Undergoing an operation is usually a big event for most people. This section describes some of the measures you can take to prepare yourself as well as possible before your surgery. This will mean you are as healthy as possible going into the surgery, increasing the chance of a good result and minimising the risk of complications.
Things you can do
Stop smoking
Smokers are significantly more likely to experience pneumonia, wound infection, and deep vein thrombosis. Surprisingly, even a few days of abstinence before the operation can result in a significant reduction in risk of these complications, although the longer you can stop smoking for before the operation, the more benefit you will gain. Finally, stopping smoking before an operation doubles the chance that you will quit permanently compared with stopping at other times. If you need any help with stopping smoking please ask your General Practitioner or Pharmacist who will be able to advise you.
Exercise and diet
try to keep fit and healthy in the days and weeks before your surgery. This includes regular, gentle exercise and maintaining a balanced, healthy diet with good hydration and plenty of iron, vitamin C and other vitamins, which can boost your immune system and contribute to a smoother and faster recovery. Also try to avoid alcohol in the days before and after your surgery.
Herbal remedies
It is important to stop taking herbal supplements at least 7 days before the surgery as some ingredients can affect the action of certain anaesthetic and other medications, as well as reducing the ability of blood to clot. This includes natural substances such as ginger, garlic, St John’s Wort, Echinacea, Gingko, Ginseng and Valerian. You should let your anaesthetist and surgeon know if you have been taking any herbal remedies regularly.
Before the procedure
The hospital where you will be having your surgery will contact you beforehand to go over some health related questions and decide whether any specific investigations such as blood tests, ECG or chest X-ray may be required.
If you have any specific medical conditions such as high blood pressure, diabetes or asthma, please bring these to the attention of Professor Chatrath’s team and to the preadmission team at the hospital so appropriate planning can be undertaken.
Your regular medications
In most cases you can continue any regular medications you normally take up until the day of surgery. On the day of surgery, any medication that needs to be taken first thing in the morning can be taken as usual with some water; any medications required later on should not be taken until after discussion with the anaesthetist. Usually any dose close to the operation will be delayed to be taken as soon as the operation has finished and you are back on the ward. There are however some exceptions as discussed below.
Oral contraceptive and HRT
The advice here is controversial and there is no clear guidance unfortunately however the following should hopefully prove useful. The general advice is that they should be stopped 4 weeks before any major surgery, with alternative precautions for birth control being taken. This is because the oral contraceptive pill and HRT increase the risk of a deep vein thrombosis (clot in the leg which can spread to the lungs). However, the risk of a DVT is very low after ENT surgery in general, which means that even if the pill/HRT is not stopped the risk of getting a DVT is still low (but is technically increased compared with if it is stopped). In any case we routinely take measures during surgery to reduce the risk of a thrombosis, such as compression stockings, pressure boots and sometimes a blood thinning injection if needed, as well as the fact that the vast majority of our ENT patients are all up and about and mobile shortly after the surgery, which itself reduces the risk of thrombosis too. On balance, we would suggest that it is sensible to discontinue the pill/HRT before surgery and use alternative birth control precautions if at all possible.
Anticoagulants
If you routinely take blood thinning medication such as warfarin, aspirin, clopidogrel or apixaban, some adjustment to these medications is likely to be required before the surgery. It is best to discuss this with Professor Chatrath’s team and with the preadmission clinic at the hospital where your operation is to take place. Alternatively, you might already be under the care of an anticoagulation clinic who will be able to advise on the correct protocol for adjustment. Sometimes it is as simple of stopping the medication a few days before surgery and then restarting afterwards; in other cases, an alternative medication needs to be prescribed or administered for a short period.
On the day of the operation
You must not eat or drink milk for at least six hours prior to the operation. This includes tea with milk. For a morning operation this means missing breakfast; for an afternoon operation this means having an early breakfast, no later than 6 hours before your admission time. You can continue to have small sips of clear fluid such as water (or tea without milk) up to two hours before the operation.
Further information
Please contact:
Maria, Secretary to Professor Paul Chatrath
Tel: 020 3865 7225
Email: contact@london-ent.co.uk
Or visit the website for further information:
www.london-ent.co.uk