Preoperative Instructions for Surgery Under Local Anesthesia

Before Surgery:

1. Do not take aspirin, medications containing aspirin, any anti-inflammatory and herbal alternatives two weeks prior to surgery. Please refer to medications to avoid list. If you are unsure if a medication that you are taking is to be avoided, please ask the doctor. If needed, Tylenol may be taken.

2. Smoking must be stopped two weeks prior to, and two weeks after surgery. Nicotine patches and gum MAY NOT BE USED.

3. PLEASE BE AWARE, THAT SMOKING OR THE USE OF UNAUTHORIZED MEDICATIONS CAN LEAD TO COMPLICATIONS AND JEOPARDIZE THE RESULT OF YOUR SURGERY!

4. Report any signs of a cold or infection occurring within the week prior to your surgery.

Day of Surgery:

1. Your surgery is scheduled in the office and is under local anesthesia. If your surgery is in the morning you may have a light breakfast but please limit your coffee or tea to one cup. If your surgery is in the afternoon, you may also have a light lunch.

2. Wear comfortable, loose fitting clothes, which do not have to be pulled on over your head, i.e., a button-down blouse or shirt and loose fitting skirt or pants. If your procedure is on your face please do not wear makeup.

3. Do not save questions for the morning of your surgery. This is a busy time for us and it should be relaxing time for you. Please contact the office PRIOR to your surgery if you should have any questions.

4. If you will be receiving Valium prior to your surgery please arrive one hour prior to your scheduled surgery time. You must have someone drive you home after surgery.

5. All of the above items are important. Please take the time to read through this one more time the day before your surgery.

6. YOU MUST ARRIVE AT YOUR SCHEDULED SURGERY TIME. IF YOU ARE LATE, YOUR SURGERY MAY BE CANCELLED.

Preoperative Instructions for Surgery Under General Anesthesia

Before Surgery :

1. Do not take aspirin, medications containing aspirin, any anti-inflammatory and herbal alternatives two weeks prior to surgery. Please refer to medications to avoid list. If you are unsure if a medication that you are taking is to be avoided, please ask the doctor. If needed, Tylenol may be taken.

2. Do not take Vitamin E or alternative medicines (i.e. Gingko Boloba, St. John's Wort, or Ginseng) for two weeks prior to surgery, unless approved by your surgeon. These may interfere with the clotting process. You may take a multivitamin.

3. You must arrange to have a responsible adult over the age of 18 to drive you home after surgery.

4. Report any signs of a cold or infection occurring within two weeks prior to your surgery.

5. PLEASE BE AWARE, THAT SMOKING OR THE USE OF UNAUTHORIZED MEDICATIONS CAN LEAD TO COMPLICATIONS AND JEOPARDIZE THE RESULTS OF YOUR SURGERY!

6. Avoid sun burning or over exposing your skin to sunrays for two weeks prior to surgery. Any evidence of sunburn will result in your surgery being cancelled.

7. Weight gain can increase your risk of surgery as well as affect the aesthetic and functional results. A weight gain of 5 lbs. or greater between the time of your initial consultation and your preoperative visit may result in your surgery being cancelled.

8. Fill all prescriptions prior to your surgery date and bring them with you on the day of surgery.

9. Drink plenty of fluids throughout the day before your surgery. Do not eat or drink anything after midnight the day before your surgery.

DAY OF SURGERY:

1. If you take prescribed hypertensive medication in the morning, TAKE THEM with a small sip of water.

2. Please arrive one hour prior to your procedure. If you are late, your surgery will be cancelled.

3. YOU MUST ARRANGE TO HAVE SOMEONE PICK YOU UP AND STAY AT HOME WITH YOU THAT EVENING. IF YOU DO NOT HAVE A RESPONSIBLE ADULT OVER 18 YEARS OF AGE TO STAY WITH YOU THE FIRST EVENING, YOUR SURGERY WILL BE CANCELLED.

4. Wear comfortable, loose fitting clothes that do not have to be pulled on over your head, i.e., a button-down or zipper blouse or shirt and loose fitting skirt or pants. NO MAKE-UP (including lipstick, mascara, nail polish etc.), Jewelry, Pantyhose, or high heels. Do not apply lotion to hands or body.

6. Do not save questions for the morning of your surgery. This is a busy time for us and it should be a relaxing time for you. Please contact the office PRIOR to your surgery if you have any questions.

MEDICATIONS THAT MAY CAUSE BLEEDING PROBLEMS AND SHOULD BE AVOIDED 2 WEEKS PRIOR TO SURGERY

4-Way Cold Tablets
Ascriptin
Ascriptin with Codeine
Advil
Aleve
Alka-Seltzer
Anacin
Anaprox
Arthopan Liquid
ASA and Codeine
Asprin
Ascriptin
Aspergum
Bayer
BC Tablets and powder
Bromo-Seltzer
Bufferin
Bufferin with Codeine #3
Cama Arthritis Pain Reliever
Clinoril
Congesprin Chewable Tablets
Cope Tablets
Coricidin "D" Congestant Tablets
Coricidin
Coumadin
Darvon with ASA
Darvon Compound
Disalcid
Doan's Pills
Dolobid
Dristan
Duragesic
Easprin
ECOTRIN
Empirin
Emperin with Codeine
Equagesic
Excedrin
Feldene
Fenoprofen
Florinal Tablets
Florinal with Codeine
Ibuprofen
Indocin
Indomethasin
Lodine
Micrainin
Midol
Motrin
Nalfon
Naprosyn (Naproxen)
Norgesic and Norgesic Forte
Nuprin
Nyquil
Nytol
Orudis
Oxycodone
Pamprin
Percodan
Persantine
Phenaphene
Propoxyphene
Robaxisal
Synalgos - DC Capsules
Talwin
Trilisate
Zorpin

Natural Products That should be avoided prior to surgery.

The "natural products" listed below may be beneficial for a variety of ailments, but THEIR USE AROUND THE TIME OF SURGERY MAY NOT BE DESIRABLE. Therefore, it is advisable to stop taking these products to avoid problems with surgery and anesthesia. If time permits, discontinue the use of these products TWO WEEKS prior to surgery and TWO WEEKS after surgery. Specific supplements that should be discontinued include:

Bilberry (Vaccinium myrtillus) ~ Contain anthocyanosides, flavonoid compounds that improve visual acuity and are important in the treatment of eye disorders. Excellent antioxidant that strengthens capillaries and collagen. Has antiplatelet activity and may inhibit clot formation.

Cayenne (Capsicum annuum) ~ used for GJ tract disorders. Overdose may cause severe hypothermia.

Dong Quai (Angelica sinensis) ~ The main application is in the relief of menstrual disorders and menstrual cramps. Often used to relieve menopausal symptoms. Active constituent is coumarin derivatives, which may potentiate existing anticoagulant medications.

Echinacea (Echinacea augusifolia) ~ Immune system stimulant with anti-inflammatory, antiviral, and antibacterial effects. Used as a prophylaxis for upper respiratory infections. Use of echinacea may impact the liver when general anesthetic or certain other medications such as anabolic steroids or methotrexate are used.

Feverfew (Tanacetum paithenium) ~ Used for migraine headache prevention and for arthritis, rheumatic disease, and allergies. May increase bleeding, especially in patients taking certain anticlotting medications.

Fish Oil Capsules ~ Supplies important omega-6 fatty acid, DHA, and EPA, used to reduce cholesterol and triglyceride levels. Has blood-thinning properties.

Garlic (Allium sativum) ~Garlic has vasodilatory, hypocholesterolemic effects, and antiplatelet effects. May augment effects of coumadin, warfarin, and NSAIDs, causing abnormal bleeding time.

Ginger (Zingiber officinale) ~Useful as antispasmodic, anti-inflammatory, and antinauseant. Prophylactic for motion sickness and used to stimulate appetite. Useful for postoperative emesis. Use of ginger may alter bleeding time. Ginger may interfere with cardiac and anticoagulant medications.

Ginkgo Biloba ~One of the oldest living tree species which can live up to 1000 years and grow to a height of 120 feet. Used as an antioxidant and circulatory stimulant. Used for treatment of intermittent claudication, tinnitus, vertigo, memory enhancement, and sexual dysfunction. Anticoagulant activity is 3x’s stronger than vitamin E.

Ginseng (Panax ginsenglPanax quinquefolium) ~ At least 3 different varieties: Asian, American, and Siberian. Improves physical and cognitive performance, mood, or metabolism. An adaptogen and an antioxidant. Anticoagulant that may interact with cardiac, hypo/hyperintensive medications and hypoglycemic agents.

Hawthorne (Crataegus laevigata) ~The extract is used for its ability to potentiate the action of cardiac glycosides. Used in the treatment of ischemic heart disease, hypertension, angina, and chronic congestive heart disease. Potentiates the actions of digitalis and other cardiac
drugs.

Kava Kava (Piper methystlcum) ~ Sedative. analgesic, soporific, anticonvulsant, muscle relaxant, anxiolytic. Similar to the effects of benzodiazepines in treatment of anxiety. May potentiate CNS effects of barbiturates, alcohol, antidepressants, antipsychotics, and general anesthetics.

Licorice Root (Glycyrrhiza glabra) ~ Used for gastric and duodenal ulcers, gastritis, and cough/bronchitis. Gly- cyrrhizic acid in licorice may cause high blood pressure, hypokalemia (low potassium), and edema.

Ma Huang (Ephedra sinlca) ~ Used in weight loss and energy products; a natural amphetamine with powerful stimulant effects. More than 800 adverse reactions reported with the FDA. Causes hypertension, tachycardia, cardiomyopathy, and cardiac dysrhythmias.

Melatonin ~ A hormone secreted by the pineal gland. Regulates many other hormones that are involved in controlling circadian rhythm. Used for jet lag, insomnia, and SAD (seasonal affective disorder). May potentiate CNS effects of barbiturates and general anesthetics.

Red Clover (Trifolium pratense) ~ Used to relieve menopausal symptoms. Active constituent includes coumarin derivatives, which may potentiate existing anticoagulant medications.

St. John's Wort (Hypericum perloratum)~ Herb used as mild antidepressant, sedative, anxiolytic. May have a monoamine oxidase (MGA) inhibitory effect. Can interact with MAG inhibitors and other antidepressants. Many other drug interactions reported.

Valerian (Valeriana offlcinaiis) ~ Used as a sedative, hypnotic, and antispasmodic in the GI tract. Relieves anxiety, nervousness, and insomnia. May increase effects of sedative hypnotics.

Vitamin E ~ Important fat-soluble vitamin that acts as an antioxidant and prevents the oxidation of polyunsaturated fatty acids. Used in the prevention and treatment of cardio- vascular disease, cancer, age-related degenerative diseases. Anticlotting benefits can prolong bleeding time.

Yohimbe (Corynanthe yohlmbe) ~ "Natural Viagra" that has MAG effects. Yohimbine is the agent extracted from the bark of theyohimbe tree. The tree grows in the African nations of Cameroon, Gabon, and Zaire. Purported to have both psychological and physical effects. Increases the potency of anesthetics

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