Hiru Mathur D.D.S., M.S.

15200 Southwest Fwy, Suite 120

Sugar Land, TX 77478

281-494-2477

PRE-OPERATIVE INFORMATION FORM FOR ORAL AND IV SEDATION

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No sedatives for 24 hours before and 24 hours after sedation (examples: alcohol, over the counter allergy medications).
No stimulants for 12 hours before and 12 hours after sedation (examples: Nothing containing sugar, caffeine, or nicotine)
No chance of pregnancy prior to and during sedation (possible cleft lip in unborn child)
Patient should not have sensitivities to benzodiazepines such as Valium, Versed, or any other contra-indications prior to sedation.
Patient must have a responsible person bring them to their appointment, and take them home from their appointment (and stay with them until recovered).
No operating a motor vehicle (driving) for 24 hours after sedation.
No operating hazardous devices or machinery (examples: chain saw, lawn tractor) for 24 hours after sedation.
No heavy lifting for 24 hours after sedation.
No climbing stairs for 24 hours after sedation or until completely recovered.
IV Sedation patients, NO food or water for 8 hours prior to appointment.
ORAL SEDATION patients, a small amount of food such as water, toast, etc. is allowed if taking prescribed medication(s) and/or oral sedation.
Do not wear contact lenses the day of surgery.
Do not wear facial make-up the day of surgery.
Wear comfortable, loose clothing the day of surgery.

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