Preparing for Anaesthesia 1. About Anaesthesia Anaesthesia refers to a state of no sensation and can be general, regional or local. General anaesthesia involves drugs which induce a deep sleep; regional anaesthesia (epidural/spinal/nerve block) involves injecting drugs around the spine or nerve to numb the abdomen and limbs; local anaesthesia involves injecting drugs into the skin to numb a small area. For some procedures, sedation may be used alone or in combination with regional anaesthesia. It involves intravenous injection of drugs to produce sleepiness or a light sleep but stop short of general anaesthesia. Your anaestheisa care will be provided by an Anaesthesiologist who is a medically trained doctor who specialize in anaesthesiology, and accredited by the Hong Kong College of Anaesthesiologists and hold Specialist Registration with the Hong Kong Medical Council.   2. Preparing For Your Anaesthetic Pre-existing medical conditions Pre-existing medical conditions should be under good control prior to a planned medical or surgical procedure. A few common conditions are high blood pressure, asthma and diabetes. Smoking Smoking is harmful to your health and it can cause cancer and chronic lung and heart conditions. it is also bad in the short term around the time of operations. Quitting a few weeks prior to your anaesthetic will allow your lungs to recover and help your breathing during your operation. It will also increase the levels of oxygen in your blood and improve wound healing. Teeth If you have loose teeth you are advised to see your dentist prior to your anaesthetic. Food & Drink Restriction Please follow these guidelines carefully prior to a general or regional (spinal/epidural) anaesthetic. For local anaesthetic procedures - where an anaesthesiologist is not involved - it is not usually necessary to starve preoperatively but you are advised to consult your surgeon. Food and fluids are restricted to reduce the risk of aspiration by reducing the contents of your stomach. Aspiration occurs when an object or liquid is inhaled into the respiratory tract when a person regurgitates contents into the throat. Aspiration during anesthesia in an adequately fasted patient is uncommon, but if it occurs it can cause severe complications. Do not eat for a minimum of 6 hours before your surgery Clear fluids may be given up to 2 hours before your surgery Children over 1 year No food or milk for 6 hours prior to surgery Clear fluids may be given up to 2 hours before surgery Babies under 1 year on regular milk feeds No formula milk feeds for 6 hours prior to surgery No breast milk for 4 hours prior to surgery Clear fluids may be given up to 2 hours before surgery "Clear fluids" means only the following: plain water, black tea or coffee. The following are not permitted: milk in tea or coffee, fruit juices, alcohol, chewing gum and sweets. Your Usual Medications If you take any medicines on a regular basis, such as diabetes medicines or heart medicines, ask your surgeon whether you should take your medicines on the day before or the day of your surgery. Some of the commonly used drugs are summarized in our "Perioperative Management of Chronic Medications". Drug can be taken with a sip of water within 6 hours before your surgery. Herbal & Alternative Therapy The actual ingredients of many herbal and alternative therapies are uncertain and in some circumstances will interact with anaesthesia. We would advise that all herbal and alternative medications are stopped at least one week prior to surgery. Serious Anaesthetic Reaction Very rarely, due to genetic factors, there can be a potentially fatal reaction to anaesthesia. If you or any blood relative has previously had a severe reaction to an anaesthetic please alert your surgeon and anaesthesiologist. Medicine given before anesthesia You may be given a medicine before anesthesia. Medicines may be given by mouth or by injection immediately before anesthesia. An example is oral medication to reduce the acidity of gastric fluid so that chemical injury to the lungs is reduced in the event of gastric aspiration during anaesthesia. Anesthetic Informed Consent Your anaesthesiologist will discuss your anesthesia care with you so that you will understand what is involved, and you can then give your informed consent. You will be able to ask questions and express any concerns. In the meantime please take time to read through the anaesthesia related information provided in our website. 3. Perioperative Management of Chronic Medications Please bring your regular drugs and medical devices to the hospital, and if possible inform doctors and nurses the name of the drugs you take when you are admitted to the hospital Anti-arrhythmics Anti-hypertensives Anti-anginal drugs Should be continued until and including the day of operation Aspirin May be continued until and including the day of the operation unless specifically stated otherwise by the surgical service Plavix (Clopidogrel) Should be discontinued at least 14 days prior to the planned operation unless specifically stated otherwise by the surgical service Oral anticoagulants (Warfarin) Should be discontinued at least 3 days prior to the planned operation unless specifically stated otherwise by the surgical service Asthma & COPD drugs Should be continued until and including the day of operation Anti-convulsants Anti-parkinson drugs Should be continued until and including the day of the operation Anti-anxiety drugs Anti-depressants Anti-psychotics Should be continued until and including the day of the operation except Monoamine Oxidase Inhibitors which should be discontinued at least 2 full weeks prior to the planned operation Gastroesophageal reflux drugs Anti-emetics Should be continued until and including the day of the operation Insulin All insulin preparations should be taken at the usual dosages for the entire day preceding the planned operation then follow the instruction by the surgical service Oral hypoglycemics Should be taken until the day before the operation but discontinued on the day of the operation Anti-thyroid drugs Thyroxine Steroids Oral contraceptives Should be continued until and including the day of the operation   Aspirin NSAIDs May be continued until and including the day of the operation unless specifically stated otherwise by the surgical service Over the counter vitamin May be continued until the day before the planned operation Herbal preparation Should be discontinued at least one full week prior to the planned operation Sleep apnoea syndrome   If you require CPAP at night, please bring it with you to the hospital on the day of your operation. The above list is by no means exhaustive, but simply acts as a general guide for the perioperative management of chronic medications for patients with pre-existing medical problems