Anesthesia and comorbidities Flashcards
what are the effects of DM on CVS
- Myocardial infarction
- Hypertention
- iscahemic heart disease
- Cardiomyopathy
- Cerebrovascular acccident
What are the effects of DM on the Nervous System
Increased risk of stroke
autonomic and peripheral neuropathy
What are the effects of DM on Respiratory system
increased risk of perioperative chest infections
Effectsof DM on GIT
Gastroparesis-reflux
effects of DM on renal
increased risk of renal failure
effects of DM on musculoskeletal
Stiffening of ligaments around the joints leading to limited mobility and cause proteolysis which affects wound healing
In a patient with DM what’s important in preop assessment
FBC
HBA1C
U&Es
Cr
ECG
Urine protein
intra op what’s the blood glucose level are we targeting
6 and 8
which group is treated as minor surgery
if the patient is expects to eat within 4 hrs of the operation
management of well controlled dm/minor surgery/normal fbs
Non insulin dependent diabetics:
First on the list
Omit oral hypoglycemics
Blood sugar monitoring:
- 1 hr pre-op
- at least once intra-op or every hour if procedure extends more than an hour
Post op 2 hourly until eating, then 8 hrly
Insulin dependent diabetics: type 2/type 1
First on the list
Omit normal sc insulin if glucose<7mmol/l
Give half normal insulin if glucose > 7mmol/l
Blood sugar monitoring:
- 1 hr preop
- atleast once intraop
-Post op 2 hourly until eating, then 4 hrly
Restart normal sc insulin with first meal
management for major surgery
Plan includes patients for minor surgery whose admission blood glucose is > 7mmol/dl
Check blood sugar and potassium pre-op
Omit oral hypoglycemics or normal sc insulin
Start on IVF
Start IV insulin sliding scale (in the ward)
Blood glucose measurement:
-2 hourly from start of sliding scale
- hourly intraop
-Hourly post op until 4 hrs then 2 hrly.
PERIOPERATIVE RISKS ASSOCIATED WITH SEVERE UNTREATED HTN
Associated with serious post op complications e.g MI, Cerebral hemorrhage/infarction, renal failure
PRE-OP CONSIDERATIONS TO MAKE in a patient with HTN
Is the HTN primary or secondary?
Is the surgery urgent or not?
Is regional anaesthesia possible for the proposed surgery or not?
Does the patient have any evidence/signs of end organ damage?
Stage 1 and 2 HTN should not be delayed surgery
Pre-op antihypertensive management need not to be interrupted except for the following medications:
ARBs
ACE inhibitors
ISSUES TO CONSIDER WHEN ADMINISTERING ANEASTHESIA TO EPILEPTIC PATIENTS
Many antiepileptic drugs induce liver enzymes that can lead to reduced activity/ duration of action of anaesthetic drugs
Avoid hyperventilation as it leads to hypocarbia causing reduced blood flow
Avoid prolonged starvation to minimize metabolic disturbance
