- Non-clear liquids: Beverages containing milk, cream, pulp (juice), or other particles can behave like solids in the stomach. This includes protein shakes, smoothies, and dairy products.
- Mints and gum: Chewing gum and sucking on mints stimulates the production of stomach acid and saliva, increasing the volume of stomach contents and the risk of reflux.
- Alcohol: Consuming alcohol the night before or within 24 hours of surgery is extremely dangerous. It can interfere with the anesthetic, increase the risk of bleeding, and cause heart and lung problems.
Medications, Supplements, and Other Substances
While many people believe they can continue their regular routine, many common medications and supplements must be stopped. It is imperative to have a detailed conversation with your surgical team about everything you take.
Medications and Supplements to Discuss
- Blood thinners: Medications like aspirin, clopidogrel (Plavix), and warfarin (Coumadin) can increase the risk of bleeding during and after surgery. You will need specific instructions on when to stop these.
- Herbal supplements: Many supplements, such as garlic, ginger, ginkgo biloba, and St. John's Wort, can have a blood-thinning effect or interfere with anesthesia drugs. Stop these at least one to two weeks prior.
- NSAIDs: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) should be avoided as they can increase bleeding risk.
- Diabetic medications: Since you will be fasting, your dose of insulin or other diabetic medications will need to be adjusted. Do not take these without specific instructions from your doctor.
- Recreational drugs: Use of marijuana, CBD, or other substances should be disclosed to your doctor, as they can affect anesthesia and pain management.
Personal Preparation and Hygiene
The night before surgery is not the time for your normal beauty routine. For medical professionals to monitor your health effectively, certain personal items and products must be removed.
- Makeup and nail polish: Avoid wearing makeup or nail polish. The color of your nail beds is an important indicator of blood circulation and oxygen levels. A pulse oximeter clipped to your finger won't work properly through nail polish.
- Jewelry and piercings: All jewelry, including wedding rings and body piercings, must be removed to prevent burns from surgical instruments, accidental loss, and swelling.
- Heavy lotions and hair products: Excessive products on the skin and hair can interfere with monitoring equipment and antiseptic scrubs.
Comparison of Pre-op Preparations
| Category | Avoid the Night Before | May Be Allowed (Consult Doctor) |
|---|---|---|
| Food & Drink | Solid food, alcohol, milk, cream, pulp-heavy juices | Clear liquids (water, apple juice) up to 2 hours before arrival |
| Medications | Blood thinners, NSAIDs, herbal supplements, diabetic meds (unless directed) | Routine prescriptions (e.g., blood pressure) with a small sip of water |
| Personal Items | Makeup, nail polish, heavy lotion, all jewelry, piercings | Loose, comfortable clothing and necessary personal items like glasses case or hearing aid container |
Conclusion: Prioritizing Your Safety
Following your surgeon and anesthesiologist's instructions is not a suggestion—it is a mandatory step for your health and safety. Ignoring these guidelines, particularly regarding fasting and medications, puts you at a much higher risk for complications during and after your procedure. By taking the night before anesthesia seriously and preparing correctly, you ensure the best possible outcome for your surgery and recovery. For more specific, expert-level information, consult the official guidelines from the American Society of Anesthesiologists.
