help me help you

Off the top of my head: five tips for people who might need to undergo anesthesia.


1.) Know what medications you're taking, and know what you're taking them for.

I guess this must seem easier for us, because by and large if you're reading this you are on the younger end of the spectrum, statistically more likely to be healthier and on fewer medications, and demographically at least somewhat medically inclined, but--you'd be surprised how many people have no idea what medications they're taking or for what condition they were prescribed.

Patients--please know what medications you're taking! It really makes a difference, and can affect how your body might respond to anesthesia or the various insults of surgery. And it's often not quite enough information to tell me that you take "a blood pressure medication," because there are many different types and they all work through different means. Is it a beta-blocker? An ACE inhibitor? A diuretic? An alpha-2 agonist? And guess what--even if you don't know half of what I just said, it doesn't matter. Just know the names of meds you're on, tell me, and I'll figure it out, because it's my job. If it's hard for you to remember, write your med list down or have a family member help you. Carry the list with you in your wallet if necessary.


2.) Know your own medical history.

Equally important, see above. Do you have a scar over your sternum? Do you have a device implanted under your left pectoral muscle? Sure as hell I'm going to ask you about it. I'm not being nosy, I need to know these things to make sure I can take care of you in the safest way possible. If you can't remember, or have a hard time because you have a long medical history, write it all down (list of diagnoses, surgeries, doctors with contact info) and carry it with you, maybe along with your med list. Better yet, keep it as a file on your computer, so you can update and print it out as necessary.

I know it's annoying to have to answer the same questions again and again, but it's a matter of safety as well. So bring your information. And don't just trust that, "it's in the chart," because sometimes it's not. Anyway, a good medical practitioner doesn't just trust someone else's History and Physical, they do their own.


3.) Do yourself a favor and think long and hard about your allergy list.

As an anesthesiologist (or even as a doctor in general), when I ask you about drug allergies, what I'm really asking you is, "will the benefit of me giving your a certain medication as indicated be outweighed by an adverse reaction of giving you that medication, and do I have good alternatives?" Putting lots and lots and lots of drugs on your allergy list to which you're not actually allergic does nothing but tie my hands to treat you in the safest and most efficacious way possible. Feel free to tell me if you tolerate some meds worse or better than others--if Flagyl makes you queasy or that historically you respond better to morphine than Dilaudid. I do want to know these things, so yes, tell me. But when you tell someone that you're allergic to every antibiotic on the planet because sometimes antibiotics give you the runs, it can really hamper our ability to treat you in a safe, effective, evidence-based way, because the word "allergy" means something very specific in medicine, and we take that word very seriously.

(Also: no one is allergic to epinephrine. Your adrenal glands make epinephrine. If you were allergic to epinephrine we wouldn't be standing here having this conversation right now. Sorry, pet peeve. I don't blame patients for saying it, by the way--I blame the boneheads who, knowing better, write it down anyway and thus immortalize it in the medical record.)


4.) Don't eat or drink after midnight the day of surgery, but it's OK to take most medications.

The surgical team may ask you to hold certain medications prior to surgery, and most of these medications make sense to stop. Since you're not going to be eating for a good couple of hours the day of surgery, it makes sense, for example not to take medications that will further lower your blood sugar (meaning oral medications for diabetes, or your full dose of injected insulin--brittle diabetics, consult your endocrinologist for specific instructions). Also, as surgeons try to keep bleeding to a minimum when they're cutting on you, so with some exceptions in specific cases (like if you've recently had a stent placed in your heart for example, of if you risk for clotting outweighs your risk for bleeding), it's usually advisable to stop taking any blood thinners or certain anti-inflammatory medications for a period of time prior to the surgery date.

But for the most part, other medications are fine to take the morning of surgery, if that's when you usually take them. In fact, I prefer it if you take most of those morning medications, particularly including any medications for your heart, your blood pressure, any breathing issues you might have, or medications for chronic pain. When you think about it, it makes sense: you want to be medically optimized for surgery, not with your blood pressure through the roof, wheezing, and with your pain out of control even before incision.

 Have questions about taking or stopping a specific medication before you get to the OR? Ask to speak to an anesthesiologist prior to your surgery date. Don't just call the surgeon's office and ask--often the person fielding the call (not always a medical professional) will not have the first clue, and will instead say, just because he or she thinks it's the safest answer, "don't take any medications the day of surgery." I had a myasthenic patient come in for an afternoon surgery having skipped several doses of Mestinon because the secretary she talked to told her not to take her meds. Like I said, if you have medical questions about day of surgery medications, ask to talk to an anesthesiologist beforehand. Again: it's our job.


5.) If you have any specific fears or concerns about the anesthesia itself, let us know beforehand.

Help us help you! Are you claustrophobic and hate the idea of having a mask over your face? Do you have a needle phobia? Did you have a family member with a very bad reaction to anesthesia, or have you yourself have a traumatic anesthetic experience in the past? Do you have questions about "The Michael Jackson Drug" and want to know exactly how the same fate will not befall you? Let us know! We can help you! There are things we can do to make things easier! Better! Smoother! Less scary! We have all sorts of tricks in our bag, is all I'm saying. We just need to know when and for whom to pull them out.


Medical professionals in this or other fields: another other tips?


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For people of a certain age, Whitney Houston runs throughout the soundtrack of our childhood and adolescence. So if you want to pretend that you've never been alone in the bathroom hoping that the tile acoustics would help you better belt out the chorus of "One Moment in Time," I'd think I'd have to call you a damn liar.





Thank you, Whitney. You were transcendent.