Peri-Operative Management Flashcards
What is the WHO pain relief ladder?
1 - Non-opioid, +/- adjuvant
2 - opioid for mild/moderate pain +/- non-opioid/adjuvant
3 - opioid for moderate/severe pain +/- non-opioid/adjuvant
What are risk factors for DVT?
Pregnancy Trauma Surgery Immobility Cancer
What are signs of a DVT?
Warm, tender, swollen calf
Fever
Pitting oedema
How is the Wells score calculated?
Active ca Paralysis, or recent immobilisation Recently bedridden Local tenderness along venous system Entire leg swollen Calf swelling >3cm than unaffected leg Pitting oedema Collateral superficial veins Previous DVT Alternative diagnosis more likely (-2)
How is D-dimer used in DVT investigation?
Wells score 1 or less - do d-dimer, if -ve DVT excluded
Wells score >2 - do d-dimer and leg USS
How is a DVT managed?
Abixaban or rivaroxaban
If not suitable => LMWH
When does a person require an IVC filter?
Active bleeding
Failed anti-coagulation
Minimises risk of PE
How should pts with DM on insulin be managed for surgery?
1) try to place first on list
2) continue long acting insulin at normal times
3) AM list => no rapid/mixed insulin, PM list => AM dose of rapid insulin can be given
4) not eating until evening and high BMs => VRII
5) don’t give any rapid acting insulin while on VRII
How should pts with DM on oral hypoglycaemic agents be managed for surgery?
1) give meds as normal the night before, except sulphonylureas (causes prolonged hypoglycaemia)
2) If eating post-op; AM - omit morning meds, give after surgery. PM - take morning meds, omit midday dose, take with late lunch
3) Not eating post-op => start on VRII 2hrs before surgery, restart oral hypoglycaemic once eating
When should a pt with DM be started on VRII for surgery?
If they won’t be eating or drinking post-op
Check BMs regularly, aim for 6-10mmol
How is a person taken off VRII?
Once eating again
Give normal dose of rapid acting, then stop VRII 30 mins later
How are pts on steroids managed in surgery?
Require extra corticosteroid replacement if taking >5mg of prednisolone or equivalent for >2 wks
What steroid replacement is required for moderate procedures?
50mg hydrocortisone for induction
25mg ever 8hrs for 24hrs
What steroid replacement is required for major surgery?
100mg hydrocortisone before induction
50mg every 8hrs for 24hrs, then half each day until maintenance dose is reached
How is a pt on warfarin managed before major surgery?
Stop 3-5 days pre-op
Can start LMWH instead (stop 6hrs before surgery)
Vit K/FFP if emergency surgery
Cover with LMWH when re-warfarinising
