Life in the laparoscopic fast lane: evidence-based perioperative management and enhanced recovery in benign gynaecological laparoscopy TOG 2021 Flashcards
How much has ERAS reduced average length stay in hospital after Lap hysterectomy?
34 to 20 hours
When does ERAS commence?q
From booking the surgery
When should patient abstain from smoking or alcohol?
4 weeks
How long before surgery should COCP be stopped?
4 weeks
What should HAb1c be prep?
<69 8.5%
BM pre op 6-10
When should surgery cancelled based on ketones?
If urinary ketone >3+ or blood ketones >3
In surgery how often should BM be checked? Aims
Hourly
6-10 max 12
Algorithm to guide management of pre-op anaemia
Which patients require an ECG pre-op?
> ASA 2
When should Vitamin K be stopped pre op?
5 days before elective surgery, INT checked day before surgery
If >1.5 give phytomednadione
When can restart LMWH/warfain post-op?
LMWH 48 hours after surgery
Warfarin once bleeding risk minimised
When should Apixiban, rivaroxaban, edoxaban be stopped?
Restart?
If CC > 30, 48 hours
CC < 30, 72 hours
Restart after 48 hours before full dose
When should Dabigatran be stopped?
Creatinine clearance ≥80 ml/min: stop 48 hours prior
Creatinine clearance ≥50 to <80 ml/min: stop 72 hours prior
Creatinine clearance ≥30 ml/min to <50 ml/min: stop 96 hours prior
When should aspirin be stopped?
Can continue
When should Clopidogrel, prasugrel, ticagrelor be stopped?
If recent ACS/stent - postpone surgery if possible
Stop 7 days before
Restart when haemostats achieved 12-12 hours post surgery
