Glossary

Quick access pre-assessment guidelines.

Blood Product - Patients who decline blood products

If you have chosen to decline blood products, please clarify this at POA clinic.

You will be required to bring the relevant legal documentation you may already have, or you may be required to fill in a form which will clarify which types of blood products you will and will not consent to having. This will be filed in your clinical notes for the surgical and anaesthetic team to be aware of on the day of the surgery.

We will discuss the alternatives that are available and can be provided by The 乐鱼体育 hospital. The alternatives include the use of tranexamic acid, cell salvage and other forms of therapy. After this discussion, a member of the POA team may need to consultant with other teams if necessary to provide medical care to minimise the effects of blood loss prior to the surgery itself.

Please see documents below for further information:
Cell Salvage Information

Cardiac devices - how this could affect you if you are having surgery

Some patients have long term implanted cardiac devices either to help with their function. If you have one of these, please let a member of the POA team know.

On the day of your POA clinic appointment, please bring the implant device card with you if you have it. Your implant will be checked regularly, therefore please also bring the latest clinic letter/check up letter that you have.

If you have not had it checked in a while, this may require the POA team to refer you to cardiac services to have your device checked.

On the day of surgery the device may need de-activating and then re-activating. This will be arranged by the POA team, however careful planning needs to be made to arranging this.

You may also require HDU care post op, to ensure the safe working of your device after the surgery has been performed.

Diabetes

Peri-Operative Diabetes Management

High blood sugars in surgical patients are associated with increased risk of complications and mortality around the time of an operation.
Before going for surgery diabetes control should be optimised as much as possible aiming for a HbA1c <69 mmol.mol-1
Elective surgery may be postponed while this HbA1c target is being achieved through changes to lifestyle and diabetes management. You may be referred to your GP and/or diabetes specialist team to help to achieve this.
Patients with an insulin pump are usually referred to a diabetic specialist team prior to surgery.
During the pre-operative period other areas that can be optimised include:

Exercise
Weight management
Smoking cessation
Good nutrition and alcohol reduction
Managing complications associated with diabetes (e.g. blood pressure, heart disease)
Wellbeing and psychological preparation

Prior to Surgery On Admission to Hospital General aims:

General aims:

To minimise disruption to routine diabetes management
To minimise the fasting period
To maintain normal blood sugars
Ideally diabetic patients should be the first patient on the operating list to minimise fasting period.

Individualised plan:

Each patient should have an individualised plan for medication on the day of surgery and how to re-instate medication after surgery. Patients, GPs and healthcare providers involved in surgery should be aware of the plan.
Patients should feel empowered to ask about benefits, risks, alternatives and be involved in shared-decision making when formulating plans around their diabetes management
Generally:

If taking oral medication to control your diabetes you will be advised on whether to continue or hold you medication depending on which medications you are taking and whether your operation is planned for the morning or afternoon
If taking insulin to control diabetes you will be advised on whether to continue, reduce or omit the dose depending on your regime, type of insulin you are taking and the timing of your operation

Under specific circumstances it may be necessary to start a variable-rate intravenous insulin infusion (VRIII) for example if blood sugars are very difficult to control, if the starvation time is long and involves missing more than one meal or if you have diabetes and require emergency surgery. This treatment is administered by a member of staff with appropriate training and blood sugars will be regularly monitored during this time

After surgery

Oral hypoglycaemic agents should be re-started once you are ready to eat and drink again. Adjustments may need to be made to some drugs if it is thought that food intake may be reduced after your procedure
Subcutaneous insulin should be re-commenced when you are ready to eat and drink again. The dose may need to be adjusted due to post-operative stress, infection or if your food intake has changed.
If you were on a VRIII there may be an overlap from the end of the VRIII and restarting your subcutaneous insulin
Blood sugars will be closely monitored during this time with the aim of maintaining a normal blood sugar
It may be necessary to refer to specialist diabetic teams if blood sugars are difficult to manage during this time

References
Association of Anaesthetists of Great Britain and Ireland. Peri-operative management of the surgical patient with diabetes 2015. Anaesthesia 2015; 70: 1427-1440

Fasting requirements if you're having an anaesthetic

For your safety, you need to be fasted for 6 hours for food and 2 hours for clear fluids, if you are having any type of anaesthetic.

Fasting is very important in order for us to carry out your procedure safely. If you have anything in your stomach whilst under anaesthetic, there is a chance it could come back up when unconscious and inadvertently go into your lungs. We minimise this risk by advising the rules on fasting prior to any anaesthetic.

Hand surgery

Hand surgery can impact your life significantly. Prior to surgery please ensure you elevate your arm if it is in a sling, take regular pain killers, keep dressings clean and dry, and try to reduce smoking as this can impair wound healing. On the day of surgery you may be given information about regional anaesthesia to help with pain. Please remove all jewellery and nail polish and wear loose fitting clothes.

You will be given post-op wound care and things to look out for and any important information you may need for your recovery.

Additional information available here.

Iron replacement and how to increase absorption

Pre-Operative Iron Replacement

Anaemia is a condition where you have lower than normal red blood cells able to carry oxygen around the body. You may feel tired, weak, or dizzy, alternatively you may experience no symptoms at all. There are several different causes of anaemia
A simple blood test can detect anaemia and may help to find the underlying cause
Identifying and treating anaemia at the earliest opportunity before your surgery can improve recovery and reduce the risk of complications after your operation
Iron-deficiency is a leading cause of anaemia, we will focus on treatment options your medical team may offer for this in this article

Oral Iron Tablets

There are several different types you could be offered but generally these are tablets that contain higher doses of iron than you would have for simple health supplementation
Iron tablets are absorbed much better on an empty stomach (one or two hours before food)
Tea, coffee, eggs and 憄hytates� found in beans, seeds, nuts or grains can reduce absorption of iron tablets and should be avoided within two hours of taking iron tablets
Vitamin C taken with the iron tablets does not seem to increase absorption
Side effects include darker than usual stool, constipation, diarrhoea, reduced appetite and nausea
Taking iron tablets once a day or every other day may reduce side effects, if side effects occur contact your medical team for further advice or to discuss alternatives
It can take several months to replenish iron stores and so ideally treatment should be started months in advance of surgery
If taking other regular medication discuss with your doctor or pharmacist how iron tablets may interact with these

Iron infusions

Iron infusions may be offered in specific situations for example if a patient is intolerant to oral tablets, not responding to oral tablets or if the operation is urgent and there is only a limited time for treatment

Patients are encouraged to ask questions about investigations and treatment options when meeting with healthcare professionals. Asking about benefits, risks and alternatives may help establish what is important to you and work with the healthcare team to find the best course of treatment for you.

References

Hawkins T, Agarwal S, Evans CR. 慍entre for Perioperative Care anaemia guideline: Implications for Anaesthesia�. BJA. 130 (2): 115-119 (2023)

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Medication instructions preoperatively

If you suffer with chronic pain, please continue to take your regular pain relief regime (including any patches) and bring your pain medication prescription with you to your POA appointment and on the morning of your surgery. If you don't, you may not be prescribed the correct dose of your usual pain relief medication during your stay with us.

You may be asked to stop Aspirin or Clopidogrel 7 days before your surgery

You may be asked to stop Warfarin 5 days before your surgery and prescribed anticoagulant injections instead until the day of the surgery. Instructions will be given to you regarding when to re-start your warfarin depending on the type of surgery and duration of stay in hospital.

If you are on oral anticoagulation medication such as Dabigatran, Rivaroxaban, or apixaban, you may be asked to stop this a few days before your surgery. During your POA appointment you will be given more specific instructions about when to stop and restart this.

Medications you may be taking following a Transplant, can also interact with medication given to you during your surgery. For this reason, please let the POA team know so they can provide further advice.

If you take any biologic therapies (such as those used for autoimmune diseases), these can sometimes impact your ability to heal from surgery. So please let the POA team know as these may need to be discontinued for a period of time preoperatively after seeking advice from the doctor who prescribed this medication.

Continue to take your thyroid medication as usual.

If you have high blood pressure and take ramipril/enalapril, please stop taking this medication 24 hours prior to surgery. However, if you take any other types of medication related to blood pressure, please continue these.

You will be instructed clearly about your diabetes medication during your POA appointment. Please bring all medication with you to your appointment.

Continue to take your anti-acid reflux medication such as Lansoprazole/ Omeprazole/ ranitidine.

Obstructive Sleep Apnoea (OSA) and what this means

Obstructive Sleep Apnoea is a relatively common condition where the walls of the throat relax and narrow during sleep and can interrupt normal breathing.

The condition makes anaesthesia riskier because it slows down breathing and can make you more sensitive to its effects. Due to the slow breathing, this can lead to a slower wake up time after an anaesthetic.

You may be referred for sleep studies if you meet certain criteria identified at POA clinic.

If you already have a diagnosis, please remember to bring your clinic letters with you and if you are treated with CPAP, it is vital you remember to bring the machine with you for your hospital stay after surgery. You may be required to use your CPAP machine in hospital.

Over the counter/herbal

Based on the evidence available, it is generally advised that you stop taking any herbal medication 2 weeks prior to elective surgery. Please bring all medications with you to your POA appointment so that a personalised plan can be made.

Please try and avoid consuming any restricted drugs including cannabis for at least 72 hours prior to your surgery.

You may continue to take any anti-reflux/indigestion relief/laxatives as you need.

If you are taking over the counter medication for a sore throat/cough/cold relief, please let one of the POA team know.

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