Preparation for Surgery
MS
to be some differences of opinion.
One that is not disputed, that everyone agrees to---avoid NSAIDs two weeks
before surgery.
Some also say avoid Vitamin E. I think some also say avoid Vitamin C, and
some say avoid all vitamin and mineral supplements. One web site I saw had a
very long list of medicines and substances to avoid, including even sudafed,
a few antibiotics, ginger, garlic, etc.
Besides the one type of medicine that everyone agrees should be avoided
before surgery, NSAIDs, what are people's opinions about other substances
that should be avoided before surgery, if any.
St. Campion
>Besides the one type of medicine that everyone agrees should be avoided
>before surgery, NSAIDs, what are people's opinions about other substances
>that should be avoided before surgery, if any.
Cigarettes.
NSAIDS
Aspirin ( an NSAID )
Many common OTC drugs have NSAIDS ( eg Nurofen , Nurofen for children
)
--------------------------------------------------------
There is no God but chaos
And Temujin Genghis Khan is his prophet.
ENTconsult
the Amer Soc of Anesthesiologists advises to avoid
feverfew
garlic
ginger
ginkgo-biloba,
ginsend
kava-kava a
St John's wart
for 2-3 weeks before surgery. Of course aspirin and related products.
*from The Sinus Cure by D Bruce and M Grossan. Ballantin 2001.
Murray Grossan, M.D.
http://www.ent-consult.com
http://www.TinnitusRelief.net
http://www.emedicine.com/ent/topic516.htm
Richard Cavell
seem
> to be some differences of opinion.
There's a long list, but it depends on the type of operation and the type of
anaesthetic.
> One that is not disputed, that everyone agrees to---avoid NSAIDs two weeks
> before surgery.
In general.
I saw a patient who had 4 teeth extracted while fully anticoagulated with
warfarin (INR ~3.5). I saw him several hours later, when he was bleeding
uncontrollably.
(He had transposition of the great vessel repair at birth).
It depends on the relative risk of stopping the anticoagulation versus
continuing it.
> Some also say avoid Vitamin E. I think some also say avoid Vitamin C,
I can't see that they would make any difference. Vit E is supposed to be
prescribed to plastic surgery patients, according to my textbook. (Helps
skin healing).
> some say avoid all vitamin and mineral supplements. One web site I saw had
a
> very long list of medicines and substances to avoid, including even
sudafed,
Dries up secretions -> increases risk of atelectasis, pneumonia, etc.
> Besides the one type of medicine that everyone agrees should be avoided
> before surgery, NSAIDs, what are people's opinions about other substances
> that should be avoided before surgery, if any.
It depends on so many different things. Anaesthetists spend years training
in how to know these things for sure.
MS
should avoid food with those substances, or just not take supplements with
them?
"ENTconsult" <entco...@aol.com> wrote in message
news:20020417022715...@mb-cg.aol.com...
Colin Campbell
<m...@nospam.com> wrote:
>Besides the one type of medicine that everyone agrees should be avoided
>before surgery, NSAIDs, what are people's opinions about other substances
>that should be avoided before surgery, if any.
It would be a good idea to avoid all supplements (except for any your
doctor specifically recommends) if you are having surgery. The
problem with supplements is that they are generally not tested and
nobody knows what they will cross-react with.
"With Confidence in our Armed Forces -
with the determination of our people -
we will gain the inevitable triumph -
so help us god."
Franklin Delano Roseveldt, 8 december 1941
ENTconsult
supplements. I will try to find out - anyone know?
One of the best ways to get an uncomplicated surgery is to make sure you aren't
coming down with the flu or a cold before surgery.
Steve Harris
news:a9j824$if$1...@otis.netspace.net.au...
> > What medicines and supplements should be avoided before surgery? There
> seem
> > to be some differences of opinion.
>
> There's a long list, but it depends on the type of operation and the type
of
> anaesthetic.
>
> > One that is not disputed, that everyone agrees to---avoid NSAIDs two
weeks
> > before surgery.
COMMENT
Sorry, but it depends on the NSAID. Aspirin will hurt your bleeding time for
2 days; possibly longer if your platelet numbers or production is abnormal.
Aspirin is very different than other NSAIDs because its action is
irreversible in platelets-- a single aspirin dose (more than 1/8th of a
standard tablet) slightly disables every platelet in your body permanently,
so that somewhere around a quarter of your platelets must be replaced before
the body is back to normal bleeding times (for which you need less than a
quarter of your normal platelets...). Many other NSAIDs (ibuprofen) only
cause problems while they're in your system-- less than a day. A few
non-aspirin salicylates (eg salsalate) and COX-2 inhibitors (Vioxx) have
very little effect on platelets and are perfectly fine to take when having
dental and other procedures.
> In general.
>
> I saw a patient who had 4 teeth extracted while fully anticoagulated with
> warfarin (INR ~3.5). I saw him several hours later, when he was bleeding
> uncontrollably.
>
> (He had transposition of the great vessel repair at birth).
>
> It depends on the relative risk of stopping the anticoagulation versus
> continuing it.
And it also depends on the surgery. Standard abdominal surgery where
bleeding is controlled with vessel ligation/ cautery and direct
visualization of bleeders, has very little more bleeding with or without
aspirin (this has been studied). Surgery in which bleeding must be
controlled from large raw surfaces by direct pressure only (tooth
extractions, liposuction, facelifts) have a huge aspirin effect, and that is
why dentists and plastic surgeons are relatively more crazy about aspirin
and other NSAIDs than are other kinds of surgeons. FYI.
> > Some also say avoid Vitamin E. I think some also say avoid Vitamin C,
>
> I can't see that they would make any difference. Vit E is supposed to be
> prescribed to plastic surgery patients, according to my textbook. (Helps
> skin healing).
Attitude of plastics people to vitamin E varries widely. Alas, no good
studies exist on bleeding in plastic surgery and vitamin E supplements. I'd
be surprised if it makes any difference for the person not taking coumadin.
Other plastics people are paranoid. There isn't even good evidence one way
or the other on topical vitamin E, with studies going both ways.
J Burn Care Rehabil 1986 Jul-Aug;7(4):309-12
Failure of topical steroids and vitamin E to reduce postoperative scar
formation following reconstructive surgery.
Jenkins M, Alexander JW, MacMillan BG, Waymack JP, Kopcha R.
Shriners Burns Institute, Cincinnati, OH 45219.
One hundred fifty-nine operative procedures for postburn contractures of
interdigital webs (96), the axilla (46), or the neck (17) were prospectively
randomized to be treated postoperatively for four months with a topical
steroid (Aristocort A), topical vitamin E, or the base cream carrier for
these drugs. The nature of the medication was blinded both to the patient
and to the evaluator. Patients were followed for one year. Observations were
made for range of motion, scar thickness, change in graft size, and ultimate
cosmetic appearance. No beneficial effect of either vitamin E or topical
steroid could be demonstrated. However, adverse reactions occurred in 16.4%
of patients receiving active drug, compared to 5.9% treated only with base
cream. Interestingly, the grafts initially contracted and subsequently grew
to be a size larger (about 20%) than the original graft by one year. It is
concluded that neither topical steroid nor topical vitamin E is effective in
reducing scar formation after grafting procedures for reconstruction for
postburn contractures.
Publication Types:
Clinical Trial
Randomized Controlled Trial
>
--
I welcome Email from strangers with the minimal cleverness to fix my address
(it's an open-book test). I strongly recommend recipients of unsolicited
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name of the last ISP address on the viewsource header, then forward message
& headers to "abuse@[offendingISP]."
Steven Litvintchouk
ENTconsult wrote:
>
> I don't know why the Amer Acad of Anesth said to avoid garlic and ginger
> supplements. I will try to find out - anyone know?
> One of the best ways to get an uncomplicated surgery is to make sure you aren't
> coming down with the flu or a cold before surgery.
I see.
So you only perform sinus surgery only on patients who don't have sinus
infections?
How convenient.
If I didn't have a stubborn sinus infection that multiple courses of
antibiotics didn't touch, I wouldn't have needed the surgery. My
surgeon had to operate on me right thru my infection.
--
Steven D. Litvintchouk
Email: sdli...@earthlink.net
MS
"Steve Harris" <sbha...@ix.RETICULATEDOBJECTcom.com> wrote in message
news:a9kjd1$jqj$1...@slb4.atl.mindspring.net...
> > > One that is not disputed, that everyone agrees to---avoid NSAIDs two
> weeks
> > > before surgery.
>
> COMMENT
>
>
> Sorry, but it depends on the NSAID. Aspirin will hurt your bleeding time
for
> 2 days; possibly longer if your platelet numbers or production is
abnormal.
> Aspirin is very different than other NSAIDs because its action is
> irreversible in platelets-- a single aspirin dose (more than 1/8th of a
> standard tablet) slightly disables every platelet in your body
permanently,
> so that somewhere around a quarter of your platelets must be replaced
before
> the body is back to normal bleeding times (for which you need less than a
> quarter of your normal platelets...). Many other NSAIDs (ibuprofen) only
> cause problems while they're in your system-- less than a day. A few
> non-aspirin salicylates (eg salsalate) and COX-2 inhibitors (Vioxx) have
> very little effect on platelets and are perfectly fine to take when having
> dental and other procedures.
So, are you saying you disagree with the generally stated axiom to avoid
NSAIDs entirely for two weeks before surgery, that that's not necessary. No
aspirin a few days before, and no ibuprofen and others from the day before
the surgery?
Michael Roose
<sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
| a single aspirin dose (more than 1/8th of a
|standard tablet) slightly disables every platelet in your body permanently,
|so that somewhere around a quarter of your platelets must be replaced before
|the body is back to normal bleeding times (for which you need less than a
|quarter of your normal platelets...).
How is it that they are only "slightly" disabled. Isn't this an
either/or proposition?
Whether it is or isn't, can you assume that large doses of aspirin
over continuous periods of time would create a permanent "bleed-out"
condition?
Steve Harris
news:ubu0krj...@corp.supernews.com...
If your platelet count is normal, that should be all that is needed, yes.
And ONCE again, much depends on the surgury. If you've having facelift or
liposuction you may need to stop aspirin for a full week to get every last
platelet you have, working.
I don't think anybody can justify 2 weeks, for anything.
SBH
Steve Harris
news:njaubuc2616bjrse3...@4ax.com...
> On Wed, 17 Apr 2002 13:45:15 -0600, "Steve Harris"
> <sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
>
> | a single aspirin dose (more than 1/8th of a
> |standard tablet) slightly disables every platelet in your body
permanently,
> |so that somewhere around a quarter of your platelets must be replaced
before
> |the body is back to normal bleeding times (for which you need less than a
> |quarter of your normal platelets...).
>
> How is it that they are only "slightly" disabled. Isn't this an
> either/or proposition?
Not at all, and that's the point. Each platelet still works, just not quite
as well.
> Whether it is or isn't, can you assume that large doses of aspirin
> over continuous periods of time would create a permanent "bleed-out"
> condition?
No. The amount of aspirin over 40 mg a day has almost no (not quite none,
but almost) additional effect on platelets. Larger doses of aspirin are
irritating to the stomach, but how well you stand up to that is individual.
Many people with rheumatoid arthritis in the old days took 20 aspirin a day
for 20 years without harm. Of course, not everyone can get away with that.
SBH
Larry Preuss
<sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
> > So, are you saying you disagree with the generally stated axiom to avoid
> > NSAIDs entirely for two weeks before surgery, that that's not necessary.
> No
> > aspirin a few days before, and no ibuprofen and others from the day before
> > the surgery?
> >
>
>
> If your platelet count is normal, that should be all that is needed, yes.
I don't think this is entirely correct. ASA interferes with the
function of platelets in clotting not by reducing their absolute number
but by making them stick to each other less well. For this reason they
do not hold together in forming the framework for a clot as well as
normal and, as has been said before, one aspirin hit decreases the
stickiness of a platelet for its entire life in the circulation.
Larry
Larry Preuss
<sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
> Many people with rheumatoid arthritis in the old days took 20 aspirin a day
> for 20 years without harm. Of course, not everyone can get away with that.
>
> SBH
In those old days one of the ways used to judge the dose of aspirin
that could be given for the arthritis was to slowly increase the dose
until the ringing (buzzing?) in the ears became really bothersome.
Larry
CBI
"Steve Harris" <sbha...@ix.RETICULATEDOBJECTcom.com> wrote in message
news:a9nevr$hg0$1...@slb4.atl.mindspring.net...
> " MS" <m...@nospam.com> wrote in message
> news:ubu0krj...@corp.supernews.com...
> >
> > So, are you saying you disagree with the generally stated axiom to avoid
> > NSAIDs entirely for two weeks before surgery, that that's not necessary.
> No
> > aspirin a few days before, and no ibuprofen and others from the day
before
> > the surgery?
> >
>
>
> If your platelet count is normal, that should be all that is needed, yes.
>
> And ONCE again, much depends on the surgury. If you've having facelift or
> liposuction you may need to stop aspirin for a full week to get every last
> platelet you have, working.
>
> I don't think anybody can justify 2 weeks, for anything.
>
I'll second that.
--
CBI, MD
"Believe those who are seeking the truth; doubt those who find it."
-Andre Gide
Steve Harris
news:180420022021206731%LPr...@provide.net...
Yep. It worked, too.
Steve Harris
COMMENT:
Yes, if you'd been reading, you'd find I never said otherwise.
Still, to get rid of the aspirin platelet effect you need to make 50,000 to
100,000 new platelets per mm^3. How long it takes you to do that is the
question. Generally you can figure that somebody with a platelet count of
400,000 is making them twice as fast as someone at 200,000 and so on (since
everybody loses about the same fraction every day). That doesn't hold for
people who have the low count because of consumption (bleeding or some other
problem), so you can't always say that people with low counts are making
them slowly. What you can say is that people with nice high counts are
making them fast, and will recover normal bleeding times more quickly after
an aspirin dose.
Clear now?
CBI
"Larry Preuss" <LPr...@provide.net> wrote in message
news:180420022018085224%LPr...@provide.net...
I don't think Steve was suggesting that the number of platelets is reduced
by NSAIDS. What he means is that clotting largely depends on how many
functioning platelets you have. One important difference between aspirin and
the other NSAIDS is that aspirin inactivates the platelet permanently while
the other NSAIDS do so reversibly. This means that the anticoagulation by
NSAIDS is largely determined by pharmicokinteics - when the drug is gone so
are the platelet effects. The duration of action of aspirin depends on how
fast you make new platelets.
It has long been observed that the life of a platelet is about 1 week. This
means that if you take aspirin and "poison" them all it will take a week to
regenerate the full complement (hence the advice to stay off aspirin for a
week prior to surgery). The thing is that you have many more platelets than
you need. An average count is about 200K but you only need 20K to control
most bleeding (really 10K) and certainly no more than 50K for almost any
situation. This means that once the aspirin has left the system (back to
pharmicokinetics) you only need a day or two (possibly much less - 8
hours?) to produce enough functioning platelets to undergo most surgeries.
Obviously, if you have fewer than the usual number of platelets or their
function is subpar then these numbers will not apply.
I, for one, have never heard anyone recommend staying off NSAIDS for two
weeks. The usual advice is to stay off aspirin for a week and Motrin etc for
three days (and now you know why this is wrong).
CBI
"Larry Preuss" <LPr...@provide.net> wrote in message
news:180420022021206731%LPr...@provide.net...
"Aspirin 'till tinnitus"
CBI
"Steve Harris" <sbha...@ix.RETICULATEDOBJECTcom.com> wrote in message
news:a9ngrh$3rb$1...@slb4.atl.mindspring.net...
> "Michael Roose" <somewhatus...@hotmail.com> wrote in message
> news:njaubuc2616bjrse3...@4ax.com...
> > On Wed, 17 Apr 2002 13:45:15 -0600, "Steve Harris"
> > <sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
> >
> > | a single aspirin dose (more than 1/8th of a
> > |standard tablet) slightly disables every platelet in your body
> permanently,
> > |so that somewhere around a quarter of your platelets must be replaced
> before
> > |the body is back to normal bleeding times (for which you need less than
a
> > |quarter of your normal platelets...).
> >
> > How is it that they are only "slightly" disabled. Isn't this an
> > either/or proposition?
>
> Not at all, and that's the point. Each platelet still works, just not
quite
> as well.
>
Right - it is because the aspirin is not inhibiting one platelet but the
millions of cyclooxygenase enzymes in it. You can inhibit any fraction of
them.
>
> > Whether it is or isn't, can you assume that large doses of aspirin
> > over continuous periods of time would create a permanent "bleed-out"
> > condition?
>
> No. The amount of aspirin over 40 mg a day has almost no (not quite none,
> but almost) additional effect on platelets. Larger doses of aspirin are
> irritating to the stomach, but how well you stand up to that is
individual.
> Many people with rheumatoid arthritis in the old days took 20 aspirin a
day
> for 20 years without harm. Of course, not everyone can get away with that.
>
Actually, everything I have read suggests that there is little difference in
the efficacy or toxicity of doses of aspirin ranging from 60mg to 1000mg per
day.
Michael Roose
wrote:
|Actually, everything I have read suggests that there is little difference in
|the efficacy or toxicity of doses of aspirin ranging from 60mg to 1000mg per
|day.
Then the typical aspirin tablet of 200 mg + is nothing more than a
reason to sell more aspirin, eh?
CBI
"Michael Roose" <somewhatus...@hotmail.com> wrote in message
news:9jvubu0ft6cnrjoe5...@4ax.com...
If used as a "blood thinner" - yes. For pain - no.
ENTconsult
nosebleeds in persons taking aspirin and Gingko.
Current practice is to recommend a baby aspirin daily as a means of preventing
a bood clot in the heart. Also to take aspirin if you suspect a heart attack.
Larry Preuss
<sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
> > I don't think this is entirely correct. ASA interferes with the
> > function of platelets in clotting not by reducing their absolute number
> > but by making them stick to each other less well. For this reason they
> > do not hold together in forming the framework for a clot as well as
> > normal and, as has been said before, one aspirin hit decreases the
> > stickiness of a platelet for its entire life in the circulation.
> > Larry
>
> COMMENT:
>
> Yes, if you'd been reading, you'd find I never said otherwise.
>
> Still, to get rid of the aspirin platelet effect you need to make 50,000 to
> 100,000 new platelets per mm^3. How long it takes you to do that is the
> question. Generally you can figure that somebody with a platelet count of
> 400,000 is making them twice as fast as someone at 200,000 and so on (since
> everybody loses about the same fraction every day). That doesn't hold for
> people who have the low count because of consumption (bleeding or some other
> problem), so you can't always say that people with low counts are making
> them slowly. What you can say is that people with nice high counts are
> making them fast, and will recover normal bleeding times more quickly after
> an aspirin dose.
>
> Clear now?
>
> SBH
I'm sorry to tread on your toes. I thought you said "If your platelet
count is normal, that should be all that is needed."
Larry
Larry Preuss
<00...@mindspring.com> wrote:
That all seems very clear, and of course I agree with all of it. I
thought, however, that Steve said, "If your platelet count is normal,
that should be all that is needed."
Larry
Steve Harris
I did. If your platelet count is normal, that means you're making them fast
enough to recover normal bleeding times after 3 days off aspirin. So a week
should surely be enough.
If your platelet count is low, all bets are off, because you can't tell from
that how fast you're making them.
Larry Preuss
<sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
> > I'm sorry to tread on your toes. I thought you said "If your platelet
> > count is normal, that should be all that is needed."
> > Larry
>
>
> I did. If your platelet count is normal, that means you're making them fast
> enough to recover normal bleeding times after 3 days off aspirin. So a week
> should surely be enough.
>
> If your platelet count is low, all bets are off, because you can't tell from
> that how fast you're making them.
>
> SBH
Sorry, Steve. In all the unedited foregoing I missed the fact that you
had specified that if the count was normal after three days *off
aspirin*, bleeding from that cause should not occur. I was aware of
most of the stuff you mention just above. It's been a long time since I
was answering hematology consultations and running the anticoagulant
team, but those platelet thingies have not changed that much, and the
aspirin stuff is not new to me. I was taken off my daily aspirin and
coumadin for only four days before my pacemaker implantation three
weeks ago and my lead repositioning was done while I was on both.
Aspirin is a consideration, but not much of a concern.
Larry
Steve Harris
> In article <a9ptue$uts$1...@slb4.atl.mindspring.net>, "Steve Harris"
> <sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
>
> > > I'm sorry to tread on your toes. I thought you said "If your platelet
> > > count is normal, that should be all that is needed."
> > > Larry
> >
> >
> > I did. If your platelet count is normal, that means you're making them
fast
> > enough to recover normal bleeding times after 3 days off aspirin. So a
week
> > should surely be enough.
> >
> > If your platelet count is low, all bets are off, because you can't tell
from
> > that how fast you're making them.
> >
> > SBH
>
> Sorry, Steve. In all the unedited foregoing I missed the fact that you
> had specified that if the count was normal after three days *off
> aspirin*, bleeding from that cause should not occur.
***NO*** If your count is normal even before you stop aspirin, that means
you're making platelets fast enough to normalize bleeding time when you go
OFF aspirin. We seem to be having a severe failure to communicate.
Larry Preuss
<sbha...@ix.RETICULATEDOBJECTcom.com> wrote:
> ***NO*** If your count is normal even before you stop aspirin, that means
> you're making platelets fast enough to normalize bleeding time when you go
> OFF aspirin. We seem to be having a severe failure to communicate.
Well, Sheldon will tell you that I'm a functional illiterate, so that
could explain everthing. Sometimes if all factors are mentioned in one
statement I seem to get a glimmer, but otherwise, as you say, I suffer
from a severe communication failure.
Larry