Preparing for surgery involves temporary changes in habits and routines to ensure the safest possible procedure and recovery. The week before your operation requires avoiding certain substances and practices. These guidelines supplement, but do not replace, the specific instructions provided by your surgeon and anesthesiologist. Adhering to pre-operative instructions minimizes complications and supports a successful outcome.
Medications and Supplements That Must Be Discontinued
A number of common prescription and over-the-counter medications must be stopped seven days before surgery because they interfere with the body’s natural clotting mechanisms. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), inhibit platelet function. This increases the risk of excessive bleeding during and after the procedure. Aspirin and any aspirin-containing products also fall into this category, unless a cardiologist specifically directs otherwise.
Prescription blood thinners, known as anti-coagulants and anti-platelet medications, must also be discontinued to manage the risk of hemorrhage. These include drugs like warfarin (Coumadin), clopidogrel (Plavix), and newer oral anti-coagulants. The exact timing for stopping these is determined case-by-case by the prescribing physician. Acetaminophen (Tylenol) is considered safe for pain management during this period because it does not affect blood clotting.
Herbal and dietary supplements must be avoided, as they can present significant risks despite their “natural” origin. Many popular supplements have anti-platelet properties, which can prolong bleeding time and complicate surgical hemostasis. These include high-dose Vitamin E, fish oils (Omega-3 fatty acids), garlic, ginger, ginkgo biloba, and feverfew.
Other supplements can interact unpredictably with anesthetic agents, potentially altering the depth of sedation or affecting blood pressure. St. John’s Wort can interfere with how the body processes certain medications. Ginseng may cause fluctuations in heart rate or blood pressure during the operation. Disclose all supplement use to your care team, as they may recommend stopping all herbals and vitamins for up to two weeks before the procedure.
Lifestyle Substances: Alcohol, Nicotine, and Recreational Drugs
Alcohol consumption should cease in the week leading up to surgery because of its systemic effects on anesthesia and recovery. Alcohol is metabolized by the liver, which also processes anesthetic drugs. Its presence can interfere with the effectiveness and dosing of these agents. Chronic use can also lead to withdrawal symptoms, which may be mistaken for surgical complications post-operatively.
Alcohol acts as a diuretic, leading to dehydration and electrolyte imbalance, which complicates fluid management during the procedure. It can also thin the blood, raising the risk of excessive bleeding. Avoiding alcohol for a full week helps ensure the liver is functioning optimally and the body is properly hydrated for the stress of surgery.
Nicotine and tobacco products, including cigarettes, vapes, and patches, must be stopped due to their negative impact on oxygen delivery and wound healing. Nicotine causes blood vessels to constrict, reducing blood flow and oxygen supply to the tissues. This can delay the healing of the surgical incision and increase the risk of infection. Carbon monoxide inhaled from smoking also binds to red blood cells, restricting the blood’s capacity to transport oxygen.
Recreational substances, especially cannabis, must be disclosed and avoided due to their unpredictable interaction with anesthesia. Regular cannabis users may require significantly higher doses of common anesthetic agents, such as propofol, to maintain sedation. This increased need for medication elevates the risk of cardiovascular instability, including rapid changes in blood pressure and heart function.
Stimulant drugs, such as cocaine and amphetamines, increase the risk of serious cardiac events during surgery. Even recent use can lead to dangerously elevated heart rate and blood pressure. This is life-threatening when combined with the stress of an operation. Full disclosure of any recreational drug use is necessary for the anesthesiologist to plan a safe procedure.
Cosmetic and Physical Preparation Avoidances
External preparations and cosmetic products must be avoided in the days leading up to surgery to ensure patient safety and proper medical monitoring. Nail polish, including gel and acrylic nails, should be completely removed from at least one finger on each hand. This is necessary because the pulse oximeter measures oxygen saturation by shining a light through the nail bed, and opaque coatings interfere with its accuracy.
Refrain from wearing makeup, heavy lotions, creams, or powders on the day of surgery. Makeup can conceal subtle changes in skin color, which medical staff observe as an early indicator of circulation or oxygenation problems. Lotions and creams can interfere with the adherence of surgical tape or the antiseptic solutions used to sterilize the surgical site.
All jewelry and body piercings, including wedding rings and necklaces, must be removed before arriving at the hospital. Metal jewelry can conduct electricity and may cause burns if it contacts the electrocautery devices surgeons use to control bleeding. Jewelry and piercings can also put pressure on surrounding tissues while you are under anesthesia, potentially causing pressure injuries.