Anaesthetics + Perioperative Care Flashcards
What ASA is a normal healthy patient?
ASA I
What ASA is a brain-dead patient?
ASA VI
What ASA is a patient who will likely die without surgical management?
ASA V
How does BMI differ between ASA II and III
II: >30
III: >40
A social drinker with tight diabetes control is an ASA?
II
How does MI history differ between ASA III and IV
>3 months = III
<3 months = IV
What ASA is someone with end stage renal disease?
Regular dialysis: III
no dialysis: IV
When should you avoid TED stockings
Peripheral artery or neuropathy
Fragile or allergy prone skin
Improper fit (deformity, oedema)
VTE prophylaxis in acutely ill, palliative, psychiatrically ill
LMWH
fondapirinux sodium if above contraindicated
VTE prophylaxis in renal impairment
LMWH or UFH
May need to reduce dose
VTE prophylaxis in a cancer patient
NOT ROUTINE IF MOBILE/RECEIVING THERAPY
If a myeloma patient was receiving -lidomides + steroids, what VTE prophylaxis would you give?
Aspirin 75 or 150mg
OR
LMWH
What post-op VTE regimens would you give for an elective hip?
10 days LMWH then aspirin 75/150mg for another 28 days
OR
LMWH 28 days + VTE stockings until discharge
OR
Rivaroxaban
Post-op VTE meds for elective knee
14 days 75/150mg aspirin
OR
14 days LMWH + VTE stockings until discharge
OR
Rivaroxaban
Post-op VTE meds for fractures of pelvis, hip and prox femur
Month long regimen of
LMWH from 6-12 hours post-op
Fondapirinux 6 hours post-op where there is low risk of bleeding
Which diabetic medication do you change THE DAY BEFORE surgery?
Once daily insulin
Reduce dose by 20%
On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on metformin?
For both
OD/BD: take normally
TDS: Omit lunchtime dose
On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on glicliazide
Morning
OD: omit
BD: omit morning dose
Afternoon
OD or BD: omit
On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on a -flozin?
Omit all on day of surgery
On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on lantus
Reduce dose by 20% for day before and of surgery
On surgery day, what do you do
a) in the morning
b) in the afternoon
if the patient is on novomix/humulin 3
Twice daily/biphasics
Half morning dose, don’t change evening dose
What two diabetic drugs are taken as normal the day before and of surgery?
- gliptins (DPPIV inhibitors)
- tides (GLP-1 analogues)
Patient gets a fever on day 1 post-op; what is the likely cause? how would you treat it?
Wind (1-2), water (3), wound (5), walking (5-7), wonder drug (7+)
Ateclasis
Sit upright, breathing exercises
Patient gets a fever day 7 post-op, what is the cause?
Wind (1-2), water (3), wound (5), walking (5-7), wonder drug (7+)
