Perioperative medical management Flashcards
What drug type most commonly causes anaphylaxis in surgery? Specific drug?
Antibiotics
Teicoplanin
What agent is second most likely to cause anaphylaxis?
Chlorhexidine
Define malignant hyperthermia? What causes it?
progressive, life threatening hyperthermic reaction causing tachycardia, increased HR, sweating, increase end tidal volume
Triggered by volatile anaesthetic gas or suxamethonium
What is the presentation of malignant hyperthermia? If it is left untreated what happens?
Increased HR Sweating Increased temperature Increase end tidal volume Muscle rigidity Untreated then increased metabolic rate leading to hypercapnia, increased muscle breakdown, acidosis, hyperkalaemia, arrhythmia, cardiac arrest
What is the treatment for malignant hyperthermia?
Dantrolene
What type of drug is suxamethonium
Muscle relaxant
Broken down very quickly, fast acting
What breaks down suxamethonium?
plasma cholinesterase
What genetic abnormal physiology can lead to a personal suffering suxamethonium apnoea?
Due to change in cholinesterase structure meaning the drug isnt broken down for a prolonged period
Define post operative nausea and vomiting?
Occurence overall in patients? in high risk?
Any nausea of vomiting up to 48 hours post op
Occurs in 30% of all patients and 80% of high risk
3 patient associated risks to developing post operative nausea and vomiting?
Female
Non-smoker
Decrease risk with increase age
Give 4 anaesthetic related risks and 3 types of surgeries that are more likely to suffer post operative nausea and vomiting?
Volatile anaesthetic use NO Perioperative use of opioids Duration of surgery ENT, gynae and opthalmology
What anaesthesia methods can you put in place to reduce the chances of post operative nausea and vomiting?
Use an neuraxial anaesthetic
Total IV anaesthetic (propofol infusion)
What is Total IV Anaesthetic and why is it useful in combating post operative nausea and vomiting?
Propofol
Short acting
Decreases consciousness and limits memory
What 3 antiemetics are used first line in post operative nausea and vomiting and what receptors do they act on?
Ondansetron (serotonin antagonist)
Dexamethasone (corticosteroid)
droperidol (dopamine antagonist)
What 4 antiemetics are used second line in post operative nausea and vomiting? what receptors do they act on?
Cyclizine (Histamine antagonist)
Metaclopromide
Prochlorperazine (D2 receptor antagonist)
Hyoscine (mAch receptor antagonist)
Which antiemetic should not be used in Parkinsons?
Dopamine antagonists - droperidol
What is the major side effect of serotonin receptor antagonist anti-emetics?
QT prolongation and potential torsades de pointes
what 4 receptors can be found in the vomiting centre?
Histamine
Serotonin
Dopamine
Acetylcholine
What monitoring is need post operatively?
HR/BP - any MI?
RR, WOB, O2 sats - any post oper pulmonary complications?
Fluids - any ongoing losses? electrolytes replacement needed?
What do you want to try and remove ASAP after surgery?
Remove drains, NG and catheters ASAP
Start oral fluids ASAP
Importance of analgesia post op?
Allows quicker return to baseline functioning, increase oral intake, mobilise sooner
Importance of mobilization early post op? How can you do this?
Maintains muscle strength and joint mobility, less VTEs, less PPCs
Encourage deep breathing, incentive spirometry, chest physio, mobilise with physio
Why is post operative nutrition important? What can dietician advice on?
Important to prevent catabolism state with muscle breakdown and weight loss, wound dehiscence
Dietician - do they need TPN? NG? prevent re-feeding syndrome.
Simple interventions you can put in place post operatively to ensure no complications occur?
Early mobilisation Nutrition Monitor for sepsis VTE prophylaxis Prevent skin breakdown
What does enhanced recovery after surgery refer to?
Protocols that are put in place perioperatively in order to decrease hospital stay, rates of readmission and time to full recovery
Multimodal perioperative care pathways
How is ERAS fulfilled both pre, intra and post op?
Pre op = organ function maintained, analgesia, nutrition, counselling, carb drinks
intra op = Standardised anaesthetic, analgesia pathway, actively warmed above 36 degrees, conservative IV fluids
Post op = nutrition, remove drains/NG, early mobilization, analgesia that is opioid sparing
What type of nutrition is given to patients pre op and how does this help post operatively?
Carbohydrate filled drinks which help reduce post op nausea and vomiting, pain and diarrhoea as well as wound dehiscence
Why are conservative IV fluids intraoperatively part of the ERAS pathway?
Every litre of fluids used increases the hospital stay by 24 hours
