Periop management Flashcards
How does OCP/HRT vary with surgery?
Stop 4 weeks before surgery
Restart 2 weeks post op if mobile
What anaesthetic procedure should be avoided in warfarinised patients?
Epidural
Spinal
Regional blocks
What pre op investigations can be done?
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
How long does a patient need to be nil by mouth for pre op?
≥2h for clear fluids
≥6h for solids
What is the prophylactic antibiotic regime given pre op?
GI or orthopaedic surgery
Ceftriaxone + Metronidazole
Vancomycin if MRSA +ive
What is ASA grade I?
Healthy patient
What is ASA grade II?
Patient with mild systemic disease
What is ASA grade III?
Patient with severe systemic disease that limits activity
What is ASA grade IV?
A patient with systemic disease that is a constant threat to life
What is ASA grade V?
A patient that is not expected to survive more than 24 hours even with treatment
Dead
What can be done for diabetic patients during surgery?
Omit insulin dose prior to surgery or oral hypoglycaemics if not ID
Give sliding scale during surgery, regularly checking BMs
How do steroids effect surgery?
Need to be increased due to stress
Increased risk of infection and poorer wound healing
How do you manage a low thromboembolic risk patient on anticoagulants needing surgery?
Stop warfarin 5 days prior to surgery, need INR
How do you manage a high thromboembolic risk patient on anticoagulants needing surgery?
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
How do you manage anticoagulated patients needing emergency surgery?
Stop warfarin
Give vit K 5mg IV
Request FFP to give - cover surgery
What agent is used to induce anaesthesia?
Propofol
What agents can be used for muscle relaxation during anaesthesia?
Depolarising - suxamethonium
Non - depolarising - vecuronium, atracurium
What can be used to maintain the airway during anaesthesia?
Laryngeal mask airway - low risk of aspiration
Endotracheal tube
What is used to maintain anaesthesia?
Volatile agents eg halothane, enflurane
Propofol
How are patients brought out of anaesthesia?
Change volatile agents to inhaled oxygen
Reverse paralysis with neostigmine (Can add atropine to stop muscarinic side effects)
What predmedications should be given pre anaesthesia? (5)
Anxiolytic Analgesia Anti emetic Antacids Antibiotics
What can be used as a regional anaesthetic?
Bupivacaine - longer acting agent
What are some of the complications of anaesthesia?
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
