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Yr 6 PACES knowledge > Peri-op management > Flashcards

Peri-op management Flashcards

1
Q

Peri-op considerations for T1DM pt

A

Put patient on list first
Omit AM insulin if surgery is in morning

Start SLIDING SCALE (5% dextrose w 20mM KCl at 125ml/hr + 50U actrapid)

  • continue sliding scale until tolerating food
  • check glucose hourly
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2
Q

Peri-op consideration for T2DM pt (no insulin tx)

A

Omit any oral hypoglycaemic on AM of surgery

  • if eating post-op: resume oral hypoglycaemic with meal
  • if not eating: check fasting glucose + start sliding scale
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3
Q

what anaesthesia should be avoided in patients taking warfarin

A

Epidural, spinal, regional blocks

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4
Q

Peri-op Considerations for pts on warfarin

A

Low VTE risk: stop warfarin 5 days pre-op + restart the next day

High VTE risk:
- 5 days preop - stop warfarin + start LMWH
- 1 day preop - stop LMWH
- Post op: start LMWH + warfarin
(stop LMWH when INR>2)
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5
Q

What must you do for a pt on warfarin who needs emergency surgery?

A

Stop warfarin

IV Vit K
Request FFP to cover surgery

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6
Q

What medications must be given prior to anaesthesia

A

Analgesia
Anti-emetics
Antacids
Antibiotics

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7
Q

What cautions are taken at end of anaesthesia

A
  • Change inspired gas –> 100% O2

- Reverse paralysis: neostigmine + atropine

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8
Q

3 Weak opioids?

A

Codeine
Dihydrocodeine
Tramadol

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9
Q

Strong opioids - name 3

A

Morphine
Oxycodon
Fentanyl

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10
Q

Complications of anaesthesia

A

Intubation:
- oropharyngeal trauma, oesophageal intubation!

  • Urinary retention
  • Pressure sores

Loss of muscle power:

  • Corneal abrasion
  • No cough –> atelectasis + pneumonia

Anaphylaxis: rare!

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11
Q

Maintenance fluids - NICE recommendations

A

25-30ml/kg/day of water
1mM/kg/day of Na, Cl, K
50-100g dextrose

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12
Q

what structure is commonly at risk of damage in colonic resection/gynae surgery?

A

ureters

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13
Q

Why does neurosurgery often –> electrolyte disturbance

A

SIADH –> hyponatremia

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14
Q

Pre-op planning - pt takes warfarin. what precautions must you take for their procedure?

A
  • Avoid epidural/spinal/regional blocks
  • Stop warfarin 5 days pre-op
  • If low VTE riskL restart warfarin day after op
  • if
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15
Q

Specific complications for DM patients

A

Risk of hypo due to NBM
INFECTION
IHD, PVD

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16
Q

Specific periop risks for a patient taking steroids

  • precaution taken?
A

Infection
Poor wound healing
Adrenal crisis

IV hydrocortisone

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17
Q

Important points to note in Hx of pre-op assessment

A
  • PC: SITE of surgery,
  • PMH: DM, jaundice
  • cardioresp: MI, HTN, asthma, COPD
  • DH: steroids, insulin, warfarin, smoking, OCP, anaphylaxis
  • Intubation risk: neck arthritis, dentures, loose teeth
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18
Q

Caution in OCP taking patients

A

stop 4 weeks prior to surgery

restart 2 weeks after

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19
Q

Pre-op investigations

A

Routine bloods: FBC, U+Es, LFTs, clotting, glucose

Others: TFTs, G+S, X-match (6 units for AAA, 4 units for gastrectomy)

Cardiopulmonary function:
- CXR, ECG, echo, PFTs, exercise test

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20
Q

NBM for how long pre-op

A

2 hours: fluids

6 hours: food

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21
Q

Bowel prep - indications? 2 types?

A

Indicated for most L sided colon surgeries

Macrogol
Picolax

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22
Q

Indications for pre-op abx prophylaxis

A

GI surgeries

Joint replacement

23
Q

Interventions for DVT prophylaxis

A

Early mobilisation
TEDs
LMWH
Intermittent compression boots

24
Q

Diabetes - what specific risks do they have for surgery?

A

Risk of hypo from NBM
Risk of high glucose as cortisol antagonises insulin
Infection
Cardiac probs

25
Q

3 specific risks of surgery in patients with jaundcie

A

1) obstructive jaundice - big risk of AKI
2) coagulopathy
3) infection –> cholangitis

26
Q

Pre-op management of patients with jaundice

A

1) check clotting
2) 1L 0.9% saline pre-op
3) Urinary catheter + monitor UO
4) Abx prophylaxis

27
Q

Specific risk of surgery in patients w COPD

A

1) atelectasis
2) aspiration
3) pneumonia

28
Q

Complications of anaesthesia

A

Propofol induction –> cardiorespiratory depression

Intubation –> oropharyngeal trauma, sore throat, oesophageal intubation

Loss of pain –> urinary retention, pressure sores, nerve palsies

Loss of muscle power –> corneal abrasion, atelectasis + pneumonia

Anaphylaxis - rare but serious!!

29
Q

Indication for spinal/epidural anaesthesia

A

1st line for bowel resection!!!

  • avoid in anti coagulated patients
30
Q

Post-op interventions to enhance recovery after surgery

A

Aggressive pain + nausea Mx
Early mobilisation
Remove drains + catheters ASAP

31
Q

General surgical complications

A

Immediate: primary/reactive haemorrhage, damage to local structures, oropharyngeal trauma

Early: 
Atelectasis, pneumonia
Secondary haemorrhage (from infection)
Anastomotic leak
VTE
Wound infection, dehiscence
C diff colitis

Late:
Failure/recurrence
Scarring
Neuropathic pain

32
Q

Post-op haemorrhage classification

A

Primary: starts during surgery
Reactive: due to increased CO + BP
Secondary: >24h after surgery, often from infection

33
Q

Causes of post-op urinary retention

A

Drugs: opioids, anaesthesia, antimuscarinics
PAIN –> sympathetic activity
Social: hospital environment

34
Q

Mx of post-op urinary retention

A

Analgesia
Catheterise
TWOC

35
Q

Causes of pulmonary atelectasis?
Findings O/E?
Mx?

A

Causes: smoking, COPD, pain -> weak cough

O/E: dull bases + reduced AE, occurs WITHIN 48 HOURS

Mx: Analgesia, chest physio

36
Q

Wound infection:
Timing?
RFs?

A

5-7 days post-op

RFs:
pre-op: DM, steroids, viscus perforation
operative: contaminated/dirty, duration, pre-op abx
post-op: contamination from staff

37
Q 
Wound dehiscence:
Definition?
Timing + presentation?
RFs?
Mx?
A
  • Rupture of a wound along the suture line
  • 10 days post-op, preceded by serosanguinous discharge
  • RFs (same as incisional hernia?):
    Pre op: DM, obesity, smoking, malnutrition, roids
    During operation: surgical skill, site of incision
    Post-op: High IAP, infection

Mx: ABC

  • Place gauze soaked in warm saline over the wound
  • Fast bleep surgical reg + warn theatre + anaesthetist
  • Opioid analgesia
  • Prep pt for surgery: G+S, X-match, clotting, stop warfarin
38
Q

Specific complications w cholecystectomy

A 
Recurrence of stones
Bile leak
CBD injury
Conversion to open - common
Loose stools
39
Q

Complications of inguinal hernia repair

A

Early:

  • seroma formation (common)
  • infection
  • urinary retention

Late

  • Neuropathic pain
  • Ischemic orchitis: RARE BUT SERIOUS
  • Recurrence
40
Q

Complications of colonic surgery

A 
Early:
Ileus
Anastomotic leak
C Diff colitis
Abscess

Late:
Adhesions!!!!!
Incisional hernia

41
Q

Causes of ileus

A

Bowel handling
Opioid analgesia
Electrolyte imbalance

42
Q

Complications of splenectomy

A

Infection from encapsulated organism
Thrombocytosis –> VTE
Ileus

43
Q

Complications of aortic surgery

A 
Major bleed
AKI
Gut ischemia
Aorto-enteric fistula
Trash foot
44
Q

Breast surgery - complications

A

Seroma
Lymphoedema
Skin necrosis

45
Q

4 complications of prostatectomy

A

Retrograde ejaculation
Erectile dysfunction
Urinary incontinence
Prostatitis

46
Q

Complications of thyroidectomy

A

Wound haematoma –> tracheal obstruction
R laryngeal nerve injury -> hoarse voice
Hypoparathyroidism
Hypothyroidism

47
Q

Complications of hip replacement

A 
Deep infection
VTE
Blood loss!!!
Nerve injury - superior gluteal nerve, sciatic nerve
Leg length discrepancy
48
Q

Causes of post-op pyrexia

A

Early (<5 days):

  1. Physiological response
  2. Atelectasis
  3. Blood transfusion

Delayed (>5 days):

  • Pneumonia
  • VTE
  • Wound infection
  • Anastomotic leak
  • Collection/abscess
49
Q

Presentation of post-op collection

A

> 5 days post-op

Swinging fevers
Rigors
Peritonitis +/-shoulder tip pain

50
Q

Mx of collection

A

Abx

Drainage - percutaneous or surgical

51
Q

Most common causative organism of cellulitis

A

beta-haemolytic strep (ie strep pyogenes)

52
Q

Prevention of post-phlebitic syndrome

A

Graduated compression stockings

53
Q

What is wells score

A

Assesses probability of DVT

Low risk –> do D-dimer
High risk –> do Compression USS

Yr 6 PACES knowledge (14 decks)

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