Periop management

Question 1

How does OCP/HRT vary with surgery?

Answer 1

Stop 4 weeks before surgery

Restart 2 weeks post op if mobile

Question 2

What anaesthetic procedure should be avoided in warfarinised patients?

Answer 2

Epidural
Spinal
Regional blocks

Question 3

What pre op investigations can be done?

Answer 3

Bloods - FBC, U+Es, INR, G+S, LFTs, TFTs
*If having Gastrectomy or AAA repair - do cross match
BM
CXR
Echo
ECG
PFT - if known disease/obese
MRSA swabs

Question 4

How long does a patient need to be nil by mouth for pre op?

Answer 4

≥2h for clear fluids

≥6h for solids

Question 5

What is the prophylactic antibiotic regime given pre op?

Answer 5

GI or orthopaedic surgery
Ceftriaxone + Metronidazole
Vancomycin if MRSA +ive

Question 6

What is ASA grade I?

Answer 6

Healthy patient

Question 7

What is ASA grade II?

Answer 7

Patient with mild systemic disease

Question 8

What is ASA grade III?

Answer 8

Patient with severe systemic disease that limits activity

Question 9

What is ASA grade IV?

Answer 9

A patient with systemic disease that is a constant threat to life

Question 10

What is ASA grade V?

Answer 10

A patient that is not expected to survive more than 24 hours even with treatment
Dead

Question 11

What can be done for diabetic patients during surgery?

Answer 11

Omit insulin dose prior to surgery or oral hypoglycaemics if not ID
Give sliding scale during surgery, regularly checking BMs

Question 12

How do steroids effect surgery?

Answer 12

Need to be increased due to stress

Increased risk of infection and poorer wound healing

Question 13

How do you manage a low thromboembolic risk patient on anticoagulants needing surgery?

Answer 13

Stop warfarin 5 days prior to surgery, need INR

Question 14

How do you manage a high thromboembolic risk patient on anticoagulants needing surgery?

Answer 14

Stop warfarin 5 days pre op, give LMWH - stop 12 hours before op. Restart 6 hours post op, start warfarin next day. Stop LMWH when INR >2

Question 15

How do you manage anticoagulated patients needing emergency surgery?

Answer 15

Stop warfarin
Give vit K 5mg IV
Request FFP to give - cover surgery

Question 16

What agent is used to induce anaesthesia?

Answer 16

Propofol

Question 17

What agents can be used for muscle relaxation during anaesthesia?

Answer 17

Depolarising - suxamethonium

Non - depolarising - vecuronium, atracurium

Question 18

What can be used to maintain the airway during anaesthesia?

Answer 18

Laryngeal mask airway - low risk of aspiration

Endotracheal tube

Question 19

What is used to maintain anaesthesia?

Answer 19

Volatile agents eg halothane, enflurane

Propofol

Question 20

How are patients brought out of anaesthesia?

Answer 20

Change volatile agents to inhaled oxygen

Reverse paralysis with neostigmine (Can add atropine to stop muscarinic side effects)

Question 21

What predmedications should be given pre anaesthesia? (5)

Answer 21

Anxiolytic
Analgesia
Anti emetic
Antacids
Antibiotics

Question 22

What can be used as a regional anaesthetic?

Answer 22

Bupivacaine - longer acting agent

Question 23

What are some of the complications of anaesthesia?

Answer 23

Cardiac arrest
Respiratory depression
Oro-pharyngeal injury (Check no loose teeth)
Loss of sensation - pressure ulcers
Malignant hyperpyrxia - high rise in temp + masseter spasm - halothane or suxamethonium can precipitate this. Give dantrolene + cool
Anaphylaxis