What to tell your anesthesia provider before surgery
A checklist of what actually changes the anesthetic — and what you can safely stop worrying about.
Every clinical claim on this page is cited to its source below. How we source clinical content — including the corrections we have made and why.
The pre-anesthesia interview is short, it usually happens on a day when you are already nervous, and it is often the only chance to change the plan before it starts. This is what is actually worth saying.
The short version
- Bring records from your last anesthetic if you have them. This is the single most useful thing on the list, and almost nobody does it.
- List every medication, including the ones that don’t feel like medications — weekly injections, supplements, cannabis, over-the-counter products.
- Say what happened last time, especially if something did not work — the local anesthetic, the nausea, the waking up.
- Name your conditions even if you think they are irrelevant. Several conditions that sound unrelated to surgery change the anesthetic substantially.
- Ask about fasting specifically if prolonged fasting makes you unwell. It is one of the more grantable requests.
- You will not be judged for what you disclose. The interview is clinical, not legal or moral.
1. Your medications — including the ones that don’t feel like medications
This is where most of the changeable risk sits. Some drugs need to be stopped days in advance, some should specifically not be stopped, and the guidance on several of them has changed recently enough that pre-op instruction sheets have not all caught up.
| If you take | Why it matters |
|---|---|
| A GLP-1 drug — Ozempic, Wegovy, Mounjaro, Trulicity, Rybelsus, Saxenda, Zepbound | These slow stomach emptying. The guidance reversed in 2024 — most patients are now advised to continue rather than hold. Read more about GLP-1 agonists and anesthesia |
| Buprenorphine — Suboxone, Subutex, Sublocade, Belbuca, Butrans | The advice reversed here too. Current guidance is to continue it, not stop it, and stopping carries real risk. Read more about buprenorphine and surgery |
| Clopidogrel (Plavix) or another blood thinner | Determines whether you can have a spinal, epidural or nerve block, and how far in advance it must be stopped. Read more about clopidogrel hold times |
| Cannabis, in any form | Changes how much anesthetic you need — measurably. Also affects the airway if you smoke it, and pain afterward. Read more about cannabis and anesthesia |
| Metformin | Frequently held unnecessarily. Current guidance is far more permissive than most pre-op instruction sheets, so it is worth asking rather than assuming |
| Anything for blood pressure, heart rate or orthostatic symptoms | Midodrine, fludrocortisone, beta blockers and similar drugs each change the plan, and whether to take them on the morning of surgery is a decision worth making in advance |
| Long-term steroids — including inhaled, nasal, topical or joint injections | These suppress the adrenal axis at sufficient dose and duration, and the non-oral routes are the ones most often missed. Read more about steroid stress dosing |
| Antihistamines you take regularly | Usually should be continued rather than swept up in the fasting instructions |
The question to actually ask: “Which of these should I take on the morning of surgery, and which should I stop — and when?” Asking it forces a decision to be made and documented, rather than the dose being held by default because you were told not to eat.
2. Your conditions — including the ones that sound unrelated
Several diagnoses that have nothing obviously to do with surgery change the anesthetic considerably. If you have any of these, say so even if nobody asks.
| Condition | What it changes |
|---|---|
| Ehlers-Danlos syndrome or hypermobility | Joint dislocation during positioning, skin tearing from tape, and local anesthetics that wear off faster than expected — which now has controlled evidence behind it. Read more about EDS and anesthesia |
| POTS or dysautonomia | Fasting is the biggest modifiable risk, and asking to be scheduled early is a reasonable request. Read more about POTS |
| Mast cell activation syndrome | Several routine anesthetic drugs release histamine directly. Bring your own list of what you have tolerated. Read more about MCAS |
| Myasthenia Gravis | Reverses the usual rules for muscle relaxants, and shapes whether you breathe on your own afterward. Read more about Myasthenia Gravis |
| Gastroparesis or reflux | Changes fasting requirements and how the airway is managed |
| Sleep apnea, treated or suspected | Changes airway planning and postoperative monitoring. Bring your machine settings if you have them |
If you have more than one of the first three, say all of them. Ehlers-Danlos, POTS and mast cell activation syndrome co-occur frequently, and each adds something the others do not.
3. What happened last time
This is the section people skip, and it contains the highest-value information in the entire interview. Anesthesia providers cannot look up what happened to you at another hospital.
- Did the local anesthetic work? If numbing has failed you before — at the dentist, during a procedure, in labor — say so plainly. This is a documented phenomenon in some conditions, not something you imagined.
- Was there a breathing tube, and was it difficult? If you were told your airway was difficult, that is critical information.
- Did you have severe nausea or vomiting? It changes the drugs given, and there are effective options.
- Did you wake up slowly, or feel unwell for days?
- Did anyone tell you something unusual happened? Even a vague memory of being told something is worth repeating.
- Do you have the records? A copy of a previous anesthetic record is worth more than any amount of description.
One specific thing worth mentioning if it applies. If you have ever turned blue, had a low oxygen reading, or been given a blue-colored antidote during a procedure — particularly after a numbing spray for an endoscopy or heart ultrasound — say so. That pattern points at a specific reaction to certain topical anesthetics, and it changes which spray is used. More on this on the methemoglobinemia page and in the transesophageal echo page, where the reaction is best documented.
4. Questions worth asking
You are allowed to ask these, and the answers change how the day goes.
- “What kind of anesthetic are you planning, and why that one?” — general, spinal, sedation and regional block are different experiences with different trade-offs.
- “Can I be scheduled early if prolonged fasting makes me unwell?” — a concrete, grantable request.
- “Will I have a breathing tube?”
- “What are you planning for nausea?” — worth asking if you have had a bad experience before.
- “What is the plan for pain afterward, and does it change because of my other medications?”
- “Will I go home the same day, and who is watching me?”
If your procedure is one of these
- Hip fracture or joint surgery, and you are older — the spinal-versus-general question has been studied directly and the answer is less clear-cut than most people assume. Spinal anesthesia in elderly patients
- A spinal anesthetic — blood pressure drops are the common event, and there are ways to reduce it. Does ondansetron prevent spinal hypotension?
- Heart bypass surgery — the anesthetic has three distinct phases and the recovery is planned around them. CABG anesthesia, step by step
- A transesophageal echocardiogram — a sedation with a genuinely narrow margin, and worth understanding beforehand. TEE anesthesia and sedation
- A nerve block or epidural — dose limits matter, and so does what else you have been given. Local anesthetic maximum doses
5. Things you do not need to worry about
Some common fears are either myths or much smaller than they feel. Each of these has been examined directly.
- “I’m allergic to eggs or soy, so I can’t have propofol.” The evidence found no connection between propofol allergy and food allergy, and the studies concluded the avoidance practice is not evidence based.
- “I’m allergic to shellfish, so I can’t have contrast dye.” You cannot be allergic to iodine — it is an element your thyroid runs on. Shellfish allergy is to a muscle protein not present in contrast.
- “I have to stop my metformin for 48 hours.” Usually not, under current guidance.
- “I told them I use cannabis and they’ll report me.” They will not. They are asking because it changes the dose. More on cannabis
- “I’m on buprenorphine so they won’t treat my pain.” Current guidance says the opposite — the drug should be continued and your pain treated. More on buprenorphine
- “I have EDS so I can’t have a spinal.” Not true as a blanket rule. More on EDS
- “I’ll say something embarrassing under anesthesia.” Essentially never happens, and nothing said would leave the room.
A checklist to bring with you
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- Full medication list, with doses and when you last took each
- Weekly injections listed separately, with the date of the last dose
- Supplements, herbal products, cannabis and CBD
- All diagnoses, including ones that seem unrelated
- Previous anesthetic records, or the hospital and approximate date
- What went wrong last time, if anything
- Whether local anesthetic has ever failed to work on you
- Allergies, and what actually happened in each reaction
- Whether prolonged fasting makes you unwell
- Your questions, written down
All the clinical guides
Written for licensed clinicians, but readable if you want the detail behind anything above.
Hypermobility and dysautonomia
Medications and surgery
Local anesthetic and sedation safety
Spinal anesthesia
Airway and rapid sequence induction
Conditions and procedures
Frequently asked questions
What should I tell the anesthesiologist before surgery?
Your complete medication list including weekly injections, supplements and cannabis; all of your diagnoses even the ones that seem unrelated; what happened during any previous anesthetic, particularly anything that went wrong; whether local anesthetic has ever failed to work on you; and your allergies with a description of what actually happened. If you can bring records from a previous anesthetic, that is the single most useful item.
What medications do I need to stop before surgery?
It depends on the drug, and several recommendations have changed recently. Blood thinners such as clopidogrel usually need to be stopped days in advance. GLP-1 drugs like Ozempic and Mounjaro were previously held but current guidance is for most patients to continue. Buprenorphine should generally be continued rather than stopped. Ask specifically which to take on the morning of surgery rather than assuming that fasting means stopping everything.
Should I tell them about cannabis or recreational drug use?
Yes. The interview is clinical rather than legal, and cannabis in particular measurably changes how much anesthetic you need. Not disclosing it means the dose is estimated from the wrong starting point.
Why do they ask about previous anesthetics?
Because the record is not available to them and the information is genuinely useful. Difficult airway management, local anesthetic that did not work, severe nausea, or slow waking are all things that change the plan — and none of them can be predicted from an examination.
Can I ask to be scheduled first if fasting makes me unwell?
Yes, and it is one of the more practical requests to make. It matters particularly if you have POTS, dysautonomia, diabetes or any condition where prolonged fasting is poorly tolerated. Ask in advance rather than on the day.
Do I need to mention supplements and over-the-counter products?
Yes. Several affect bleeding or interact with anesthetic drugs, and many people do not think of them as medications. The same applies to CBD products and to anything taken weekly rather than daily.
References and sources
Each linked guide above carries its own full reference list, sourced to the primary literature and current society guidance. Sourcing standards for all clinical content are described at how we source clinical content.
Disclaimer. This page is written to help you prepare for a conversation with your anesthesia team — it does not replace that conversation, and it is not medical advice about your own care. Do not start, stop or change any medication on the basis of this page; the point of the checklist is to raise the question with the people looking after you, who know your history and can make the decision with you.
This checklist is drawn from Helix Anesthesia — a point-of-care clinical reference built by a practicing CRNA, with surgical cases, drug dosing, regional blocks and crisis checklists, all cited and available offline.
Helix Anesthesia is a reference tool for the people looking after you rather than something you need yourself — but the sourcing behind every number in it is public, and you are welcome to read it.
How we source clinical content