7 Surgery Workshop Flashcards
With opiate prescribe
Docusate and antiemetic
Frequency of DVT is … In general surgery
25-33% and 45-70% in total hip replacements
Cardiac drugs
Give all except ACEi at2 antagonists and diuretics
beta blockers help suppress tachy and BP increase from surgery
Aspirin
Safe to continue unless high post op bleed risk.
If for primary prevention stop 7 days before.
Eplilepsy and Parkinsons drugs
Give
Asthma drugs
Give
Medication to reduce gastric acid
Give (reduces risk of aspiration)
Thyroid meds
Give
Steroids
Give
Immunosuppressants and Cancer drugs
Give
Tranquillisers and antidepressants
Give ((except maoi which should stop 2 weeks before)
Analgesics
Give
Antipsychotics
Omit unless otherwise instructed as may potentiate arrhythmias and hypotension
Oral hypogylcemic
Omit on morning of surgery
Clopidogrel
Stop 7 days pre op. But if post coronary stent or ACS ideally delay surgery until safe to stop clop (3-12 months)
Dipyridamole
Stop 24 before surgery
Lithium
Omit 24 hours pre-op as can cause electrolyte inbalance
ACHE for dementia
Galantamine and rivastigmine - Stop 24 hours pre op as they prolong the action of muscle relaxants
Donepazil - don’t stop as its half life is too long
Orc /HRT
Stop 4 weeks prior , if not possible use stockings and LMWH prophylaxis
Diuretics and ace I
Discuss - as the can drop BP in surgery but local practice differs
Hyponatremia post surgery can lead to
Cognative impairment
Post surgery consider 5
Monitor renal func (and u and e) Fluid replacement Nutritional requirement Pain control Med review
Why is fluid replacement required3
Significant fluid loss (bleeding, burns patients)
Noble to take fluids
Resuscitation - going into shock from trauma
Signs of dehydration
Headache Dry lips and skin Confusion Decreased urine output Thirst Constipation Capillary refill time Skin turgidity
How to evaluate response to fluid therapy
Urine output
Weight (but this doesn’t tell where the fluid is)
Feeling better
U&e comes down
Do we give a pre op dose of LMWH in practice
Only when bridging therapy with warfarin.
You’d give post op and then usually stop on discharge.
Risk factors for PONV
Sex female History of motion sickness Opiate use Previous PONV Non smoker Surgery type and duration
Eg of an antiemetic for PONV
Ondansetron - usually IM or IV at induction of 30 mins before end of surgery
Oran Diabetes control post surgery
She wouldn’t eat much in the eve so omit.
Monitor and if BG levels risk over 12 give 0.1mg/kg soluble.
Restart in the morning, if she doesn’t eat much use half dose
Summarise bridging warfarin to LMWH
Last warfarin dose 6 days pre surgery
Start LMWH two days after this
Stop LMWH 24hours before surgery
Depending on bleed risk start LMWH some time after surgery and warfarin ASAP.
Continue LMWH until INR therapeutic for 2 dans and min 5 days.
When to start LMWH again:
Prophylactic LMWH (low clot risk):
–Low bleed risk - evening post op
–High bleed risk - 24 – 48 hrs post-op
Therapeutic LMWH (high clot risk):
–Low bleed risk – prophylactic dose evening post op then therapeutic dose 24 – 48 hrs post-op
–High bleed risk - prophylactic dose 24 – 48 hrs post-op then therapeutic dose 48 – 72 hrs post-op
Summarise grinding warfarin with UFH
Last warfarin dose eve 6 days before
Admit for UFH once INR less than 3.
Stop UFH 6 hours before.
Risk factors in surgery
Age Complexity Duration of anaesthesia Co pathologies (Obesity) Clotting disorders Concurrent medication/alcohol use
