In most cases, you do not need to remove all nail polish before your procedure.

We recommend that you:

• Remove nail polish from at least one finger (preferably the index finger) on the hand not being operated on

• This allows the anaesthetist to use a monitor (pulse oximeter) to accurately measure your oxygen levels during surgery

If you have gel or acrylic nails, removing one nail (if possible) is helpful, as these can interfere more with monitoring.

There is no strong evidence that nail polish increases infection risk, and routine removal of all polish is usually unnecessary.

However, please note:

• Some hospitals or anaesthetists may still prefer all nail polish to be removed

• To avoid delays on the day of surgery, it is safest to follow any specific instructions provided by your surgical facility

If you are unsure, feel free to check with our rooms prior to your procedure.

Cigarette smoking (even just one or two!) can effect wound and tissue healing.

It also effects the rate of Complications both surgical & anaesthetic.

I therefore strongly recommend that you do not smoke for one week prior to surgery and one month after your surgery.

There are particular operations where smoking can dramatically alter the rate of healing.

These include:

- Scaphoid Fractures

- Ulnar Osteotomies

- Fusions esp Midcarpal fusions

- Dupuytrens surgery esp involving skin grafts

 Aspirin: If you are taking aspirin under your doctor’s orders (e.g. you have previously had a blood clot, stroke, heart attack, etc) it is preferable that you continue taking your aspirin unless specifically asked to cease it by me.

Vitamin E: You should avoid medicines containing vitamin E for four weeks after surgery.

Warfarin: In most circumstances I do not stop Warfarin for straight forward hand surgery if the INR is around 2. I am more concerned about the rare but catastrophic complications of Heart attack or Stroke than the small increased risk of bleeding or bruising after surgery. Note most hand surgery is performed with a tourniquet which stops any bleeding at the time of surgery. For major bone surgery it should be ceased 2 - 3 days prior to your surgery after consultation with your treating Physician / Cardiologist.

Xarelto (rivaroxiban) and Eliquis (apixaban) inhibit blood clotting factor Xa. They should be stopped 2 days before major surgery ( eg Bone surgery, FCR Interposition arthroplasty ) and withheld one day before minor surgery (eg Trigger finger).

These can be resumed the day after surgery if there is no bleeding.

The following guidelines are for patients with Diabetes Mellitus presenting for surgery.

1. Omit the following medications 48 Hours prior to your surgery. Notify your general practitioner and / or your diabetes specialist of these plans.

- Dapagliflozin (Forxiga), - Empagliflozin (Jardiance), - Ertugliflozin (Steglatro) - Xigduo, Jardiamet, Segluromet - (Glyxambi, Qtern, Steglujan). These medications have been associated with an increased risk of diabetic ketoacidosis. For more information.

2. Omit All Oral hypoglycaemic medications (including metformin) on the day of surgery. eg - Gliclazide ( Diamicron ) - Metformin ( Diabex)

3.. You will have to FAST for 6 hours prior to your operation. You may drink WATER up until you are called for to your surgery ( Sip to Send)  

4. . Bring your medications with you to the hospital.

5. Every attempt will be made for your surgery to be performed at the start of the operating list.

6. Notify nursing staff upon your arrival in the hospital that you are Diabetic so that your blood sugar can be monitored every 2 hours.

7. For Patients on Insulin. - Notify your GP or Diabetic specialist that you are having surgery. - In general Take a HALF of your usual morning dose of insulin. - If your planned surgery is likely to be > 1 hour duration (moderate to major surgery) you may need an IV dr1p with 5% Dextrose inserted on admission to hospital 8. All patients with Diabetes Mellitus are to RESUME NORMAL DIET AND USUAL DIABETES TREATMENT as soon as possible post surgery

Ozempic or Mounjaro Ozempic (semaglutide) and Mounjaro (tirzepatide) are once-weekly injectable medications used primarily to manage type 2 diabetes and for weight loss.

Special Care is Needed Before Surgery These medications delay stomach emptying, increasing the risk of regurgitation and aspiration during anaesthesia or sedation — a potentially life-threatening complication.

Recommendations for Perioperative Management

Withhold Ozempic & Mounjaro for at least 1 week before elective procedures with GA or sedation.

For daily GLP-1 agonists (e.g., liraglutide/Saxenda/Victoza): hold the day before surgery.

Preoperative Fasting and "Sip Til Send" Patients must be on free fluids for 24 hours prior to surgery. THIS MEANS NO SOLID FOOD FOR 24 HOURS.

You may continue to drink WATER until 6 hours before anaesthesia.

If you have not stopped GLP-1 agonists as recommended your surgery may be CANCELLED.

Continue to use your regular medications as instructed with a sip of water on the day of surgery.   

Note specific instructions for Diabetics, Those taking Blood thinners and Weight Loss medications