Fromms lecture via Boblin Flashcards
What are the two purposes for pre-op evaluation?
Identify modifiable risk factors
Risk assessment
What does every patient need?
Every patient needs detailed H & P
What cardiac meds can you and cant you take prior to surgery?
Safe and proper to take BP and anti-anginal meds
Diuretics customarily held
What diabetic meds can you and cant you take prior to surgery?
Long acting insulin– reduced dose (1/2 dose)
Oral- sulfonylureas and metformin not given
What anti coag meds can you and cant you take prior to surgery?
Depends on the risk of surgical bleeding and how likely will thrombosis be
Generally, stop ASA 7 days before surgery and convert from coumadin to a LMW Heparin (Lovenox)
When do you stop ASA before surgery?
7 days
What is the optimal time sto stop smoking prior to surgery?
8 weeks
What level of impairment on lung function testing would prevent surgery from occurring?
None – if breathing normally (if not, recommend pre-op PFTs)
How long before surgery should warfarin be stopped…aspirin?
4-5 days before surgery for warfarin and 7 days for ASA.
How do you manage someone that needs constant anticoagulation?
Heparinize except on day of surgery
How do you manage metformin around the time of surgery?
D/C on day of surgery
Who needs cardiac testing prior to surgery?
Patients who would need cardiac testing regardless of whether they were going to surgery Unstable angina Poorly compensated or new CHF Arrhythmia Severe valvular disease (AS, MR)
What factors predict pulmonary complications after surgery?
Smoking
Lengthy surgery
Surgery near diaphragm
Current infection
What makes a patient high risk for VTE? (DVT, PE)
Removal of cancer Preexisting hypercoagulable state Previous DVT, PE Prolonged recovery --Immobile --Prolonged intubation Orthopedic or trauma surgery Spinal cord injury
What would be the mostappropriate test for preoperative evaluation?
CXR
