perioperatibe management of patients

Question 1

what are the principles of anaemia with surgery?

Answer 1

All patients listed for major surgery should have a full blood count pre-operatively. If this is abnormal, haematinics such as ferritin, transferrin saturation, B12 and folate should be checked.
Anaemia = Haemoglobin <130g/L (men) or <120g/L (women)

Question 2

causes of anamia?

Answer 2

Iron deficiency (most common)
Vitamin B12 or folate deficiency
Renal failure
Malignancy
Menorrhagia
Anaemia of chronic disease
Drugs e.g. chemotherapy agents

Question 3

pre-operative management of anaemia?

Answer 3

Oral iron if >6 weeks until planned surgery
IV iron if <6 weeks until planned surgery
B12/folate replacement
Erythropoiesis‐stimulating agent (ESA) therapy
Transfusion if profound anaemia and surgery cannot be delayed

Question 4

post operative management of anaemia?

Answer 4

Transfusion
IV iron
Oral iron

Question 5

principles of management with pts on steroids?

Answer 5

When the body experiences acute stress (e.g. illness, trauma, surgery), the steroid demand increases.
Patients on long term steroids cannot respond to this demand because their adrenal function is suppressed.
Therefore, patients who are on long term steroids usually need more steroids than usual during periods of physiological stress e.g. surgery or acute illness

Question 6

peri operative management of pts on steroids?

Answer 6

Switch oral steroids to 50-100mg IV hydrocortisone.
If there is associated hypotension then fludrocortisone can be added.
For minor operations oral prednisolone can be restarted immediately post-operatively. If the surgery is major then they may require IV hydrocortisone for up to 72 hours post-op.

Question 7

what happens with glucose control in surgery?

Answer 7

Surgical stress can induce hyperglycemia, and alterations in medication timing or dosage may be necessary due to fasting or changes in renal function.

Question 8

potential complications of surgery in diabetics?

Answer 8

Hyperglycemia
Hypoglycemia
DKA
lactic acidosis

Question 9

what is hyperglycaemia ?

Answer 9

Characterised by blood glucose levels >180 mg/dL, symptoms include polyuria, polydipsia, and unexplained weight loss.

Question 10

what is hypoglycaemia?

Answer 10

Characterised by blood glucose levels <70 mg/dL, symptoms include palpitations, tremor, sweating, anxiety, and confusion.

Question 11

what is DKA?

Answer 11

Common in type 1 diabetics, symptoms include polyuria, polydipsia, nausea, vomiting, abdominal pain, and fruity-smelling breath.

Question 12

what is lactic acidosis?

Answer 12

A potential complication of metformin use, especially in renal impairment. Symptoms include abdominal discomfort, nausea, vomiting, muscle pain, and rapid breathing.

Question 13

investigations for diabetics going through surgery?

Answer 13

Management of peri-operative diabetes involves frequent glucose monitoring, often through point-of-care blood glucose testing, to guide treatment adjustments. In some cases, HbA1c levels can provide additional information on long-term glycemic control prior to surgery.

Question 14

how do you take diabetes meds before surgery?

Answer 14

Question 15

what do insulin dependent diabetics do for surgery?

Answer 15

Question 16

when are oral diabetes meds restarted?

Answer 16

After surgery, all oral medications should generally be restarted the morning following surgery.

Question 17

causes of post op N+V

Answer 17

Infection
Hypovolaemia
Pain
Paralytic ileus
Drugs

Question 18

non meds management of PONV

Answer 18

Minimise patient movement
Analagesia
IV fluids if dehydrated

Question 19

med management of PONV

Answer 19

5HT3 receptor antagonist e.g. Ondansetron - first line. Risk of QT prolongation and constipation
Histamine (H1) receptor antagonist e.g. Cyclizine. Avoid in severe heart failure
Dopamine (D2) receptor antagonist e.g. Prochlorperazine. Risk of extrapyramidal side effects (dystonic reactions)

Question 20

other anti emetics used for PONV

Answer 20

Other anti-emetics such as corticosteroids or Metoclopramide reserved for specific cases of post-operative nausea and vomiting.

Question 21

what is post op poor urinary output?

Answer 21

Post-operative poor urinary output is defined as a decrease in the normal volume of urine produced following a surgical procedure. Typically, an output of less than 0.5 mL/kg/hour in adults is considered low.

Question 22

what can cause poor urinary output (pre renal)

Answer 22

Pre-renal: This results from decreased blood flow to the kidneys. Causes include:
Hypovolaemia
Hypotension
Dehydration

Question 23

what can cause poor urinary output (renal)

Answer 23

This is due to intrinsic damage to the kidney tissues. Causes include:
Acute tubular necrosis

Question 24

what can cause poor urinary output (post renal)

Answer 24

This occurs due to obstructions that prevent urine from being expelled from the body. Causes include:
Benign prostatic hypertrophy
Effects of drugs such as anticholinergic or alpha adrenoreceptor antagonists, often used in anaesthetics
Pain following surgery, particularly hernia operations
Psychological inhibition
Opiate analgesia

Question 25

features post op poor urinary output?

Answer 25

Decreased frequency or volume of urination
Hypotension and tachycardia (pre-renal causes)
Abdominal pain or discomfort, particularly after hernia operations (post-renal causes)
Symptoms of drug side effects such as dry mouth, blurred vision, and constipation (post-renal causes due to anticholinergic drugs)

Question 26

ix for poor urine output

Answer 26

Urine output measurement: To assess the volume and frequency of urination.
Urinalysis: To check for signs of infection or other urinary tract disorders.
Blood tests - U+E to monitor kidney function
Ultrasound of kidneys and bladder: To identify any potential obstructions in the urinary tract.

Question 27

mx poor urine output

Answer 27

Correction of any fluid or electrolyte imbalances: This may involve intravenous fluids or electrolyte supplements.
Management of underlying causes: This could involve altering medication regimens, addressing hypotension, or relieving any obstructions in the urinary tract.
Urinary catheterization: If poor urinary output persists despite initial management, catheterization may be necessary to monitor urine output and relieve bladder distension.

Question 28

rules for pre op oral fluids?

Answer 28

Patients should be informed that they are allowed to consume clear fluids until 2 hours before their scheduled operation. Clear fluids encompass water, fruit juice without pulp, coffee or tea without milk, and ice lollies.

Question 29

rules for pre op IV fluids?

Answer 29

Intraoperative Maintenance: During surgery, practitioners are advised to consider using intravenous crystalloid solutions to maintain fluid balance.

Question 30

rules for pre op food?

Answer 30

Patients are generally advised to have their last meal/solid food/non-clear fluids for at least 6 hours before their surgery.