Peri OP considerations Flashcards
Induction of anesthesia
triggers sympathetic activation that may raise systemic blood pressure (BP) by 20 to 30 mm Hg in normotensive patients, and up to 90 mm Hg in untreated patients.
BP that cancels surgery
systolic BP >180 mmHg, diastolic BP >110 mmHg
When are stress tests needed prior to surgery
If the patient is unable to climb a flight of stairs
Should blood pressure meds be held?
ARB ,ACE , diuretics held the morning of surgery
Decisions on if bridging therapy for anticoagulation is required
CHADS2 (predicts risk of stroke)
When is warfarin stopped?
5 days prior to surgery
check INR the day before surgery and if not normalized given Vitamin K 1-2 mg
restart 12 hours after surgery
When to stop heparin options?
LMWH - 24 hours
Unfractionated- 6 hours
restart therapeutic doses 48 hours after surgery
how do you manage clopidogrel around surgery?
stop 1 week prior to surgery
restart 12 hours after surgery
How do you manage aspirin around surgery
if high risk - continue
if low risk stop 10 days prior to surgery
Definition of SIRS
≥ 2 of the following:
- temperature > 38ᵒ or < 36ᵒ
- heart rate > 90 BPM or > 2 SD above normal for age
- WBC > 12.000/mm3 or < 4,000/mm3
- RR > 20/minute
Definition of Sepsis
SIRS with infection
Severe Sepsis
End-Organ Damage or lactate >4
Should OCP’s be discontinued around surgery?
Only if it is major surgery and they would need to be stopped 6 weeks prior to surgery.
alternative heparin ppx can be considered.
