Perioperative Care Flashcards
Indication to Delay Surgery
MI
3-6 months
1) pre OP stop aspirin
2) warfarin last dose pre op
abdominal hysterectomy name 2 drugs
HRT surgery delay time
!) Aspirin stopped 5 days before surgery
2) Warfarin stopped 5 days before surgery
3) Blood thinners stopped Warfarin, Enalapril
4) 4 weeks
Parkland Formula
4 × 100 × percentage burn
Disease highest pre OP risk
Type 1 diabetes
Regular oral medication pre op
- Timing for the last dose of a PPI/H2 antagonists / prokinetics before anaesthesia for patients at risk of regurgitation?
30 min
- last PPI dose before surgery = 1hr 30min
SUBJECT: Preparation for Surgery
Mr Firenzi is 55 year old man about to go in for surgery. His PMH includes porphyria and GORD. You are the 4th year medical student with the anaesthetist. During the surgery he is given suxamethonium.
1) Can Mr Firenzi have a snack 10 min before the operation?
2) Minimum starvation time before surgery?
2) What is the best way of putting a patient with GORD to sleep?
3) Name a post op complication of using suxamethonium
- NO
- starvation time before surgery= 6 hrs
- GORD to sleep = Rapid Sequence Induction
- Suxamethonium apnoea
SUBJECT: Immediate post surgery complication
Mr Firenzi is 55 year old man has just finished surgery. You are the 4th year medical student with the anaesthetist. After the surgery the aneasthetist notices that Mr Firenzi’s temperature is 40, his muscles are rigid and he is tachycardic.
1) What could be causing these immediate post op symptoms of high temp, muscle rigidity and tachycardia?
1) immediate post op symptoms of high temp, muscle rigidity and tachycardia (malignant hyperthermia = reaction to anaesthetic agents
SUBJECT: Preparation for Surgery
Title: ASA
What ASA grade am I?
- Normal healthy patient
- A patient with mild systemic disease
- A patient with severe systemic disease
- A declared brain-dead patient
ASA grade 1 = Normal healthy patient
ASA grade 2 = Mild systemic disease
ASA grade 3 = Severe systemic disease
ASA grade 6 = declared brain-dead patient
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Preparation for Surgery
30 min
Preparation for Surgery
90 min
Preparation for Surgery VTE Risk
Virchow (1856) identified three factors as contributing to the formation of venous thrombi
Venous stasis
Hypercoagulability
Vessel wall injury
The thrombus is composed of red cells, fibrin and platelets and is liable to embolize and cause pulmonary embolism (PE).
Which of the following are possible consequences of PE?
Right Ventricular Failure
Left Ventricular Failure
Right Ventricular Failure
Post Surgery
All surgical inpatients should be offered ________ unless contraindicated, e.g. peripheral arterial disease
graduated compression anti-embolism stockings (thigh length or knee length)
Preparation for Surgery
patients at increased risk of VTE and those having orthopaedic surgery should be offered
LMWH - enoxaparin
Preparation for Surgery
Risk factors for venous thromboembolism include:
Select one or more options from the list below.
Possible answers: A. BMI of >25 kg/m2 B. Cancer C. Age <40 years D. Nephrotic syndrome E. Crohn’s disease
Cancer
Nephrotic Syndrome
Crohns
Needlestick Injury
Which types of Hepatitis can be transmitted through blood
Hepatitis B
Hepatitis C
SURGERY
Many patients undergoing major surgery have post-operative analgesia provided by a continued use of a regional technique. For abdominal, thoracic or lower limb surgery what type of pain management de
epidural catheter
SURGERY
If adequate analgesia is not achieved within ___ minutes the epidural has failed
Complete the sentence
30 min
DURING SURGERY
It is essential to monitor the patient’s blood pressure every ___ min for at least 20 min, treating hypotension with vasopressors.
5
PONV
1st line anti-emetic post op to treat PONV
Ondansetron 4mg IV
TITLE
A 78-year-old man is due to have an anterior resection for colorectal carcinoma. He is currently on clopidogrel. He has been on clopidogrel for the past 6 months due to the insertion of a drug eluting stent during primary percutaneous coronary intervention for a STEMI.
When should you advise him to stop taking his clopidogrel?
1 week before
