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Yr 6 PACES knowledge COPY RJ Challenger > 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
3 specific risks of surgery in patients with jaundcie
1) obstructive jaundice - big risk of AKI 2) coagulopathy 3) infection --\> cholangitis
26
Pre-op management of patients with jaundice
1) check clotting 2) 1L 0.9% saline pre-op 3) Urinary catheter + monitor UO 4) Abx prophylaxis
27
Specific risk of surgery in patients w COPD
1) atelectasis 2) aspiration 3) pneumonia
28
Complications of anaesthesia
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
Indication for spinal/epidural anaesthesia
1st line for bowel resection!!! - avoid in anti coagulated patients
30
Post-op interventions to enhance recovery after surgery
Aggressive pain + nausea Mx Early mobilisation Remove drains + catheters ASAP
31
General surgical complications
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
Post-op haemorrhage classification
Primary: starts during surgery Reactive: due to increased CO + BP Secondary: \>24h after surgery, often from infection
33
Causes of post-op urinary retention
Drugs: opioids, anaesthesia, antimuscarinics PAIN --\> sympathetic activity Social: hospital environment
34
Mx of post-op urinary retention
Analgesia Catheterise TWOC
35
Causes of pulmonary atelectasis? Findings O/E? Mx?
Causes: smoking, COPD, pain -\> weak cough O/E: dull bases + reduced AE, occurs WITHIN 48 HOURS Mx: Analgesia, chest physio
36
Wound infection: Timing? RFs?
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
Wound dehiscence: Definition? Timing + presentation? RFs? Mx?
- 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
Specific complications w cholecystectomy
Recurrence of stones Bile leak CBD injury Conversion to open - common Loose stools
39
Complications of inguinal hernia repair
Early: - seroma formation (common) - infection - urinary retention Late - Neuropathic pain - Ischemic orchitis: RARE BUT SERIOUS - Recurrence
40
Complications of colonic surgery
Early: Ileus Anastomotic leak C Diff colitis Abscess Late: Adhesions!!!!! Incisional hernia
41
Causes of ileus
Bowel handling Opioid analgesia Electrolyte imbalance
42
Complications of splenectomy
Infection from encapsulated organism Thrombocytosis --\> VTE Ileus
43
Complications of aortic surgery
Major bleed AKI Gut ischemia Aorto-enteric fistula Trash foot
44
Breast surgery - complications
Seroma Lymphoedema Skin necrosis
45
4 complications of prostatectomy
Retrograde ejaculation Erectile dysfunction Urinary incontinence Prostatitis
46
Complications of thyroidectomy
Wound haematoma --\> tracheal obstruction R laryngeal nerve injury -\> hoarse voice Hypoparathyroidism Hypothyroidism
47
Complications of hip replacement
Deep infection VTE Blood loss!!! Nerve injury - superior gluteal nerve, sciatic nerve Leg length discrepancy
48
Causes of post-op pyrexia
Early (\<5 days): 1. Physiological response 2. Atelectasis 3. Blood transfusion Delayed (\>5 days): - Pneumonia - VTE - Wound infection - Anastomotic leak - Collection/abscess
49
Presentation of post-op collection
\>5 days post-op Swinging fevers Rigors Peritonitis +/-shoulder tip pain
50
Mx of collection
Abx Drainage - percutaneous or surgical
51
Most common causative organism of cellulitis
beta-haemolytic strep (ie strep pyogenes)
52
Prevention of post-phlebitic syndrome
Graduated compression stockings
53
What is wells score
Assesses probability of DVT Low risk --\> do D-dimer High risk --\> do Compression USS
54
Outline general Pre-op care?
Past medical history -MI? Asthma? Diabetes? HTN? Rheumatic fever? Epilepsy? Jaundice? Assess cardiorespiratory system WHO surgical checklist Neck stability Thrombosis prophylaxis Mark correct side for surgery Investigations ////////////////////////////// "PAWN TMI" For past medical history bit "MAD Hypertense REJ"

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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