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Phase 4 > Perioperative 2 > Flashcards

Perioperative 2 Flashcards

1
Q

What specific blood investigations should be done into black afro caribbean individuals prior to surgery?

A

Electrophoresis

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2
Q

What surgery should be avoided when a patient is anti-coagulated?

A

Spinal epidurals

Regional blocks

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3
Q

When should warfarin be stopped prior to surgery?

A

5 days prior

If high risk start on LMWH.
The withhold 12 hours prior and restart 6 hours post surgery.

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4
Q

When should prophylactic antibiotics be given and name some common surgeries that they are given with:

A

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
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5
Q

What are the important pre-medications that should be given prior to induction of anesthesia?

A

7 A’s

  • Anti-emetics
  • Analgesia
  • Anti- Anxiolytics
  • Anti- reflux
  • Ant- secretions - glycopyrronium
  • Antibiotics
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6
Q

Outline how pain can lead to poorer outcomes:

A

Reduced movement - P.E

Reduced shallow breathing/ cough - atelectasis / pneumonia

Vasoconstriction due to sympathetic response
- poor wound healing

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7
Q

What are the aims of ERAS?

A
  • optimise patient preoperatively
  • Avoid iatrogenic issues
  • Minimise adverse physiological/ pathological responses
  • speed up return to function
  • recognise abnormal recovery
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8
Q

What are some post opp complications?

A

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

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9
Q

Causes of post opp pyrexia:

A

Early:

  • Blood transfusion reaction
  • SIRS response
  • Atelectasis
  • Superficial infection - cellulitis

> 5days post opp:

  • Pneumonia
  • P.E/ DVT
  • Anastomotic leak
  • Wound infection
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10
Q

What things can be done post operatively to get the patient back to baseline quickly?

A
  • Effective analgesia
  • Effective Anti- emetics
  • Early reintroduction to fluids and food
  • Early mobilisation + physiotherapy
  • Removal of drains and catheters etc
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11
Q

When is parental feeding indicated?

A

Gut rest

  • Crohn’s
  • Ulcerative colitis
  • Pancreatitis - severe

High output stoma

Short bowel syndrome

High dose chemotherapy

Bowel obstruction

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12
Q

What complications can occur with a stoma?

A

Early:
Haemorrhage
Ischemia
High output

Late:

  • obstruction
  • dermatitis around stoma
  • Prolapse
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13
Q

What areas should be avoided for a stoma site?

A

Bony areas

Skin folds

Umbilicus

Waistline

Sites patient is likely to sit/ lean on

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14
Q

When metronidazole is used as a prophylactic agent when and how should it be given?

A

2 hours prior

PR

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15
Q

What are the aims of anaesthesia?

A

Hypnosis
Analgesia
Muscle relaxation

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16
Q

What are the types of haemorrhage?

A

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

17
Q

Which anti-thrombotic prophylaxis should be used in major orthopaedic surgery?

A

Fondaparinux
- has greater effect than LMWH without increased bleeding risk.

Works on: Factor Xa

18
Q

What are some specific surgical complications:

A

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)
19
Q

When should the oral contraceptive be stopped and then recontinued?

A

4 weeks before

2 weeks after surgery

20
Q

When should MRSA positive patients be operated on?

A

Last on the list

- to reduce risk of spread to other patients

21
Q

What are the ASA levels?

A

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

22
Q

What is needed for there to be capacity?

A

Patient has to:

  • understand
  • retain
  • Weigh up the pro’s and con’s
  • be able to communicate back
23
Q

What should be considered when gaining consent?

A

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

24
Q

What is an early sign of malignant hyperthermia?

A

Masseter spasming

25
Q

Why should surgery be avoided in jaundice patients?

A

Higher risk of bleeding
- Bile needed for Vit K uptake

Increased risk of sepsis
- cholangitis

Increased risk of AKI
- from sepsis

Phase 4 (49 decks)

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