Anesthesia: Preparing For Anesthesia

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Preparing for Anesthesia

Being well-prepared for anesthesia may help you remain calm and relaxed. If you take the time to learn about your procedure and the anesthesia, you will be better able to understand the information and instructions you are given. Knowing what to expect can help decrease tension and anxiety.

Usually, your surgeon's office, clinic, or hospital will contact you in advance to give you information about what to do the evening before and the day of the procedure. Your surgeon will also provide information about what will happen when you arrive at the clinic or hospital, during the procedure, and afterward.

Food and drink restrictions

As part of the preparation for your procedure, you are not allowed to eat or drink anything for a certain time period before anesthesia. The following times are averages. In some cases, such as in those people with gastroesophageal reflux disease (GERD), the restrictions must be started earlier for safety.

• Do not eat for 6 hours before anesthesia.
• You may drink clear liquids only (water, filtered apple juice, black coffee or tea, and clear carbonated beverages such as Seven-Up) up to 2 hours before your surgery. You should having nothing else to eat or drink for at least 6 hours before anesthesia.

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 is very uncommon, but it can cause severe complications.

Medicine restrictions

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 procedure. Some medicines may interact with the anesthetics and other medicines used for anesthesia.

Informed consent

Before any nonemergency surgery or procedure, most surgery centers and hospitals have a surgery consent for you to sign. This is called an informed consent because your surgeon will explain why your surgery is needed, what it will involve, its risks and expected outcome, and how long it will take you to recover. After discussing this information, you may be asked to sign the informed consent. It needs to be signed before you receive any medicines that could affect your state of mind.

Your anesthesia specialist will discuss the anesthesia care for your surgery 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.

If the person undergoing anesthesia is a child or is mentally incompetent to sign a consent form, the consent may be signed by a responsible family member or guardian.

Mental relaxation techniques

Many people experience anxiety before medical procedures, especially surgery. Mental relaxation techniques can help reduce anxiety. If you will be awake during the procedure, you also can use these techniques to relax while it is being done. They can also be used to help reduce pain and anxiety following your procedure.

Some mental relaxation techniques that may be useful include:

• Optimistic self-recitation, in which you focus on and recite thoughts that are optimistic and positive.
• Guided imagery (visualization), a method of using your imagination to help you relax and release tension by concentrating on a pleasant experience or restful scene.
• Meditation, to help focus your attention on feeling calm and relaxed. You may want to focus on a single image, a sound, or your own breathing.
• Distraction techniques, such as listening to music through headphones.

Medicine given before anesthesia

You may be given a medicine before anesthesia. Medicines may be given by mouth or by injection immediately before anesthesia.

Medicine is given before anesthesia for many reasons, including:

• Relieve anxiety. The medicines most commonly given to relieve anxiety are benzodiazepines such as midazolam (Versed), diazepam (Valium), and lorazepam (Ativan).
• Relieve or prevent pain. Medicines to relieve pain (analgesics) may be given to people who are in pain before the procedure begins as well as to reduce pain during the procedure.
• Reduce secretions. Certain medicines (anticholinergic agents) may be used to reduce secretions in the mouth and respiratory tract.
• Reduce the volume and acidity of fluids in the stomach to help reduce the risk of aspiration. Aspiration occurs when an object or liquid is inhaled into the respiratory tract. In some cases, medicines are given to reduce or neutralize stomach acidity in order to lower the risk of injury if stomach juices are regurgitated into the throat or inhaled into the airway.
• Reduce nausea and vomiting. People who are at risk for nausea and vomiting either during the procedure or during recovery may receive medicines called antiemetics.
• Control body functions. Medicines may be given that help control the body's automatic responses to the pain and stress of surgery. Other medicines may be given to help maintain heartbeat or blood pressure at a stable and regular level.

Other preparation

For many procedures, medicines are given through a vein (intravenously, IV). An IV is usually inserted into a vein in the hand or lower arm. When the IV is in place, medicines or fluids can be given quickly into your bloodstream. Children and some adults may find insertion of the IV painful and stressful. In these cases, the IV may be inserted after they have been sedated or after an inhaled anesthetic has been given through a mask.

Some of the instruments used to monitor your breathing, blood pressure, and heart function may be placed on your body while you are being prepared for your surgery.

Helping children prepare for anesthesia

Children do better when receiving anesthesia if they know what to expect. You can help relieve your child's anxiety or fears by being calm and explaining what will happen at the clinic or hospital. Explain to your child that he or she will be in unfamiliar surroundings but that many doctors and nurses will be there to help.

It is best to be honest and explain that there may be some discomfort or pain after the procedure, but reassure your child that you will be close by. Bringing familiar items such as books or toys may help comfort and distract your child.

Last updated:	February 04, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, John M. Freedman, MD - Anesthesiology
Editors:	Maria G. Essig, MS, ELS, Pat Truman, MATC