Perioperative 2 Flashcards
What specific blood investigations should be done into black afro caribbean individuals prior to surgery?
Electrophoresis
What surgery should be avoided when a patient is anti-coagulated?
Spinal epidurals
Regional blocks
When should warfarin be stopped prior to surgery?
5 days prior
If high risk start on LMWH.
The withhold 12 hours prior and restart 6 hours post surgery.
When should prophylactic antibiotics be given and name some common surgeries that they are given with:
Should be given 30 mins before skin incision.
Another dose if surgery >3 hours.
- Appendicectomy: IV Tazocin/ IV Co-amoxiclav
- Gastric surgery: IV Co-amoxiclav
- Vascular surgery: IV flucloxacillin + Gentamicin
What are the important pre-medications that should be given prior to induction of anesthesia?
7 A’s
- Anti-emetics
- Analgesia
- Anti- Anxiolytics
- Anti- reflux
- Ant- secretions - glycopyrronium
- Antibiotics
Outline how pain can lead to poorer outcomes:
Reduced movement - P.E
Reduced shallow breathing/ cough - atelectasis / pneumonia
Vasoconstriction due to sympathetic response
- poor wound healing
What are the aims of ERAS?
- optimise patient preoperatively
- Avoid iatrogenic issues
- Minimise adverse physiological/ pathological responses
- speed up return to function
- recognise abnormal recovery
What are some post opp complications?
Pyrexia
Confusion
- hypoxia
- drugs
- urinary retention
- Infection
Breathlessness
- pneumonia
- atelectasis
- fluid overload
Low blood pressure
- hypovolemia
- bleeding
Hypertensive:
- pain
- too much fluid
- lack of anti-hypertensives
Reduced urine output
- blocked catheter
- AKI
Nausea and vomiting
- drugs (opioids)
- Pain
- Obstruction
Hyponatremia
Causes of post opp pyrexia:
Early:
- Blood transfusion reaction
- SIRS response
- Atelectasis
- Superficial infection - cellulitis
> 5days post opp:
- Pneumonia
- P.E/ DVT
- Anastomotic leak
- Wound infection
What things can be done post operatively to get the patient back to baseline quickly?
- Effective analgesia
- Effective Anti- emetics
- Early reintroduction to fluids and food
- Early mobilisation + physiotherapy
- Removal of drains and catheters etc
When is parental feeding indicated?
Gut rest
- Crohn’s
- Ulcerative colitis
- Pancreatitis - severe
High output stoma
Short bowel syndrome
High dose chemotherapy
Bowel obstruction
What complications can occur with a stoma?
Early:
Haemorrhage
Ischemia
High output
Late:
- obstruction
- dermatitis around stoma
- Prolapse
What areas should be avoided for a stoma site?
Bony areas
Skin folds
Umbilicus
Waistline
Sites patient is likely to sit/ lean on
When metronidazole is used as a prophylactic agent when and how should it be given?
2 hours prior
PR
What are the aims of anaesthesia?
Hypnosis
Analgesia
Muscle relaxation
What are the types of haemorrhage?
Primary - directly due to surgery
Reactive - early after surgery, usually due to increased cardiac output
Secondary - later, usually due to infection or opening of wounds
Which anti-thrombotic prophylaxis should be used in major orthopaedic surgery?
Fondaparinux
- has greater effect than LMWH without increased bleeding risk.
Works on: Factor Xa
What are some specific surgical complications:
Aortic:
- Gut ischemia
- Damage to ureters
- Damage to spinal artery - paraplegia
Laparotomy:
- wound dehiscence
Small bowel:
- small bowel <150cm
Biliary:
- duct bile injury
- Post cholecystectomy syndrome (due to lack of reservoir)
When should the oral contraceptive be stopped and then recontinued?
4 weeks before
2 weeks after surgery
When should MRSA positive patients be operated on?
Last on the list
- to reduce risk of spread to other patients
What are the ASA levels?
1 - Normally healthy
2 - Systemic disease - mild
3 - Severe systemic disease that limits but not incapacitating
4 - Severe systemic disease that is constant threat to life
5 - Moribund - not expected to survive 24hours
E - emergency
What is needed for there to be capacity?
Patient has to:
- understand
- retain
- Weigh up the pro’s and con’s
- be able to communicate back
What should be considered when gaining consent?
Does the patient have capacity
Are you the right person to be getting consent
Use words patient understands
Make sure its their choice
Discuss further procedures that may need to occur
What is an early sign of malignant hyperthermia?
Masseter spasming
Why should surgery be avoided in jaundice patients?
Higher risk of bleeding
- Bile needed for Vit K uptake
Increased risk of sepsis
- cholangitis
Increased risk of AKI
- from sepsis
