Preparing Your Patient for Surgery

Linda M. DeLamar, CRNA, MSN, MS

Topics in Advanced Practice Nursing eJournal. 2005;5(1)

Abstract

Proper planning, assessment, and evaluation of a patient preparing to undergo surgery are very important to assure the best outcome. During this process, the patient's medical condition and overall health can be evaluated and risk factors identified. It may be necessary to involve other specialists for consultation, including the anesthesia team. Laboratory and other diagnostic testing may be needed in advance of the procedure to assist with the evaluation process. This will also provide an opportunity to present patient education, address patient concerns, and establish a trusting relationship between the patient and primary care provider.

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Cite this: Preparing Your Patient for Surgery - Medscape - Mar 21, 2005.

Table 1. Common Herbal Supplements and Potential Clinical Effects
Herbal Supplement	Common Use	Possible Effects
Chamomile	Antispasmodic, gas relieving Light sleep aid	Anticoagulation
Echinacea	Colds, wounds/burns	Anticoagulation, hepatotoxicity, effectiveness of corticosteroids
Ephedra (Ma huang)	Treatment of asthma, fatigue, weight loss Found in diet pills, cold remedies, antifatigue remedies	Hypertension, palpitations, arrhythmias, tachycardia, enhanced sympathomimetic effects with MAOIs^[10]
Feverfew	Migraines, headaches, fever, psoriasis	Platelet inhibition, CNS stimulation (potential vasoactive agent interactions)
Garlic	↑ lipids, hypertension, antibacterial, colds, bronchitis, arteriosclerosis	Inhibited platelet aggregation, enhanced fibrinolytic activity
Ginger	Nausea, motion sickness, indigestion	Inhibits thromboxane synthetase; bleeding^[10]
Gingko	Poor circulation, memory, diabetes Degenerative nerve conditions	Vasodilation of cerebral and peripheral arteries (increase in cerebral blood flow, resulting in an increase in intracranial pressure) Platelet-activating factor is inhibited; increase in bleeding time^[10]
Ginseng	Fatigue, stress, viral infections	Hypertension, CNS stimulation, possible ↑ in anesthetic requirements
Kava	Anxiolytic, sedative	May potentiate CNS depressant effects of barbiturates, benzodiazepines, and opioids
Licorice	Arthritis, asthma, expectorant, cough suppressant, esophagitis, gastritis, peptic ulcers, poor appetite^[9]	Can cause sodium and water retention, edema, hypertension, hypokalemia^[10]
Saint John's wort	Depression, anxiety	May cause hepatic enzyme inhibition and exaggerate CNS depressant effects produced by opioids and barbiturates May have decreased hepatic production of plasma cholinesterase requiring reduced dosages of succinylcholine May have exaggerated blood pressure responses to sympathomimetic drugs^[10]
Valerian	Insomnia, restlessness	Can potentiate sedative effects of benzodiazepines, barbiturates, and opioids
Vohimbe	Impotence	May increase anesthetic needs, cause tremors, increased skeletal muscle activity Excessive doses can cause tachycardia, hypertension, paresthesias, and dissociative states

MAOI = monoamine oxidase inhibitor; CNS = central nervous system

Table 2. Fasting Guidelines
Contents	Minimum Fasting Period
Clear liquids	2 hours
Breast milk	4 hours
Infant formula	6 hours
Nonhuman milk	6 hours
Light meal	6 hours

American Association of Anesthesiologists Task Force on Preoperative Fasting. Practice guidelines for preoperative fasting and the use of pharmacological agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures. Anesthesiology . 1999;90:896-905. Used with permission.