DHx in surgery Flashcards

1
Q

DHx to continue in surgery

A

(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
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2
Q

medications that need to be STOPPED before surgery

A

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)
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3
Q

medications that need to be reviewed/ modified

A
  • 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)
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4
Q

what to do with diabetics on the day before surgery?

A
  • stop metformin
  • give short as normal
  • give 80% long as normal
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5
Q

what to do with diabetics on the morning of the surgery?

A
  • place on sliding scale of dextrose, insulin, K+

- take 80% of long acting

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6
Q

what to do with diabetics after the surgery?

A
  • 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

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7
Q

DHx to ↑ during surgery?

A

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

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8
Q

why is metformin stopped day before surgery?

why other oral hypoglycaemics or insulin stopped?

how to replace?

A

NBM before surgery and will cause lactic acidosis

cause hypoglycaemia

start a sliding scale to monitor glucose hourly

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9
Q

what if patient is on warfarin?

A

reversal of anticoagulation prior to elective surgery (after warfarin stopped)

1-5mg oral Vit K (phytomenadine) given day before surgery if INR>1.5

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10
Q

if patient with renal impairment NEEDs CT (despite contrast)?

A

given bolus of saline

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11
Q

when NOT to stop aspirin 7 days before surgery?

A
  • 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)
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