Anaesthesia Flashcards
Should clopidogrel be stopped prior to surgery? What about aspirin?
Stop clopidogrel with cardiology advice
Continue aspirin
What antidiabetic medications should be continued as normal around surgery?
Metformin
Pioglitazones
Long acting insulin
What oral antihyperglycaemics should be stopped prior to surgery?
Suphonylureas
Acarbose inhibitors
Gliptins
What should be done with short acting insulin prior to surgery?
Reduce dose if taken twice a day
Omit dose before surgery if taken 3 or more times a day
How can someone with unstable diabetes be managed around surgery?
VRIII
When should metformin be stopped around surgery?
Use of contrast
What should nbe done with steroids prior to surgery
Consider increase
What should be done with ocp or hrt prior to surgery
Stop 4 weeks before
What should be done with statins prior to surgery
Continue
What are the ASA grades?
1 - fit and well
2 - mild systemic illness, obese, pregnant, smoker, drinker
3 - systemic illness with functional limitation
4 - severe systemic illness with constant treat to life
5 - moribund and wont survive without operation
6 - brain dead with organ harvest
E - emergency
Factors to consider in allowing patient to go from theatre recovery to ward
Conscious and maintaining airway Cvs stable Resp and spo2 satisfactory Pain and emesis controlled Temp normal Required meds prescribed
Risk factors for post op nausea and vomiting
Female Non smoker Hx of PONV or motion sickness Use of volatile anaesthetic or nitrous oxide Use of opioids Length of surgery Abdo or gyne surgey
Classes and examples of antiemetics
D2 antagonist - metaclopramide 5HT antagonist - ondansterone Ach antagonist - hypocine H1 antagonist cyclizine Steroid - dexamethasone
Adrs and example of ach antagonist for nausea
Hyocine
Paradoxical bradycardia, anhydrosis, dry mouth, itching, blurred vision
Adrs and example of 5ht antagonist for nausea
Ondansterone
Headaches, constipation
