Preparing your patient for an anesthetic at St. John's Hospital.
There are many differing opinions related to which medications should be continued and which medications should be stopped prior to a procedure. Some medications will require close consultation with the surgeon or the prescribing specialist (such as the patient's cardiologist or internist) in order to completely assess the benefits and risks. This document represents our summary of current best practices and is provided to serve as a guide in advising your patient.
The medications administered during an anesthetic and those required for post-op pain control can put some patients with sleep apnea at risk. Many factors are considered to keep your patient with sleep apnea safe during the post-operative recovery period. Many patients with sleep apnea may undergo an outpatient procedure and safely go home after their initial recovery is complete. However, some may require an overnight stay in the hospital for additional monitoring and observation. The severity of your patient's obstructive sleep apnea, type of anesthetic, length of procedure, amount of pain medications required after the procedure, and compliance with the use of their CPAP machine are all important considerations.
This document outlines some of the decision-making steps that are used to determine if a patient with known or suspected sleep apnea is a candidate for outpatient surgery. It is based on the broader experience that now exists after years of caring for patients with obstructive sleep apnea and was established with input from surgeons who are specialists in ear, nose and throat disease.
The STOP-BANG Tool is a research validated tool used to predict the likelihood that a patient may have sleep apnea (in the absence of a pre-existing diagnosis or sleep study).
The Peri-Operative Risk Scoring Tool is used in conjunction with the patient's medical history and perioperative assessment to estimate the risk present following your patient's surgical procedure and anesthetic.
AAPA physicians use the current ACC/AHA Criteria to direct peri-operative testing and evaluation of patients with cardiac disease undergoing non-cardiac surgery. To minimize the risk of cancellation, we recommend that physicians performing pre-operative evaluations adhere to these guidelines.
The prerequisite NPO status prior to surgery and the stress of the perioperative period may necessitate modifications to your diabetic patient's usual insulin or oral hypoglycemic regimen. The attached Diabetes Reference Tool from UpToDate contains guidelines about the management of the diabetic patient undergoing surgery.
The risks versus benefits of discontinuing or maintaining anticoagulation therapy must be carefully considered. AAPA recommends that input from the prescribing physician, in conjunction with the surgeon, be used to guide the decision regarding when or if anticoagulant medications should be stopped.
Many procedures are commonly performed under neuraxial anesthesia. The attached Anticoagulant Reference document provides information about spinal or epidural anesthesia/analgesia for the patient receiving medications that inhibit normal clotting function.
Certain herbal supplements may have unwanted surgical side effects and should be discontinued. Please reference our Herbal Medication Guidelines to determine if and when a supplement should be stopped.
This Labor Analgesia educational handout may be used within your practice to provide answers.
Patients must have someone drive them home or accompany them if they plan to use public transportation. Patients must also have a responsible person (age 16 or older) stay with them overnight. This is to ensure the patient's safety during their early recovery period. This document outlines safety expectations for outpatient procedures.