Peri- op

Question 1

I LACK OP

Answer 1

I LACK OP

I - Insulin

L - Lithium
A - Anticoagulants
C - COCP/HRT
K - K sparing diuretics

O - Oral hypoglycemics
P - Perindopril and other ACEis

Question 2

When to stop
- I Lack OP

Answer 2

When to stop

4 Weeks
- COCP/HRT

1 Day
- Lithium

0 Day
- k sparing
- ACEi

Variable
- Anticoagulant
- Hypoglycemics

Question 3

Peri-op Anticoagulation

• Warfarin
• LMWH

Answer 3

Peri-op Anticoagulation

• Warfarin
  1. Stop 5 days before surgery
  2. INR >1.5 day before: VitK PO
  3. Restart evening or POD1
  4. Bridging therapy for high risk

5. Emergency surgery
   - If 6hr: IV Vit K if can delay
   + Prothrombin complex if not

• LMWH
  1. Stop 24 hours before surgery
  2. High risk: restart after 48h

Question 4

Diabetic Meds

• Day before
• AM Op
• PM Op

Answer 4

Diabetic Meds

• Day before
  1. All orals as normal
  2. OD Insulins reduce 20%
• AM Op
  1. TDS metformin: omit lunchtime
  2. OD/BD gliclazide: omit morning
  3. DPP4, GLP1 normal
  4. SGLT2: omit
  5. OD insulin: reduce 20%
  6. BD insulin: 50% morning, 100% evening
• PM Op
  1. TDS metformin: omit lunchtime
  2. OD/BD gliclazide: omit all
  3. DPP4, GLP1 normal
  4. SGLT2: omit
  5. OD insulin: reduce 20%
  6. BD insulin: 50% morning, 100% evening