DHx in surgery Flashcards
DHx to continue in surgery
(most should be continued as a general rule, especially if you don’t recognise it and there’s no guidance on it)
- AEDs
- anti-PD
- anti-pyschotics
- anxiolytics
- B- blockers (ALWAYS)
- bronchodilators
- CCBs (ALWAYS)
- CVS DHx (except ARBs, ACEi, spirinolactone)
- thyroid/antithyroid
- glaucoma
- immunosuppressants
- drugs of dependence
medications that need to be STOPPED before surgery
I LACK OP
- Insulin (except long acting)
- Li+ (24 hrs before)
- Anticoagulants (warfarin, heparin)/Antiplatelets (aspirin, clopidogrel, dihydramole) (aspirin: 7 days before)
- COCP/HRT (4 weeks before)
- K+ sparing diuretic (morning)
- Oral hypoglycaemics - metformin (24 hrs before, can substitute with sliding scale) (if metformin continued, can cause lactic acidosis)
- Perinodpil/ACEi, ARBs (morning)
medications that need to be reviewed/ modified
- aspirin and antiplatelets (decision to be made by surgeon 5-7 days before)
- warfarin (converted to therapeutic tinzaparin)
- MAOIs and TCAs can interact with anaesthetics drugs (decision by anaesthetist)
what to do with diabetics on the day before surgery?
- stop metformin
- give short as normal
- give 80% long as normal
what to do with diabetics on the morning of the surgery?
- place on sliding scale of dextrose, insulin, K+
- take 80% of long acting
what to do with diabetics after the surgery?
- convert to S/C insulin (when pt can eat w/t V)
- stop sliding scale 30-60 minutes after the first meal-time short acting dose
DHx to ↑ during surgery?
steroids!
pts on long term corticosteroids (prednisolone) commonly have adrenal atrophy
their inability to mount a stress response to surgery means they require IV steroids at induction
to prevent profound ↓ BP
why is metformin stopped day before surgery?
why other oral hypoglycaemics or insulin stopped?
how to replace?
NBM before surgery and will cause lactic acidosis
cause hypoglycaemia
start a sliding scale to monitor glucose hourly
what if patient is on warfarin?
reversal of anticoagulation prior to elective surgery (after warfarin stopped)
1-5mg oral Vit K (phytomenadine) given day before surgery if INR>1.5
if patient with renal impairment NEEDs CT (despite contrast)?
given bolus of saline
when NOT to stop aspirin 7 days before surgery?
- main exemption from this would be a patient who had received recent vascular stenting
- surgery is usually held off until the crucial antiplatelet period has finished (high risk for stent thrombosis if stopped too early)