Patient evaluation, informed consent, preoperative assessment and care Flashcards
Patients who have had organ transplants should have Abx prophylaxis with cefalexin 1g, dicloxacillin 1g or azithromycin 500mg orally just before the procedure
F
1 hour before
if their physician has advised it
Vitamin E (alpha-tocopherol) is a potential anticoagulant.
T
The combination of non selective beta blockers (such as propranolol) and adrenaline may result in malignant hypertension, reflex bradycardia and even death
T
Selective beta blockers are ok
Patients with surgically repaired atrial or ventral septal defects are high-risk for developing bacterial endocarditis following a surgical procedure.
F
Low-risk
High-risk are pts with prosthetic valves, previous endocarditis, complex congenital heart disease, surgically constructed systemic-pulmonary shunts.
Alternatives to penicillins include macrolides
T
Appropriate antibiotics to prevent bacterial endocarditis in at risk patients are amoxicillin or if allergic, cefalexin, axithro or clindamicin
T 60min pre op Amox 2g Ceflex 2g Azithro 500mg Clinda 600mg - same for immmunosuppressed pts who have been advised they need prophylaxis
Heat electrocautery or bipolar coagulation should not be used in patients with implanted cardiac pacemakers.
F
These are advocated.
The risk of cardiac conditions has been stratified into high, moderate, low or negligible risks by the American Heart Association
T
Procedures involving infected or eroded skin are associated with significantly higher infection risk and warrant the use of prophylactic antibiotics.
T
Lidocaine and prilocaine are the preferred anesthetics for use during pregnancy
T
cat A in Aus
(B in USA but stil preferred)
Patients with hypertrophic cardiomyopathy and mitral valve prolapse with regurgitation are medium-risk for developing bacterial endocarditis following a surgical procedure.
T
High-risk categories include patients with prosthetic valves, a previous history of endocarditis, complex congenital cyanotic heart disease, and surgically constructed systemic–pulmonary shunts
Antiviral prophylaxis for laser resurfacing should begin within 48hrs preoperatively and continue until re-epithelialisation is complete, generally within 7-10 days.
T
Cephalospirin Abx can usually be given safely to penicillin allergic patients who do not have anyphylactic response to penicillin
T
Garlic, ginseng, ginger, ginkgo, St John’s wort and feverfew are all potential anticoagulants.
T
Electrocautery is the preferred method of haemostasis in patients with implanted deep-brain stimulators.
T
Consider delaying surgery in hypertensive patients with a systolic pressure of >170 mmHg and/or a diastolic pressure >100 mmHg
T
bleeding risk and stroke risk
send to GP for BP lowering
Lignocaine and prilocaine are the preferred anaesthetics for pregnancy.
T
Dabigaptran (Pradaxa) is a factor Xa inhibitor
F
direct thrombin inhibitor
Erythromycin estolate is safe to use during pregnancy.
F
Assoc with hepatotoxicity during pregnancy.
Fondaparinux and Rivaroxiban are factor 9 (IX) inhibitors
F factor 10a (Xa) inhibitors
Inactivation of the deep-brain stimulator has never been necessary as effective hemostasis can be achieved with electrocautery in dermatologic surgery
T
In pts with Hx of HSV undergoing facial resurfacing procedures antivral prophylaxis options include acyclovir 400 mg three times daily, valacyclovir 500 mg twice daily, and famciclovir 250 mg twice daily.
T
start 48 hrs before and continue until re-epithelialization 7-10 days after
There are no adverse effects associated with bupivacaine and mepivacaine use in pregnancy. .
F
Associated with increased risk of foetal bradycardia
Alcohol may result in an increased bleeding potential.
T
advise pts to avoid for 2 days prior to surgery and at least until day afterwards
Use of the hyfrecator is acceptable in pts with deep brain stimulators
F Use Electrocautery (hot wire)
Patients with implanted pacemakers and defibrillators and patients with physiologic heart murmurs are low-risk for development of bacterial endocarditis following surgery.
T
Intrapartum use of tetracycline may result in staining of foetal dental enamel.
T
Small volumes of adrenaline-containing anaesthetics cannot be given safely in patients with advanced heart disease.
F
can be
must be max conc 1:200,000
