peri-operative management Flashcards
how far in advance should DOACs be stopped before an operation
48 hours
how far in advance should clopidogrel be stopped before an operation
7 days
how far in advance should aspirin be stopped before an operation
usually can be continued
how far in advance should NSAIDs be stopped before an operation
Short-acting
Ibuprofen, diclofenac
Stop 24 hours before
surgery
Longer-acting
Piroxicam, naproxen
Stop 72 hours before
surgery
how far in advance should methotrexate be stopped before an operation
Withhold 48 hours
before any surgery
associated with
transient renal
insufficiency
how far in advance should warfarin be stopped before an operation
5 days
(low risk patients, high risk patients should be discussed with anaesthetist)
propofol mechanism of action
Majorly GABA mediated
Exert sedative effect in the brain
Quick offset and ‘wake up’ once the drug level falls below threshold by redistributing to other tissues.
Causes loss of consciousness, cardiovascular and respiratory depression.
neuromuscular blocking agents
Atracurium
Rocuronium
Suxamethonium
mechanism of action of local anaesthetic
Reversible blockade of sodium channels, inhibiting transmission of action potentials in nerve cells
why is adrenaline added to LA
Adrenaline is added to lidocaine to cause vasoconstriction – reduces bleeding and increases duration of LA
where should LA + adrenaline not be administered
Do not administer to areas of the body that have end arteries (fingers/toes) or to surgical skin flaps
names of LA
lidocaine
levobupivacaine
ropivicaine
heavy bupivicaine
names of topical LA
EMLA (5% eutectic mixture of lidocaine and prilocaine)
Ametop (4% Tetracaine gel)
should ACEi/ARB be stopped pre-op
Yes, on morning of surgery
when should you stop eating before surgery
6 hours for solids
2 hours for liquids (or sip clear liquid til send)
