perioperatibe management of patients Flashcards
what are the principles of anaemia with surgery?
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)
causes of anamia?
Iron deficiency (most common)
Vitamin B12 or folate deficiency
Renal failure
Malignancy
Menorrhagia
Anaemia of chronic disease
Drugs e.g. chemotherapy agents
pre-operative management of anaemia?
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
post operative management of anaemia?
Transfusion
IV iron
Oral iron
principles of management with pts on steroids?
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
peri operative management of pts on steroids?
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.
what happens with glucose control in surgery?
Surgical stress can induce hyperglycemia, and alterations in medication timing or dosage may be necessary due to fasting or changes in renal function.
potential complications of surgery in diabetics?
Hyperglycemia
Hypoglycemia
DKA
lactic acidosis
what is hyperglycaemia ?
Characterised by blood glucose levels >180 mg/dL, symptoms include polyuria, polydipsia, and unexplained weight loss.
what is hypoglycaemia?
Characterised by blood glucose levels <70 mg/dL, symptoms include palpitations, tremor, sweating, anxiety, and confusion.
what is DKA?
Common in type 1 diabetics, symptoms include polyuria, polydipsia, nausea, vomiting, abdominal pain, and fruity-smelling breath.
what is lactic acidosis?
A potential complication of metformin use, especially in renal impairment. Symptoms include abdominal discomfort, nausea, vomiting, muscle pain, and rapid breathing.
investigations for diabetics going through surgery?
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.
how do you take diabetes meds before surgery?
what do insulin dependent diabetics do for surgery?
when are oral diabetes meds restarted?
After surgery, all oral medications should generally be restarted the morning following surgery.
causes of post op N+V
Infection
Hypovolaemia
Pain
Paralytic ileus
Drugs
non meds management of PONV
Minimise patient movement
Analagesia
IV fluids if dehydrated
med management of PONV
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)
other anti emetics used for PONV
Other anti-emetics such as corticosteroids or Metoclopramide reserved for specific cases of post-operative nausea and vomiting.
what is post op poor urinary output?
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.
what can cause poor urinary output (pre renal)
Pre-renal: This results from decreased blood flow to the kidneys. Causes include:
Hypovolaemia
Hypotension
Dehydration
what can cause poor urinary output (renal)
This is due to intrinsic damage to the kidney tissues. Causes include:
Acute tubular necrosis
what can cause poor urinary output (post renal)
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
