General anesthetic / Intravenous sedation

 

 

The most commonly asked and misundserstood question is: "Why do I have to starve myself before this procedure?"

 

We believe the best way to inform a patient is through education so...

 

Aspiration risk if patient eats/drinks:

Aspiration of gastric contents during anesthesia: 

 

In a non-sedated patient (A-C), the body works in concert to keep things flowing to where they're supposed to.  

A) During a normal inspiration and just before swallowing food (1), the upper esophageal sphincter (UES) (2) is closed to prevent air from entering the stomach.

B) As the food is swallowed, the tongue rises to seal the mouth (1), the soft palate (2) rises to seal the nasal cavity, the UES (4) opens to allow food into the esophagus and to the stomach and importantly, the epiglottis (a flap; 3) covers the larynx to prevent food from entering the trachea and the lungs.

C) Once food is swallowed, the UES (1) closed again, the tongue drops, the soft palate drops and air can move from the nose through the sinuses and into the lungs.

 

In the sedated patient the mechanisms discussed above aren't working correctly.  They are blunted, the flaps, senses and other protective means don't work correctly. In this instance, (D), air is inspired as normal in the lungs but now, the patient begins to vomit (E) this could be due to food, acid contents and especially decreased spincter tone (i.e. the food isn't kept down anymore). The vomit enters the mouth (F) and nasal cavity, however, in this instance the protective mechanisms in (B) above aren't working properly and stomach contents are (G) (aspirated) into the lungs.  

Normal protective mechanisms from aspirating

Impaired protective mechanisms

Aspirating stomach contents almost invariably leads to a severe type of pneumonia that can be fatal even if treated aggressively. It therefore goes without saying that not eating or drinking during the prescribed period of time is essential before anesthesia.  

 

Okay, lesson over.

 

Patient instructions before intravenous (I.V.) sedation or general anesthesia: 

  1. Of utmost importance, as demonstrated above, there is to be nothing to eat or drink for eight (8) full hours before the procedure. You are, therefore asked to get good hydration the day before (at least eight (8) full glasses of juice, water, or Gatorade). The ONLY exception is as below.

    • Take any medication you would normally take in the morning with a very small sip (2 oz~50 mL) of WATER unless directed otherwise (see diabetics below).  Please let our nurse know what medications you did or didn't take.

  2. Make sure you have arranged to have an accompanying adult with you.  We ask this person arrive with you and stay in the office during the procedure.  This person should be responsible for you immediately after you leave our office and thereafter until the anesthetic and its effects have worn off (18-24 hours). 

  3. We need to place vital signs (physiological) monitors on you for the procedure.  For this reason please:

    • Remove nail polish from at least one finger on each hand;

    • Wear loose, accessible clothing;

    • Remove large necklaces, bracelets, and rings.

  4. Remove all:

    • tongue jewelry (studs, rings), lip rings, and nose rings.  Reasonable earrings are okay;

    • dentures, 'flippers', or other oral appliances;

    • contact lenses

  5. If you've taken ill or, especially if you have:

    • a respiratory illness (cough, bronchitis, pneumonia, asthma exacerbation);

    • stomach distress (nausea, vomiting);

    • fever --> Please call our office.​

  6. Pre-operatively please:

    • thoroughly brush your teeth, tongue and mouth as normal (don't swallow the toothpaste!)

    • arrive at our office on time (being late is unfair to other patients)

    • come prepared with any questions you may have (you may want to write them down as sometimes you forget them in the moment)

    • do not smoke before surgery.

 

 

 

 

 

 

 

 

Diabetics:

  • Diabetics should especially stick to the 8-hour fasting rule prior to surgery since diabetics typically clear their stomach contents slower than other the average person.  However, IF your sugars drop please treat this as you normally would and call our office before your procedure.  Try to treat this with 'clear' liquids if possible (e.g. apple juice).

  • Diabetics controlled only with ORAL medications (e.g metformin, glyburide, glipizide, Januvia...), please SKIP your a.m. morning dose since taking some of these medications on an empty stomach can cause a drop in blood sugar or metabolic issues.

  • Diabetics on INSULIN should abide by the instructions given to them at their consultation which, in general is to skip your morning insulin dose unless your blood sugar is abnormally high (please call us) - your extended release insulin taken at bedtime (e.g. Lantus, Humulin, Levimir) should carry you through the morning.

    • Measure your blood sugar at home before coming to the office,

    • Bring your insulin and glucometer to the office.

 

Asthmatics:

  • Unless directed otherwise, please take your usual inhaler medications before your surgery.  You may be asked to prophylactically use your Ventolin inhaler even if your asthma is under control. 

  • Please bring your 'rescue' (Ventolin) inhaler with you to your appointment.