Other

Question 1

What interventions have been shown to reduce post-operative delirium?

Answer 1

• Pre-operative comprehensive geriatrics assessment.
• Multi-component interventions to address patient orientation, nutrition, hydration, sleep and mobility with the help of the family in the post-operative period

Question 2

What are the special peri-operative considerations for patients with rheumatoid arthritis?

Answer 2

Obtain pre-operative c-spine x-rays prior to surgery to assess for c-spine instability.

Question 3

What are the strategies available to patients who are Jehovah’s Witness to prevent drop in Hgb?

Answer 3

(1) Decrease Phlebotomy
(2) TXA
(3) Autologous blood donation pre-operatively.
(4) Acute nor o Olympic hemodiluation
(5) RBC Salvage

Question 4

What is the recommend stress dosing for steroids in the perioperative period for major surgery?

Answer 4

Usual AM dose + HC 100 mg IV x 1 pre-op + 50 mg IV Q8H x 3 doses + 25 mg Q8H x 3 doses then back to usual dose.

Question 5

What is the perioperative stress dose steroid recommendation for patients undergoing moderate stress surgery?

Answer 5

Usual AM dose + HC 50 mg IV x 1 pre-op then 25 mg Q8H X 3, then usual dose

Question 6

Which liver cirrhosis are considered at high enough perioperative risk to consider discouraging elective surgery?

Answer 6

Decompensated cirrhosis, Child Pugh C, MELD > 15

Discourage due to high risk peri-op mortality and morbidity.

Question 7

How do you manage an ICD in the peri-operative period?

Answer 7

• ICD should be re-programmed if the surgery will be above the umbilicus w/cautery use.
• Suspend anti-tachycarrhythmia therapy and/or initiate asynchronous pacing in pacing dependent patient