peri-op stopping and starting

Question 1

unfractionated heparin
or
LMWH

the classic question….

1. which is:
   a. able to be rapidly loaded IV with bolus
   b. safe in renal impairment
   c. given subcut
   d. monitoring
   e. used in people with prosthetic heart valves?
   f. how long to stop LMWH before surgery??

Answer 1

a. unfractionated
b. unfractionated (just think the fractions are small and clog up the kidneys)…
c. LMWH (OD or BD)
d. level of anticoagulation is easily assessed using activated clotting time (ACT), or activated partial thromboplastin time (APTT)
e. UFH
f. stop at least 12 hours before surgery - because has a fairly long half life.

Question 2

when should you give pre-op prophylactic antimicrobials?

when might you need additional intra-op doses of antimicrobials?

Answer 2

30-60mins before blade to skin.
may need more careful planning if you’re giving something like Vanc which needs a slow

1. if the op is particularly prolonged
2. if there is major blood loss.

look at the trust policy!!!!!!

Question 3

what factors increase the risk of PONV?

Answer 3

female pt
inhaled anaesthetic agents
opioid analgesics - emetogenic AND delay gastric emptying
ferrous sulphate - GI irritation
Abdo / ent / gynae surgery - higher risk of PONV