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Patient Care

Surgery - General Preparation


ALWAYS CHECK WITH YOUR SURGEON FOR SPECIFIC INSTRUCTIONS

If you are on aspirin, Plavix, Coumadin, or another medication that can affect your clotting and bleeding risk, please ensure you have clear instructions from your surgeon prior to continuing or discontinuing these medications prior to surgery.  Failure to stop them appropriately could lead to your procedure being cancelled.  Stopping them inappropriately could increase risk of other problems around the time of surgery.

Bowel preparation for nephrectomy, cystectomy, and seed implant:

Introduction:

Your bowel must be clean and empty before surgery. This is a guideline to ensure your bowels are prepared for surgery.

Preparation:

Purchase a bottle of Citrate of Magnesia and one disposable enema. You can buy these over the counter at any grocery or drug store.

Avoid drinking any alcohol for 48 hours before and 48 hours after surgery.

The day before your surgery, do not eat any solid foods. Start a clear liquid diet at breakfast. Clear liquids are fluids that you can see through including: water, bouillon or clear broth, lemonade, Snapple, apple juice, Gatorade, white grape juice, cranberry juice, black coffee or tea, Jell-o and popsicles.

Drink plenty of fluids to avoid dehydration and avoid dairy products.

You will also need to clean out your bowels completely. Drink one bottle of Magnesium Citrate starting at 10am. Magnesium Citrate is best chilled and poured over ice. Please drink this slowly allowing one hour to complete the entire bottle.

Use one single use disposable fleet enema late in the afternoon.

Do not eat or drink anything after midnight and before surgery.

You may brush your teeth without swallowing the water. It is important for you to have an empty stomach at the time of your surgery.

Do not smoke after midnight the night before your surgery.

Discuss with your doctor about prescription medicines. You may be advised to take them at the normal time with small sips of water.

Diabetes Medicines Before Surgery

Diabetes medicines may need to be stopped or changed before surgery. Talk to your prescribing doctor to find out how you should change your diabetes medicines, or follow these guidelines. Follow your prescribing doctor's directions if they are different than these guidelines.

You will have less chance of infection or other problems if your blood sugar is in the normal range before your surgery.

If you are on a clear liquid diet the day before surgery, call your doctor to check if you need to make other changes to your medicine doses.

Check your blood sugar the morning of surgery. If it is above 200 or less than 70, call your prescribing doctor for more instructions. High or low blood sugars may result in a delay or cancellation of your surgery.

Make sure you tell your nurse that you have diabetes when you arrive to preoperative holding.

Your Oral Diabetes Medicines

If you take Glucophage, also called Metformin, or any other medicine that has Metformin in it, such as Metaglip, Glucovance, Avandamet, and ACTO plu Met:
Stop the medicine one day before surgery.
Do not take this medicine for 2 days after your surgery. Restart the medicine on the third day after your surgery.

If you are not sure how to adjust your medicine, be sure to call your prescribing doctor or nurse to check.

Your Insulin

If you are not sure how to adjust your insulin dose, be sure to call your prescribing doctor to check how much insulin you should take before your surgery.

If you take Lispro, Humalog, Aspart, Novolog, Glulisine, Apidra or regular insulin, do not take the dose the morning of your surgery. You can start your dose after your surgery when you are able to eat again.

If you take Detemir, Levemir, Glargine or Lantus insulin, reduce your dose either the evening before or the morning of your surgery to 80%. If you take your usual dose times 0.8, that will give you the reduced dose. For example, if your usual dose is 32 units, 32 X 0.8 = 25.6. Your reduced dose would be about 26 units.

If you are not sure, ask your prescribing doctor how much insulin you should take.

If you take NPH, 70/30, 75/25, or 50/50 insulin, reduce your evening dose the day before your surgery to 80%. Also reduce your morning dose by 50% of your usual dose the day of your surgery. For example, if your usual morning dose is 30 units, you would only take 15 units.

If you wear an insulin pump and your surgery is less than 3 hours, your doctor may decide to keep the pump on. Reduce the basal rates down by multiplying the set basal rates by 0.8, starting with the 12:00 midnight basal rate through the surgery and recovery period. Return to your usual basal rates after surgery when you are able to eat.

Talk to your doctor that prescribes your medication if you have any questions.

On the day of surgery report to Hospital Admissions, Rhodes Hall, Room 105, 450 W 10th Avenue 2 hours before your scheduled surgery. This allows time for pre-operative preparation.

Take a list of all medications, including herbs that you are currently taking with you to the surgery unit. List the dosage and time each is taken. Also, take a list of your food allergies.

Wear loose fitting clothing the day of surgery. You will be given a hospital gown and slippers to wear after your arrival.

Always check with your surgeon for additional instructions.