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Surgery and Preoperative Care Teaching Materials

Surgical Pearls - Presentation on preparing patients for surgery and supporting wound healing

Surgical talk handout - handout to accompany above talk

Surgical Pearls: An Addendum to the Preop Visit

Preoperative Clearance

Evaluate cardiac status – flights of stairs questions
Review medications and supplements for bleeding risk - The usual suspects plus
Fish oil
Vitamin E
Ginkgo, etc.
Consider perioperative beta blocker, DVT prophylaxis
Surgery-day medication management

But what might we add to this?

Preop celebrex – 200 mg before and after surgery

Mind-body Preparation

Guided imagery - Not just better emotionally, also healing better
Note there may be a role for intraoperative suggestion

Nutritional Preparation

Immunonutrition if high risk: Perative tube feed + glutamine or Impact Recover
Specific Nutrients
Vitamin C – collagen cross-linking, 1-2 grams per day
Vitamin A – 10,000 – 25,000 IU
NOT Vitamin E
Zinc 30 mg per day
Copper if copper deficient
Iron if iron deficient
Amino Acids
Arginine 17 – 30 grams per day
N-acetyl cysteine – promotes angiogenesis
Whey peptides

Herbal support




Bromelain - 500 - 1000 mg 2-3 x per day on an empty stomach
  • Decrease edema (prevent and treat)
  • Promotes absorption of antibiotics
  • Fibrinolytic, Decrease platelet aggregation
  • Topically debrides burns
  • Anti-metastatic/anti-cancer
  • Caution prior to surgery or if high risk of bleeding

Centella Asiatica (Gotu kola) - 10 – 20 mL per day of tincture or 60 mg bid of standardized extract
  • Wound Healing
  • Nervous system effects
  • Caution: potential for drug interactions
  • Inhibits CYP2C9 (warfarin, phenytoin, losartan, glipizide, fluoxetine, some NSAIDs)