Preoperative assessment: All patients have a full assessment carried out by the anaesthetist before coming to theatre. This may begin with a health screening questionnaire given or posted to you well before your operation, or a telephone call from a trained nurse. Please give accurate information, including details of any regular or recent medication, recent illnesses and adverse events related to previous anaesthetics. This information can be made available to your anaesthetist before surgery and allows him/her to address any potential problems well in advance. Patients with significant risk factors and those having major surgery will also be seen by a nurse or doctor and have tests carried out before admission.

Some higher risk patients will need to be seen by the anaesthetist in the clinic well before admission, but most will be seen the evening before (if in hospital) or on the day of surgery. Some anaesthetists prefer to telephone patients before admission, using the home or mobile number given to the surgeon's secretary. This allows concerns or questions you may have before you come to hospital to be addressed a little earlier. If he/she is unable to do this, or if you are unavailable or do not wish to discuss health matters over the telephone, a full preop assessment is done on the ward before your operation. The anaesthetist will see you, carry out a brief examination (to assess your heart, breathing and airway) and answer any questions about the anaesthetic before you come to theatre.

Medications: If you are taking regular medication for asthma, high blood pressure, a heart condition or heartburn (hiatus hernia), this should normally be taken on the morning of surgery with a small amount (up to 2 oz or 60 ml) of water. Prednisolone should also be taken. Blood thinning medication, including warfarin, aspirin and clopidogrel are normally stopped before surgery, but when they are stopped depends on the operation and on the specific condition for which the medicine has been prescribed. Most other medicines can be given either after surgery or left until the following day. What to do about medications is something to be discussed in the preoperative telephone call or visit.

Food and drink: Your stomach needs to be empty for anaesthesia to be safe. For most operations (but not for bowel surgery) a normal evening meal can be taken the night before, and snacks until midnight. If your operation is in the morning water (but no soft drinks, milk or sweets) can be taken until 5 a.m. If the operation is in the afternoon (after 1 p.m.) a light breakfast before 7 a.m. and water until 10 a.m. are allowed. If these instructions are not followed, your safety may be compromised and your operation postponed.

Smoking: The risk of chest and breathing complications during and after surgery (coughing, bronchospasm, partial lung collapse and pneumonia) is increased in cigarette smokers, although for minor and intermediate procedures the overall risk remains low. The safest approach is to stop smoking for at least two weeks before your operation. If this is not possible, reducing consumption will reduce risk. Not smoking on the day of surgery, to maximise the ability of your blood to carry oxygen, is advisable.

Please note that dental crowns, implants, bridges and veneers, along with any diseased or fractured natural teeth, are not considered to be as strong as healthy teeth and may be vulnerable to damage during anaesthesia. You will need to have a tube in your mouth while you are asleep to ensure a safe breathing passage, and the positioning or removal of this tube, or jaw movements that occur when you start to wake up, can put these at risk. I will examine your teeth preoperatively and take great care with them during the procedure. However a very small risk of damage remains.

If you become ill, for example with a cold, flu, diarrhea and/or vomiting, your operation may need to be postponed. If you do not feel well enough to have your operation, or if unsure, contact your surgeon's secretary as early as possible before your admission. She will let me know and I will try to contact you to make a judgment about the safety of anaesthesia. Sometimes this may mean coming to hospital on the morning of surgery as planned, to be assessed in person before a decision is made.