Pre-operative Instructions

When do I need to take Antibiotic prophylaxis? When should I arrive? Can I eat or drink anything on day of surgery? Can I take my normal medication in the morning? I am scheduled for surgery and I have come down with a cold. Can I proceed with surgery safely? Does my ride have to be with me? Will smoking harm me before or after surgery? Are there precautions for some medical conditions? Should I take my routine medications before surgery? When do I need to take Antibiotic prophylaxis?
  • Pre-operative antibiotics are indicated only for patients with one of the following conditions: (There may be history of heart murmur or not)
  1. Artificial heart valves
  2. history of infective endocarditis
  3. some congenital heart defects, such as a completely repaired heart defect with prosthetic material or device,, Any repaired congenital heart defect, or cardiac transplant which develops a problem in a heart valve
  • Antibiotics NO LONGER NEEDED for the following types of patients (who say they have heart murmur):
  1. Mitral valve prolapse
  2. Rheumatic heard disease
  3. bicuspid valve disease
  4. Calcified aortic stenosis
  5. congenital heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy
** Any patient not sure of what their condition is: Get their physician telephone, and call.
  • The antibiotic regimen for prevention of infective endocarditis:
Not penicillin allergic:  Amoxicillin 2 g, 60 minutes before surgery Penicillin allergic:  Cephalexin 2 g, clindamycin 600 mg, Azithromycin 500 mg, or Clarithromycin 500 mg  30-60 minutes before surgery The antibiotic regimen for prosthetic joints: Not penicillin allergic:  Amoxicillin 2 g, Cephalexin 2 g, or cephradine 2 g, 60 minutes before surgery Penicillin allergic:  Clindamycin 600 mg 60 minutes before surgery When should I arrive? It is extremely important to arrive to office at least 10 minutes before your scheduled appointment. This will allow adequate time to check in and start your procedure on time. Lateness will result in probably cancellation of your surgery which may not be able to be rescheduled for at least three to four weeks. Your appointment has been scheduled carefully to keep you on time.Please plan accordingly and discuss it with your ride. Can I eat or drink anything on day of surgery? If you are having IV sedation or considering IV sedation and just not sure, do not eat or drink anything in the morning of your appointment. Not even water. If your child is scheduled for surgery under laughing gas or local anesthesia, do not allow to drink or eat anything for at least 6 hours. This allows for the opportunity to administer IV sedation if necessary. How children respond can vary and often, IV sedation becomes necessary to complete a procedure. It is better to be prepared than not. Can I take my normal medication in the morning? If you have to take important medications in the morning, such as for blood pressure or heart, then it is ok to take them with a very small sip of water. I am scheduled for surgery and I have come down with a cold. Can I proceed with surgery safely? If you have developed a cold right before your surgery and IV sedation is planned, it is still safe to proceed with surgery if:
  • You are not having productive cough
  • You can breath fairly well from your nose
  • You are not overly congested
  • You chest feels some what good and not painful or congested.
Otherwise, it is better to postpone until you feel better. If you are having tooth ache or have an existing infection, then waiting may not be a good idea. In this case you can proceed with surgery as planned safely under nitrous oxide sedation or local anesthesia. Does my ride have to be with me? It is best to have your ride with you when you arrive and during your surgery. But if not possible, it is possible for them to come to office upon completion of your surgery. Special instructions are reviewed with them so they can assist you during your first day of recovery. Will smoking harm me before or after surgery? Smoking before and after surgery can cause many problems. Smoking before or on day of surgery compromises your oxygenation status and possibly result in poor ventilation during IV sedation. Smoking is associated with number of complications. Smoking prior to surgery is not advised in those undergoing IV sedation anesthesia as it can compromise function of oxygen carrying cells. Following surgery, smoking can result in poor healing, increased infection, bleeding immediately after surgery, dry socket, and prolonged pain.It is best to avoid smoking before or on day of surgery. After surgery, smoking causes many complications with healing, so it is also best to avoid. Are there precautions for some medical conditions? Yes. Patients with certain heart disease conditions, diabetes, hypertension, and bleeding disorders need to take certain precautions prior to surgery and anesthesia. Patients taking certain medications, such as blood thinners or bisphosphonates require special pre-operative management. If you have significant medical conditions, a pre-operative evaluation with your physician may be necessary before your oral surgery. See (Medical precautions) section for more information. Should I take my routine medications before surgery? Yes. You may take all routine medications as directed prior to your surgery. The exceptions are certain blood thinners such as Coumadin which should be stopped 72 hours before your appointment, provided it is approved by your physician. Patients taking bisphosphonates, such as Fosamax, are advised to stop them at least three months prior to surgery. Please contact Dr. Kazemi for more information.