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Edward Ray, MD
PRE-OPERATIVE INSTRUCTIONS FOR PATIENTS HAVING
MONITORED OR GENERAL ANESTHESIA
Name of Patient: _____________________________________________________________
DO NOT take aspirin or ibuprofen (ex. Aleve, Advil, Motrin) for one week prior to surgery. See attached list of other medications/supplements/herbals to avoid.
DO NOT smoke* or drink any alcoholic beverages on the day prior to surgery.
Patients under 18 years of age must
be accompanied by a parent or legal guardian who
can sign the necessary authorization and consent for surgery.
Absolutely nothing to eat or drink after 12 o'clock midnight on the evening before the surgery.
Please shower/bathe the night before surgery, wash your hair, and also brush your teeth and use mouthwash, especially if surgery is to be performed on face.
Wear no makeup; remove all hair pins, wigs, jewelry, and contact lenses.
Wear comfortable clothing —something easy to get into — no pull-over sweaters, pull- on boots, etc.
You will be observed in the recovery room following surgery until you are awake enough to go home. An adult should stay with you for the first night after surgery.
A responsible adult must
drive you home —you cannot
drive yourself or take a cab!
The person accompanying you day of surgery should leave cell phone number or number where they can be contacted if they plan to leave the ambulatory center for any reason.
(*) We strongly recommend that you quit smoking at least 2 weeks prior to surgery. This and avoidance
of smoking after surgery significantly reduces the risk of wound and healing complications.
By signing this form, you certify your understanding and wil ingness to comply with these instructions:
Signature ____________________________________________ Date _______________
Edward Ray, MD
You have been instructed to avoid aspirin and aspirin-containing medications (as wel as aspirin-related compounds that
may increase the risk of bleeding complications) to prepare you for surgery. This list has been put together for your
convenience. It may not include all
medications. If a medication you are taking is not on the list, and you take it for
minor arthritis pain or other minor pain, please ask your physician or pharmacist if it should be avoided at this time.
Acetaminophen (Tylenol) is general y safe to use before and after surgery.
Non-prescription products containing aspirin and/or
Nonprescription products containing Ibuprofen
Anacin Maximum Strength Tablets Arthritis Pain Formula
Ascriptin Caplets/Tablets or Ascriptin AID Caplets
Nonprescription products containing naproxen sodium
Nonprescription products containing ketoprofen
Extra Strength Bayer Arthritis Pain Regimen
Products containing flurbiprofen
Pepto-Bismol Liquid/Tablets St. Joseph Adult Chewable Aspirin
Therapy Bayer Caplets Ursinus Inlay-Tabs
Be sure to tell Dr. Ray about all medications, supplements and herbal pharmaceuticals that you are taking, even
if they are “over-the-counter,” since many of these can cause problems during and after surgery. Following are
some of the common ones that you may have to stop taking, in alphabetical order.
Please note that this list may not contain all potentially problematic medications (list continues on next page):
Alpha Omega supplements (fish oil), Amitriptyline
Cayenne, Chromium, Claritin, Clinoril, Concerta (for ADD/ADHD), Contac, Cope, Coricidin, Coumadin
Edward Ray, MD
Medications to Avoid List (continued)
Damason-P, Darvon, Dasin, Dipryridamole, Disalcid, Diurex, Dolobid, Dolphirn #3 Tablets, Drinopehn, Duoprin-S Syrup, Duradyne
Vitamin E, Echinacea, EFFEXOR® XR, Elavil, Emagrin, Emprazil, Endodan Tablets, Epromate Tablets, Equagesic, Equazine-M
Feldene, Fenoprofen, Fioricet, Fiorinal, Florgen PF, Fluoxetine, Flurbiprofen
Garlic (allium sativum)
tabs & do not eat garlic excessively, Genaced, Genacote, Gelpirin Tablets, Genprin, Gensan, Ghemnisym, Gingko, Ginbko Biloba, Gennin, Ginger, Goody's Headache Powder
Halfprin Tablets, Haltran, Heparin, Hydroxycut
Ibuprofen, Indocin, Indochron, Indomethacin, Infantol, Isollyl
Lanorinal, Licorice Root, Lodine, Lortab ASA
MAO inhibitors, Magan, Magnaprin, Magnasprin, Magsal, Marnal, Marthritic Tablets, Maximum Bayer Aspirin, Measurin, Meclomen, MecloFenamate Capsules, Medigistic-Plus, Medipren, Meditren, Melatonin, Menadol, Meprogesic Q, Micraninin, Mobidin, Momentum Back Ache Formula, Monogesic, Multi-Vitamin
Nalfon, Nardil, Nardilzine, Neomycin, Neogesic, Nicorette, Nicotine Patch (and any other nicotine-containing products), Norgesic, Norgesic Forte, Nuprin, NyQuil
Orphenagesic, Orphenagesic Forte, Orudis, Oruvail, Oxycodine, Oxycodone
P-A-C, Pabalate-SF, Pabrin, Pacaps, Pamprin, Panalgesic, Panodynes, Papaya, PediaProfen, Pedrazil, Percodan, Persantin, Persistin, PetoBismol, Phenaphen, Phenetron Compound, Piroxicam, Polymyxin, Ponstel, Presalin, Propoxyphene, Prozac
Relafen, Rexolate, Rhinex, Robaxin, Robasisal, Roxiprin, Rufin, Robaxisal
S-A-C, Salabuff, Salatin. Saleto, Salflex, Salicylamide, Salocol, Salsalate, Salsitab, Serzone, Sine Off, SK-65 Compound Capsules, Soma Compound, St. John’s Wort, Stanback Analgesic, Sudafed, Sulindac Tablets, Supac, Synalogos Capsules, Synalgos-DC Capsules
Talwin, Tenol-Plus, Tolectin, Tolmetin, Toradol, Trilisate, Trendar, Trental, Triaminicin, Tricosal tablets, Tri-Pain, Trigesic, Trilisate, Tusal
Valesin, Valtrex, Vanquish, Verin, Viro-Med Tablets, Vivarin, Voltaren
Warafin (Coumadin), Wellbutrin, Wesprin Buffered
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Background Information Roche Personalised Healthcare – In Brief Background Personalised Healthcare is based on the knowledge that different patients with the same clinical diagnosis may respond to the same treatment in different ways. While a certain drug might be highly effective for one patient, the same drug might not show the same desired results in another patient, despite