Chapter 4: Special pts for surgery Flashcards
Surgically manage T1DM pts
stop long-acting insulin the night before
Check basal insulin lvls (due to increase stress and intercurrent illnesses)
Check U+E
start pt on IVI of 1L OF 5% Dextrose (also given when hypoNa) - with constant infusion in a constant blood glucose is needed
Start pt on IVI 20mmol KCL/8hr
start an infusion pump with 50U short-acting insulin in 50mL 0.9% saline
Post op for T1DM pts
keep pt with IVI pump of dextrose and saline
check blood glucose through finger pricking
when able to tolearte meals, change to SC insulin + give regular insulin before meals
Surgically manage for T2DM controlled
keep regime as normal
Surgically manage for T2DM uncontrolled
Treat as if T1DM
1L 5% dextrose solutio + saline
20mmol KCl for 8 hours
Which drugs should you be aware of complications in T2DM
Sulfonylureas: do not give before surgery since they can cause hypoglycaemia when fasting
Biguanides: if pt is on poor renal function or if contrast is needed, this can cause lactic acidosis
Post op care in T2DM
Watch out if pt is fasted for post op
always take into consideration a Diabetic consultant, to see if the pt needs to supplement insulin with oral hypoglycaemics
Management of Surgery in Diet-controlled Diabetes
No problems seen Pt must be fasted as usual do not give pt 5% dextrose IVI Pt might be insulin dependant post-op Finger prick test to see glucose levels after surgery (before meals and bedtime)
Would you operate a jaundiced pt?
No, avoid as much possible
Since they can develop renal failure after surgery
Pre-op prep of jaundiced pt
Avoid morphine
Give ABx to treat sepsis to decrease risk of endotoxaemia
give 1L 0.9%saline over 30mins-1hr via IVI - to produce moderate diuresis peri-op + diuretic
urinary catheter
check clotting + prophylactic Vit K (even if normal)
Renal dose of Dopamine IVI indicated
Side effects from central line and from renal dose dopamin
Sepsis Pulmonary HT Diuresis when hypovolemic Arrhythmias Catabolism increase Impaired hypoxic ventilator Gut+Myocardial perfusion decrease Gastric motility decrease
During surgery, Jaundiced pt must take care of:
Urine output hourly
Give 0.9% saline to match output
48hours after surgery Jaundiced Pts must look out for
- Urine output every 2 hrs
- Measure U+E daily
If poor output + fluid loss = Furosemide + central line
If good output = 20mmol of K+/L of fluid after 24hrs post op
What should you do if pt is on steroids going for a major operation?
hydrocortisone given for 3-4days after surgery
then wean to previous medication
What should you do if pt is on steroids going for a minor operation?
hydrocortison IV for 24hrs after surgery, then wean to previous medication
What is the major risk of steroid dependant pts who have adrenal insufficiency?
Hypotension
