Anaesthetics Flashcards
where should diabetes patients be put on the list
first
diabetic patients managed with insulin who will be missing a meal
VRII
diabetic medications the day before surgery
take all as normal
reduce once daily insulin by 20%
diabetic medications on the day of surgery
take metformin as normal unless TDS then omit lunch dose
omit sulfonylureas
half biphasic insulin and reduce once daily by 20%
ASA classification
1: healthy
2: mild disease (smoker, BMI 30-40, controlled asthma/DM, social drinker or pregnant)
3: severe disease (BMI over 40, uncontrolled COPD/DM, dialysis, PMHx MI, pacemaker, dialysis)
4: disease that threatens life (MI, sepsis, DIC, ESRD with no dialysis)
5: not expected to survive (massive trauma, AAA)
6: brain dead
when do you stop clear fluids/food
clear fluids 2 hours before
food 6 hours before
what classes as a clear fluid
water, tea/coffee with no milk, ice lolly, fruit juice with no pulp
blood products needed if unlikely, likely and definite chance of transfusion
unlikely: group and save
likely: cross match 2 units
definite: cross match 4-6 units
chance of transfusion if hysterectomy, appendix, elective c-section, cholecystectomy, thyroid
unlikely
chance of transfusion if ruptured ectopic or hip replacement
likely
chance of transfusion if gastrectomy, oophrectomy, AAA, hepatectomy, oesophagectomy
definite
isolated fever within 24 hours post op
physiological reaction to surgery
complication of poor post op pain management
pneumonia
what does intraoperative hypothermia increase the risk of
bleeding
which anaesthetic agent is used in haemodynamically unstable patients
ketamine
