Peri operative care and Anaesthetics Flashcards
ASA grades
1 - healthy pt
2 - mild systemic illness inc social alcohol, well controlled DM/HTN, obesity, preggers
3 - severe systemic disease - poorly controlled DM/HTN
4 - severe systemic disease that is constant threat to life - sepsis, ESRD, MI, CVA
5 - not expected to survive without operation eg ruptured AAA, ICH with mass effect, major trauma
6 - brain dead for organ donation
oral hypoglycaemics day before rules
continue as normal
apart from SGLT2s (gliflozins) which omit day before and day of
oral hypoglycaemic on day of surgery
omit metformin - if TDS omit lunch dose otherwise leave the same
sulphonylureas (gliclazide) - omit doses. unless morning op then can take evening dose if eating again.
insulin basal bolus
day before surgery
day of surgery
bolus stays the same day before as eating.
bolus stops. Only give if eating. Commence VRII
basal
What happens to basal dose on day before and day of if its:
- single long acting insulin taken am OD
- single long acting insulin taken BD
- single long acting insulin taken pm OD
- no change day before, 80% on day
- change evening dose to 80% and on the day morning dose to 80%
- 80% day before, no change on day
What happens to premixed insulin doses
- day before
- morning of
- if pt isn’t eating by the evening
- if tds
- no change!
- half dose regardless of its am or pm surgery
- give long acting equivalent as still need long acting to cover them.
- half morning dose, omit lunch time dose, give evening dose as normal unless not eating then give equivalent long acting
What happens on day if pt mixes their own insulins ie a short and an intermediate acting
calculate total morning dose then give half of this as an intermediate dose only for the morning
If not eating by evening give only the basal. If eating, back to normal doses
when to do certain bloods need to be taken
when do DOACs need to be stopped
2 days before surgery
When does clopidogrel need to be stopped
7 days
When does warfarin need to be stopped
5 days
When does warfarin need to be stopped
4 weeks
INR needed before op
<1.5
INR target for Warfarin (for a fib)
2-3 (2.5)
Who has an INR target of 3.5
People with mechanical valve
