Anaesthetics cases

Question 1

Most cardiac medications should be given perioperatively as are ‘cardioprotective’, reducing risk of peri-op MI

What are the exceptions?

Answer 1

• anticoagulants (increased risk of bleeding, ?epidural haematoma > hemiplegia)
• Aspirin (increasingly being challenged)
• ACEI (often withheld on the day of surgery due to risk of renal failure and hypotension)

Question 2

T/F: oral medication cannot be given to patients who are fasted for theatre

Answer 2

false - Medication can be given (with a sip of water) to patients that are fasted for theatre.

Patients are fasted to reduce risk of aspiration during anesthesia which is negligible for tablets

Question 3

which diabetes drugs can and cannot be given on the day of surgery?

Answer 3

• insulin: short acting preparations should be withheld on the day of surgery
• sulphonyureas should also be withheld (risk of hypo)
• metformin can be given for short procedures (for longer ones where pt is not eating/ drinking for days withhold and prescribe variable rate insulin)

Question 4

T/F: the pill should be stopped on the day of surgery

Answer 4

false - 4-6 before surgery (restart at least 2 weeks post surgery, when pt is mobile - reduces DVT risk)

Question 5

Perioperative management of non-insulin dependent diabetics

1. oral diabetic medication? - when to withhold and restart
2. those on insulin?

Answer 5

1. hold all oral diabetic medication on the morning of the procedure. Restart the morning after surgery
2. switch to sliding scale infusion (restart when they can eat)

Question 6

Perioperative management of non-insulin dependent diabetics

1. The day before surgery: once daily long acting analogues given at __% dose. Other insulin?
2. The day of surgery: once daily long acting analogues given?
3. Stop any other insulin and begin what infusion
4. this should be given alongside an infusion of what
5. Continue infusion for how long?

Answer 6

1. 80% - other insulin as normal
2. at 80% dose
3. variable rate IV insulin infusion of human insulin in NaCl 0.9% given via a syringe pump at an initial rate determined by bedside BM - adjust infusion rate to maintain BM between 6-10mmol/L
4. IV KCl with glucose and NaCl
5. until pt can eat post-op. Switch to normal insulin regimen around their first meal