7 Surgery Workshop

Question 1

With opiate prescribe

Answer 1

Docusate and antiemetic

Question 2

Frequency of DVT is … In general surgery

Answer 2

25-33% and 45-70% in total hip replacements

Question 3

Cardiac drugs

Answer 3

Give all except ACEi at2 antagonists and diuretics

beta blockers help suppress tachy and BP increase from surgery

Question 4

Aspirin

Answer 4

Safe to continue unless high post op bleed risk.

If for primary prevention stop 7 days before.

Question 5

Eplilepsy and Parkinsons drugs

Answer 5

Give

Question 6

Asthma drugs

Answer 6

Give

Question 7

Medication to reduce gastric acid

Answer 7

Give (reduces risk of aspiration)

Question 8

Thyroid meds

Answer 8

Give

Question 9

Steroids

Answer 9

Give

Question 10

Immunosuppressants and Cancer drugs

Answer 10

Give

Question 11

Tranquillisers and antidepressants

Answer 11

Give ((except maoi which should stop 2 weeks before)

Question 12

Analgesics

Answer 12

Give

Question 13

Antipsychotics

Answer 13

Omit unless otherwise instructed as may potentiate arrhythmias and hypotension

Question 14

Oral hypogylcemic

Answer 14

Omit on morning of surgery

Question 15

Clopidogrel

Answer 15

Stop 7 days pre op. But if post coronary stent or ACS ideally delay surgery until safe to stop clop (3-12 months)

Question 16

Dipyridamole

Answer 16

Stop 24 before surgery

Question 17

Lithium

Answer 17

Omit 24 hours pre-op as can cause electrolyte inbalance

Question 18

ACHE for dementia

Answer 18

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

Question 19

Orc /HRT

Answer 19

Stop 4 weeks prior , if not possible use stockings and LMWH prophylaxis

Question 20

Diuretics and ace I

Answer 20

Discuss - as the can drop BP in surgery but local practice differs

Question 21

Hyponatremia post surgery can lead to

Answer 21

Cognative impairment

Question 22

Post surgery consider 5

Answer 22

Monitor renal func (and u and e)
Fluid replacement
Nutritional requirement
Pain control
Med review

Question 23

Why is fluid replacement required3

Answer 23

Significant fluid loss (bleeding, burns patients)
Noble to take fluids
Resuscitation - going into shock from trauma

Question 24

Signs of dehydration

Answer 24

Headache
Dry lips and skin
Confusion
Decreased urine output
Thirst
Constipation
Capillary refill time
Skin turgidity

Question 25

How to evaluate response to fluid therapy

Answer 25

Urine output
Weight (but this doesn’t tell where the fluid is)
Feeling better
U&e comes down

Question 26

Do we give a pre op dose of LMWH in practice

Answer 26

Only when bridging therapy with warfarin.

You’d give post op and then usually stop on discharge.

Question 27

Risk factors for PONV

Answer 27

Sex female
History of motion sickness
Opiate use
Previous PONV
Non smoker
Surgery type and duration

Question 28

Eg of an antiemetic for PONV

Answer 28

Ondansetron - usually IM or IV at induction of 30 mins before end of surgery

Question 29

Oran Diabetes control post surgery

Answer 29

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

Question 30

Summarise bridging warfarin to LMWH

Answer 30

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

Question 31

Summarise grinding warfarin with UFH

Answer 31

Last warfarin dose eve 6 days before
Admit for UFH once INR less than 3.
Stop UFH 6 hours before.

Question 32

Risk factors in surgery

Answer 32

Age
Complexity
Duration of anaesthesia
Co pathologies (Obesity)
Clotting disorders
Concurrent medication/alcohol use