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Scott's Notes > Peri-operative management, fluids and nutrition > Flashcards

Peri-operative management, fluids and nutrition Flashcards

1
Q

How much blood should be crossmatched for AAA surgery?

A

6 units

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2
Q

How long before surgery should patients be NBM for and for what?

A

> =2 hours clear fluids

>=6 hours solids

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3
Q

What surgeries would bowel prep be indicated for?

A

Left sided bowel surgeries

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4
Q

What DVT prophylaxis should lwo medium and high risk be given?

A

Low - early mobilisation
Med - early mobilisation + TEDS + 20mg enoxaparin
High - early mobilisation + TEDS + 40mg enoxaparin + intermittent compression boots perioperatively

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5
Q

What is the pathology of surgical risk to DM patients?

A

Surgery causes stress hormone release which antagonises insulin. Gombined with NBM and often concomitant IHD, this increases risk of infection and dysglycaemica

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6
Q

What are the surgical considerations around patients on longterm steroids?

A

Poor wound healing
Infection
Adrenal crisis

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7
Q

Why is it best to avoid operating on patients with jaundice?

A

High risk of renal failure in obstructive jaundice
Coagulopathy
Infection ->cholangitis

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8
Q

How many days before an operation should warfarin be stopped, and what is the target INR in most cases?

A

5 days

<1.5

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9
Q

What are the surgical risks in COPD/smokders?

A

Basal atelectasis
Aspiration
Pneumonia

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10
Q

What are the complications of anaesthesia?

A

Cardiorespiratory depression 2ary to propofol induction

Local trauma due to intubation

Loss of pain sensation can cause nerve palsies

Loss of muscle power can cause atelectasis and pneumonia (no coughing)

Anaphylaxis

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11
Q

What are some general complications to surgery?

A

Immediate (<24hrs)
Intubation related oropharyngeal trauma
Surgical trauma to local structures
Primary or reactive haemorrhage

Early (1d-1mo)
2ary haemorrhage
VTE
Urinary retention
Atelectasis and pneurmonia
Wound infection and dehiscence
Antibiotic associated colitis

Late (>1mo)
Scarring
Neuropathy
Failure/recurrence

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12
Q

What are the definitions of reactive and secondary haemorrhage?

A

Reactive haemorrhage is bleeding at the end of surgery/early post op, commonly 2ary to increased CO and BP

Secondary haemorrhage is bleeding >24 post-op which is usually due to infection

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13
Q

Why are so many surgeries complicated by atelectasis?

A

Pre op smoking
Anaesthetics increase mucous production and decrease mucociliary clearance
Pain inhibits respiratory excursion and cough

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14
Q

What are some risk factors for post op infection/dehiscence?

A 
Pre-op
Age
Comorbidities
Existing infection
Steroids

Intra-op
Duration
Closure technique

Post-op
Poor hospital hygiene

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15
Q

What complications might occur following cholecystectomy?

A 
Conversion to open
CBD injury
Bile leak
Retained stones
Steatorrhoea
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16
Q

What complications may occur folowing inguinal hernia repair?

A 
Early
Haematoma/seroma formation
Injury
Infection
Urinary retention

Late
Recurrence
Chronic groin pain/parasthesia
Ischaemic orchitis

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17
Q

What are the risk factors following colonic surgery?

A 
Early
Ileus
Anastomotic leak
Enterocutaneous fistulae
Abscesses

Late
Adhesions -> obstruction
Incisional hernia

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18
Q

What are the causes of post op ileus?

A

Bowel handling
Anaesthesia
Electrolyte imbalance

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19
Q

How might a post op ileus present and what is the treatmnt?

A

Distention
Constipation +- vomiting
Absent bowel sounds

treat with IV fluids and NGT

20
Q

What are the complications following anorectal surgery?

A

Incontinence
Stenosis
Anal fissuring

21
Q

What is the main complication following small bowel surgery?

A

Short gut syndrome

22
Q

WHat are the common side effects following spelectomy?

A

Gastric dilatation
VTE 2ary to thrombocytosis
Infection by encapsulates (haemophilus, strep, neisseria, salmonella)

23
Q

What are the complications following aortic surgery?

A 
Gut ischaemia
Renal failure
Aorto-enteric fistula
Anterior spinal syndrome 
Thromboemboli
24
Q

What are the complications following prostatectomy?

A

Urinary incontinence
ED
Retrograde ejaculation
Prostatitis

25
Q

What are the complications following thyroidectomy?

A 
Haematoma ->obstruction
Recurrent laryngeal nerve trauma
Hypoparathyroidism
Thyroid storm
Hypothyroidism
26
Q

What are the complications following a fracture repair?

A

Mal/non-union
Osteomyelitis
Avascular necrosis
Compartment syndrome

27
Q

WHat are the complications following a hip replacement?

A 
Deep infection 
VTE
Dislocation
Sciatic nerve injury
Leg length discrepancy
28
Q

When might post-op pyrexia be physiological and why?

A

0-5 days post op - SIRS 2ary to trauma

29
Q

What is the mangement of a DVT?

A

Start therapeutic LMWH @1.5mg/kg/24hrs SC

Start warfarin and stop LMWH when INR reaches 2.5

30
Q

What measures should be taken to prevent VTE?

A 
Pre
VTE risk assess
TED stockings
Hydrate
Stop OCP 4 weeks prior

Intra
Minimise duration
Minimal access
Intermittent pneumatic compression boots

Post
LMWH
Early mobilisation 
Analgesia
Physio
Hydration
31
Q

What might cause post op hypoxia?

A 
Existing lung disease
Atelectasis
Aspiration
Pneumonia
LVF
PE
Pneumothorax
Pain -> hypoventilation
32
Q

What might cause reduced post op urine output?

A

Hypovolaemia
NSAIDs/gentamicin
Post renal blocked catheter (commonest)

33
Q

What might cause post op N/V?

A

Obstruction
Ileus
Emetics e.g. opioids

34
Q

What might cause post op hypotension?

A

CHOD

Cardiogenic - MI, fluid overload
Hypovolaemia -(Haemorrhage)
Obstructive - PE
Distributive - Sepsis, neurogenic shock

35
Q

What might cause post op delerium?

A

DELERIUM

Drugs - opioids, sedatives
Eyes, ears and other sensory deficit
Low 02 states
Infection
Retention
Ictal
Underhydration
Metabolic derangement
36
Q

What is the minimum urine output for a patient?

A

0.5ml/kg/hr (30ml/hr for a 60kg pt)

37
Q

What is our daily Na and K requirement?

A

Na - 1.5-2mmol/kg/day

K - 1mmol/kg/day

38
Q

What is a normal CVP?

A

5-10cmH2O

39
Q

How much NaCl is there in a litre bag of 0.9% saline?

A

154mmol

40
Q

How much dextrose in in a liter bag of 5% dextrose?

A

50g

41
Q

What are the components of a bag of dextrose saline?

A

4% dextrose = 40g.L

0.18%NaCl = 31mM NaCl

42
Q

What is Parkland’s formula and when is it used?

A

Used for assessing fluid for burn victims

4 x weight x %burn = ml in 1st 24hrs

43
Q

What are the sodium and potassium levels in a liter of Hartmann’s?

A

131mmol Na

5mmol K

44
Q

What is the definition of refeeding syndrome?

A

Life threatening metabolic complication of refeeding via any route after a prolonged period of starvation

45
Q

What is the pathophysiology of refeeding syndrome?

A

Low carbs put you in a catabolic state with low insulin fat and protein with depletion of Po4 intracellularly

Refeeding causes increase in insulin and cellular PO4 uptake

Hypophosphataemia causes:
Rhabdomyolysis
Resp insufficiency
Arrhythmias
Shock
Seizures
46
Q

What are the biochemical abnormalities in refeeding syndrome?

A

Hypokalaemia
Hypomagnesasemia
Hypophosphataemia

47
Q

What is the management of refeeding syndrome

A

Prevention by recognising at risk patients

PO4 supplementation

Scott's Notes (21 decks)

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