25 Tips From an Anesthesiologist to Ensure a Smooth Surgery
By Dr. Zhang Wei, Department of Anesthesiology, Distinct Healthcare
"Anesthesia is just a nice nap, and then the surgery is over, right?"
If that's how you think about it, your pre-surgery mindset is excellent — but being too relaxed might cause you to overlook important perioperative preparations. On the other hand, being consumed by anxiety and losing sleep every night isn't helpful either.
So what can you do during the days before surgery? Here are 18 things you SHOULD do (YES) and 7 things you should AVOID (NO) to help you prepare.
YES: 18 Things to Do Before Surgery
1. Understand All Important Information About Your Surgery
This includes the surgical plan, risks of both surgery and anesthesia. Please read the pre-operative instructions carefully.
Tip: Answer calls from clinic nurses before your surgery. If you miss them, call back when available.
2. Exercise Regularly Before Surgery
Moderate exercise helps strengthen cardiopulmonary function and aids post-operative respiratory recovery.
Tip: If you don't enjoy exercise, try spending a few minutes daily on deep breathing exercises. This builds lung capacity and relieves pre-surgery stress. Respiratory training is especially beneficial for patients undergoing cardiac or pulmonary surgery. But don't overdo it!
3. Pay Attention to Your Mental Health
Feeling nervous or anxious before surgery is completely normal. Sharing your concerns with family and friends helps build a positive mindset.
4. Get Adequate Sleep
Maintain regular sleep patterns before surgery — this supports your recovery.
Tip: No late nights before surgery!
5. Eat a Healthy, Balanced Diet
Your body needs energy reserves for surgery. Balanced nutrition before the procedure supports post-operative healing.
Tip: Neither binge eating nor extreme dieting is recommended before surgery (except for specific bowel prep for endoscopy).
6. Follow Fasting and Fluid Restriction Guidelines
Strictly adhere to the fasting instructions provided by your medical team.
Important: Failure to follow fasting guidelines may result in surgery being delayed or cancelled!
7. Shower, Wash Your Hair, and Maintain Oral Hygiene
Bathe the evening before or morning of surgery. Brush your teeth and rinse your mouth to maintain oral cleanliness.
8. Diabetic Patients: Monitor Blood Sugar Closely
Tip: Inform your doctor about your blood sugar control status. Poorly controlled blood sugar increases surgical risk and severely impairs wound healing. Test your blood sugar on the morning of surgery. In addition to glucose levels, HbA1c (glycated hemoglobin) reflects your average blood sugar over the past 2-3 months.
9. Hypertensive Patients: Monitor Blood Pressure Regularly
Tip: Excessively high or unstable blood pressure increases the risk of cardiovascular events during surgery and may require postponement. Monitor morning and evening (not immediately after activity). Record values and share with your doctor.
10. Disclose All Current Medications
Tell your doctor about every medication you're taking and get guidance on whether to stop or reduce any.
Key medications to report: Anticoagulants, diabetes medications and insulin, antihypertensives, psychiatric medications, anti-epileptic drugs, hormones. Stop Chinese herbal medicines and herbal supplements before surgery. Keep asthma medications with you.
11. Wear Comfortable Clothing on Surgery Day
Choose comfortable clothes and easy-to-walk-in shoes.
Tip: Bring an extra set of clothes for children.
12. Leave Valuables at Home
Tip: Give phones and electronics to family members or store them in lockers.
13. Arrive 10-15 Minutes Early on Surgery Day
Tip: Medical staff need time to check vital signs, establish IV access, and prepare the surgical site.
14. Inform Staff If You Are Pregnant or Breastfeeding
Tip: Doctors will avoid medications unsuitable for breastfeeding. Many drugs carry risks during pregnancy, and surgical trauma may affect the pregnancy. Please disclose this information promptly.
15. Report Sleep Apnea
If you have sleep apnea syndrome, inform your medical team. If you use a CPAP machine at home, continue using it after surgery.
Tip: Bring your CPAP machine if you're being hospitalized.
16. Remove Dentures Before Surgery
Tip: Also report any loose teeth or dental work. During general anesthesia, dislodged dentures or loose teeth can become foreign bodies — swallowed into the digestive tract causing mucosal damage, or worse, entering the airway causing choking.
17. Prepare Storage for Glasses, Contact Lenses, and Hearing Aids
Have cases ready for these items before entering the operating room.
18. Report Any Implanted Pacemakers
Important: Surgical equipment may interfere with pacemaker function. Remind staff again on the day of surgery.
NO: 7 Things to Avoid Before Surgery
1. Don't Wear Makeup
Makeup can prevent medical staff from observing your true skin color and lip color, making it impossible to detect signs of oxygen deprivation.
Exception: Colorless lip balm is fine and even encouraged, as fasting may cause dry, cracked lips.
2. Don't Wear Nail Polish or Artificial Nails
Remove polish from at least one finger. Nail color can interfere with pulse oximetry readings.
Research shows: Black, blue, and green nail polish have the greatest impact on oxygen saturation readings. Long artificial nails prevent proper contact with the pulse oximeter sensor.
3. Don't Wear Metal Hair Accessories, Jewelry, or Watches
Reason: Electrocautery devices used during surgery can conduct electricity through metal objects, causing burns.
4. Don't Smoke or Drink Alcohol (Including E-cigarettes and Alcoholic Beverages)
Smoking risks: Increased oxygen consumption, greater cardiopulmonary burden, higher infection risk, impaired wound healing, increased blood clot formation.
The American Society of Anesthesiologists advises: "Quitting smoking even the day before your surgery can lower your risk of complications." Extend your smoke-free period as long as possible — 8 weeks significantly reduces perioperative complications.
Alcohol risks: Impairs clotting function, increases surgical bleeding, affects anesthetic drug metabolism, and may cause unpredictable reactions. Alcohol also interferes with post-operative medications like antibiotics.
Recommendation: Stop drinking at least 1 week before surgery. If that's difficult, stop at minimum 24-48 hours before.
5. Don't Drive or Make Major Decisions for 24 Hours After Surgery
You must arrange for an adult companion. Avoid being alone, operating machinery, working at heights, or heavy physical labor.
Tip: Your companion should be an adult, preferably a close relative. Don't bring young children — their needs may distract your companion, and crying may disturb your rest.
6. Don't Have Surgery During an Acute Upper Respiratory Infection
If you develop symptoms (cough, sore throat, hoarseness, runny nose, congestion, ear pain, fever), notify your medical team immediately.
Guideline: Wait at least 1-2 weeks after recovery (adults) or 2-4 weeks (children). Research shows airway hyperreactivity can persist 2-6 weeks after infection. Surgery during active infection increases risks of airway spasm, pneumonia, and hypoxemia.
7. Avoid Surgery During Menstruation
Reason: Surgery during menstruation may increase intraoperative bleeding and postoperative hematoma risk. Hormonal changes may impair wound healing. Record your last menstrual period and notify your team if your period arrives unexpectedly before surgery.
Key Takeaways
| Category | Recommendation | Why It Matters |
|---|---|---|
| Fasting | Follow strict NPO guidelines | Prevents aspiration during anesthesia |
| Medications | Report ALL current drugs | Prevents dangerous interactions |
| Blood Sugar | Monitor closely (diabetics) | Poor control increases complications |
| Smoking | Quit ASAP, minimum 24h before | Reduces respiratory complications |
| Alcohol | Stop 1 week before, minimum 48h | Affects clotting and drug metabolism |
| Nail Polish | Remove from at least 1 finger | Enables accurate oxygen monitoring |
| Companion | Arrange adult escort | Required for safe post-op transport |
Frequently Asked Questions
Q: Can I take my regular medications on the morning of surgery? A: It depends on the medication. Blood pressure medications are often continued with a small sip of water, while blood thinners and diabetes medications typically need adjustment. Always confirm with your anesthesiologist.
Q: How long do I need to fast before surgery? A: Generally, no solid food for 6-8 hours and no clear liquids for 2 hours before anesthesia. Your team will provide specific instructions based on your procedure.
Q: What if I accidentally ate or drank something? A: Inform your medical team immediately. Your surgery may need to be delayed for safety. Never hide this information — aspiration of stomach contents during anesthesia can be life-threatening.
Q: Is it normal to feel anxious before surgery? A: Absolutely. Pre-operative anxiety is extremely common. Talk to your family, practice deep breathing, and don't hesitate to discuss your concerns with your medical team. They can provide reassurance and, if needed, mild anxiolytics.
References
- Pouwels S, Fiddelaers J, Teijink JA, et al. Preoperative exercise therapy in lung surgery patients: A systematic review. Respir Med, 2015, 109(12): 1495-1504.
- Coté CJ, Goldstein EA, Fuchsman WH, et al. The effect of nail polish on pulse oximetry. Anesth Analg. 1988 Jul;67(7):683-6.
- American Society of Anesthesiologists. www.asahq.org
- Canadian Anesthesiologists' Society. www.cas.ca
- Houck P, MD. Anesthesia for the child with a recent upper respiratory infection. UpToDate.
- Razo Vazquez AO, Rosenbaum S. Anesthesia for adults with a recent upper respiratory infection. UpToDate.
