Peri-operative care

Having a procedure or operation can be daunting for a number of people, regardless of whether it is the first time or one of many. Anxiety around procedures can be much alleviated by adequate preparation. Ensure you have any procedure related questions answered. There are certain logistical aspects that you may need to work around such as transportation to and from the hospital, attendance times to the hospital and planning around any driving restrictions that may be related to the procedure itself. If you need help to clarify any of this, please feel free to contact the hospital or the practice. We would be happy to clarify or assist you in whatever way we can.

Here is a list of things to remind you that may be helpful:

  • Have your identification, Medicare and Private Health Insurance information, and availabl

  • Know your Hospital location & admission time

  • Arrange Transportation to and from the hospital

  • Know and follow your Medication instructions

  • Know and follow your Fasting instructions

  • Complete any blood work or testing requested prior to the procedure date

  • Bring with you any relevant test results e.g., CD of a CT scan

  • Have comfortable clothing to wear

  • Avoid any nail polish or fake nails

  • Avoid bringing any jewellery

Days before your procedure

Depending on your medical conditions and procedure planned, you may need to make certain changes to your medications. This may be directly related to the procedure itself or due to the level of anaesthesia necessary. We would provide you with this information, but please ensure that you are aware of the medications that you are usually taking.

Some common medications that are withheld prior to surgery are:

  • GLP-1 agonists e.g., semaglutide (Ozempic, Wegovy)

    • These agents are often taken for weight loss and slow down the transit of food through your gut. Therefore, they pose a risk of aspiration any time you require anaesthesia. To minimise this risk, you are likely to be asked to hold a few doses of this medication, which can be some weeks in advance of the procedure.

  • SGLT-2 inhibitors e.g., dapagliflozin (Forxiga) or empagliflozin (Jardiance)

    • These agents are often stopped for 2 days prior to the procedure. In other words, the last dose of the medication is to be had at least 48 hours prior to the procedure. This is especially the case for procedures requiring general anaesthesia or deep sedation.

  • Oral diabetic medications e.g., metformin, gliclazide

    • These agents lower your blood sugar level and therefore we avoid them altogether on the day of the procedure, when you are likely fasted

  • Blood thinners e.g., apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), warfarin

    • Although Dr Mehta perform most procedures on uninterrupted anticoagulation, there are certain instances where these medications may need to be withheld for 24 hours prior to and following the procedure.

    • If on warfarin, a blood test to demonstrate INR must be performed in the days preceding and on the morning of the procedure to ensure that the blood is neither too thin or not thin enough

    • Antiplatelets such as aspirin, clopidogrel and ticagrelor can often continue unless specifically stated otherwise

  • Medications that affect your heart rate or rhythm e.g., metoprolol, sotalol, flecainide, verapamil, diltiazem

    • These medications may be held depending on the nature of the procedure you are having done

There is a high likelihood that you will be asked to fast for your procedure. There are some procedures that are done under local anaesthesia alone, but the majority of them will require either sedation or general anaesthesia. Guidelines around fasting are adopted from the ANZCA (Australia New Zealand College of Anaesthesiologists).

  • Solid foods: A light low-calorie meal can be had up to 6 hours prior to your procedure

  • Clear liquids e.g., water, apple juice (no pulp): this can be had up to 2 hours prior to your procedure. Please note that this has to be strictly clear and if there is any uncertainty about this, please clarify

Fasting is a very important component of keeping you safe during your procedure and anaesthesia. Therefore, if you have breached the fasting instructions, please let us know as soon as possible as we may have to reschedule your procedure.

  • For morning procedures, please commence fasting from the midnight prior

  • For afternoon procedures, please commence fasting from 6AM, unless otherwise stated

Note that the above points are for general guidelines and serve as reminders and explanations about pertinent periprocedural aspects. Please ensure that you are very clear about your specific instructions.

After your procedure

Once your procedure is complete, you will be transported to the recovery area in the hospital and if you are staying overnight, you will then be transferred to a ward bed. There maybe certain changes to your medication, lifestyle and aftercare that you need to be aware. Please make sure that you are across these aspects.

These may include the following:

  • Driving restriction: are often driving restrictions applied after certain procedures. The level of restriction may differ based on private or commercial vehicle driving.

  • Lifestyle restriction: there may be a restriction to lifting heavy items for a couple of weeks and a restriction to moving your arm above the level of the shoulder for a few weeks (in the case of a cardiac implantable device)

  • Wound and dressing care: special attention needs to be had regarding wound care. If you are having a cardiac device implanted, your dressing is likely to stay on for 2 weeks, after which Dr. Mehta will remove your dressing.

  • Medication changes: you may have some changes to your medication with specific instructions such as restarting your blood thinners, commencing new medications and omitting others. These will be communicated to you by the doctor as well as reinforced by nursing and pharmacy staff.

  • Follow-up appointments