Greg Smith: Yeah, anesthesia needs to know as well, that smoking and drinking too. Because if there’s a concern of have you quit right before, like a couple days before surgery, sometimes it could increase secretions and make anesthesia an issue. And so it’s always important when you have your pre-op evaluation, what they may call pre-admission testing, or PATs, that you disclose smoking, how much. And then not to really change any of your habits without consulting with both the anesthesiologist, and the pre-admission testing, and the nurses, as well as the surgeon going into it.
Samir Undavia: Hey guys, welcome to NJENT. I’m Dr. Undavia. With me, I also have Dr. Reddy and Dr. Smith. Today we want to talk about pre-op instructions. And I don’t want to talk about a specific surgery today. I just want to talk about the pre-op process and what to expect on the day of surgery. So once you make the decision, with your surgeon, to have surgery, there’s a whole series of things that happens. First from an insurance standpoint, we talk to your insurance company about authorizing the surgery. Our staff takes care of that. And then typically, we’ll like to schedule a pre-op visit to go over what it’s going to be like for surgery, and then for your recovery period, and then afterwards. So I typically begin my pre-op discussions about what to avoid before surgery. And then we’ll talk a little bit about what you’d want to tell your surgeon. So I was just going to ask Dr. Reddy if he has general or specific things that he wants to know from his patients about what to avoid.
Nishant Reddy: Sure. So the big thing is trying to figure out what medications you’re on. A lot of medications can potentially interact with the surgery, and sometimes even anesthesia. And so ideally the big one we focus on is blood thinners. And there’s a lot of different blood thinners out there. Usually they’re used for patients with cardiac problems. So we’d like to generally have some type of a safe way of stopping blood thinners prior to the surgery to decrease the likelihood of intraoperative as well as postoperative bleeding. Some blood thinner examples include aspirin, and Plavix. And even over the counter pain medications such as ibuprofen or Advil or Aleve can also thin your blood. And then there’s other over the counter, either supplements or vitamins that can also cause blood thinning. Some of those things include fish oil, which is a very commonly used supplement. And the other one is vitamin E. Vitamin E is included in a lot of multivitamins and that can also cause some blood thinning effect.
Greg Smith: There’s also a bunch of herbal supplements and things, and vitamins. So typically I instruct patients to come off of all over the counter supplements and herbal treatment medications. Things like ginseng, Ginkgo biloba, ginger, even the garlic and other things that people take and think that they’re pretty harmless. Anything with salicylates like Pepto-Bismol. And there’s a bunch of other things that have a lot of salicylates in them. And so typically if you take something on a regular basis and you’re not entirely sure, ask your provider who’s doing the surgery up front. Because typically we want you off of those things anywhere from three to seven days, depending on what the supplement, what the medication is. And both your primary doctor and the surgeon, like the three of us, would be able to give you some guidance and some assistance as what medications you may want to try to avoid.
Samir Undavia: Yeah, I would not stop any medications until you talked to us, and to your primary doctor. But that was great. I did want to bring up the Pepto-Bismol because that was unknown to me until we did have some bleeding in the operating room from that. So Dr. Smith, can you just talk to me about are there any other things you would want your patients to notify you about preoperatively? Family history, anything that you also want to know from your patients?
Greg Smith: Sure. Yeah, we’d typically like to know wound healing. And so if there’s any family history of poor wound healing issues, because that could be a connective tissue disorder which would decrease the ability to heal. Even things like diabetes and smoking history, we want to ascertain because anything that might cause blood vessel disease could impair wound healing as well. And then complications with anesthesia. So things like a family member who had anesthesia and had a really bad issue with it, signaling maybe something called malignant hypothermia. And there’s some other issues with anesthesia and anesthetics that can occur. Pain medication and opioid allergies are another big thing. Because typically during anesthetic you’ll also be getting some opiates as well to help with the anesthesia and decrease the amount of anesthesia needed. So there are, allergies is a big thing. Family history of prior experiences with either poor wound healing or anesthetic problems is a big indicator that we need to know about. And typically cardiac history is something, as well, that’s a big thing. If someone has a major heart defect or something, we need to know about those things going into it.
Samir Undavia: Yeah. Especially for cardiac history, I think, if you’re on blood thinners or if you have a pacemaker, those things really do alter how we perform surgery. Additionally, if you’ve had hardware, like hip replacements, knee replacements, those things can affect where we put some of our instrumentation when we do surgery, as well. No, this was great. This was great. So last thing I wanted to talk about before I tell you what happens during the day of surgery is what, Dr. Reddy, what do you have for recommendations for smoking and drinking?
Nishant Reddy: Yeah, so smoking, like Dr. Smith was saying, can potentially affect wound healing and how quickly you recover from surgery. What we try to, in an ideal world, if you could stop smoking completely for at least a week prior to the surgery and a week afterwards, that’ll help you with the healing process. But that’s easier said than done. And we can understand that smoking and quitting smoking is very difficult thing to do. So even just cutting back on smoking though can improve things significantly. But disclosing the fact that you’re smoking and how much you’re smoking is important because it can potentially tailor the type of surgery that you’re getting, in terms of where the incision is made and things like that, to reduce the likelihood of a complication or a wound problem.
Greg Smith: An anesthesia needs to know as well, smoking and drinking too. Because if there’s a concern of have you quit right before, like a couple days before surgery, sometimes it could increase secretions and make anesthesia an issue. And so it’s always important when you have your pre-op evaluation, what they may call pre-admission testing, or PATs, that you disclose smoking, how much. And then not to really change any of your habits without consulting with both the anesthesiologists, and the pre-admission testing, and the nurses, as well as the surgeon going into it. And drinking is another big thing. There may be some things that we do where you may be drinking a lot of alcohol on a daily basis. And then if you have anesthesia, and then stop drinking after surgery because of either discomfort or pain or whatever other issues that could significantly impact withdrawal symptoms, and may make recovery significantly more risky.
Samir Undavia: I think the two other things that fall into the similar categories are vaping, and marijuana, and any other recreational drugs. We definitely want to know about those things. So I wanted to just spend a little time going over what to expect on the day of surgery.
So the first thing that happens is that you get a phone call. During these times, we get, you get two phone calls from the operating room. One is to schedule a COVID test, and two is to tell you what time to show up. And during that discussion about what time to show up, you’re going to be asked a few questions. What’s your surgeon doing? What medications do you take? Do you have any allergies? And have you had any surgeries before? And that’s the recurring theme. You’re going to be asked that several times.
Now when you get to this facility to have your surgery, most often you’re going to not want to eat or drink anything. Now we talked to you beforehand about what to take as with regards to your medications. Sometimes you’ll need to take a few medications with a tiny sip of water and that’s it. Sometimes we’ll have you hold your medications. That we’ll go over together on your pre-op day.
When you get to the surgery center, you’re going to get an IV. Sometimes you get an IV antibiotic. You’re going to meet a bunch of people. It’s a little bit overwhelming and chaotic, but it really is controlled. You’ll meet the anesthesiologist, possibly a nurse anesthetist, the OR nursing staff, the holding room nursing staff, and us, your surgeons. So then, once all of our Is are dotted and our T’s are crossed, we head back to the OR.
In the OR, it is also controlled chaos. So it feels a little bit overwhelming, but everybody’s got a specific job. There’s somebody putting cast compressors on your legs. There’s somebody putting a blood pressure cuff on your arm. There’s somebody putting EKG electrodes on your chest. And usually we have, especially these days, we have a mask on. And when that mask comes off, and an oxygen mask comes on, you know that in like 20 seconds, it’s time to go to sleep. And they usually do that through the IV unless you’re a child. And once you go to sleep with that IV, you are not going to feel anything else.
You will wake up in recovery as though no time had passed. You’ll just be groggy. But for us, we put a breathing tube in, we take the breathing tube out before you wake up. So you never feel it going in or out. Just have a sore throat for about two days. There might be some other surgical symptoms that you have, but from the anesthesia part you’ll just be a little bit groggy.
Most people do not form any new memories for a couple hours afterwards. So we often have conversations with our patients and tell them how things went, but they won’t remember. And sometimes they say, “How come you didn’t tell me how everything went?” We did. You just can’t form any new memories for a while. So you stay in recovery room for about an hour typically. And then you go home. And you’ll have some patient specific postoperative instructions that we always discuss at the pre-op visit.
And then you’ll have your regularly scheduled post-op visit in the office. And that’s what it’s like to have surgery. On the day of surgery, that’s what it’s like. It can be overwhelming, but when you know exactly what to expect, it can be tolerable.
Anything else to add, gentlemen?
Nishant Reddy: Nope.
Greg Smith: No. I think you covered everything.
Nishant Reddy: Covered everything.
Samir Undavia: All right. Well, we’re NJENT. If you have any questions, you can always call or text us at 609-710-NOSE. Or email us at email@example.com. Till next time.
Nishant Reddy: Don’t forget to like and subscribe.