Perioperative medicine

Question 1

tests to consider prior to elective surgery

Answer 1

Consider pre admission clinic to address medical issues.

Blood tests including FBC, U+E, LFTs, Clotting, Group and Save
Urine analysis
Pregnancy test
Sickle cell test
ECG/ Chest x-ray

Question 2

rules for fluids pre-surgery

Answer 2

clear fluids until 2h before operation

fast from non-clear liquids and foods for 6h before surgery

Question 3

perioperative insulin

Answer 3

if good control and minor procedures - adjust usual regimen

if long fasting time or poor control - variable rate IV insulin infusion

Question 4

perioperative metformin

Answer 4

for morning op
if OD/BD - take as normal
if TDS - omit lunchtime dose

if afternoon op
if OD/BD - take as normal
if TDS - omit lunchtime dose

Question 5

perioperative sulfonylurea

Answer 5

morning op
if OD - omit
if BD - omit morning dose

afternoon op
if OD - omit
if BD - omit both

Question 6

diabetes medications to not change perioperatively

Answer 6

DPP4 inhibitors - gliptins
GLP1 analogues - tides

Question 7

perioperative SGLT2 inhibitors

Answer 7

omit on day of surgery

Question 8

perioperative insulin

Answer 8

if OD insulins e.g., lantus

reduce dose by 20% from day before surgery

if BD or ultra long acting insulin
halve morning dose and leave evening dose unchanged

Question 9

depolarising neuromuscular blocking drugs

Answer 9

binds to nAChR - permanent depolarising of motor end plate e.g., suxamethonium

may cause malignant hyperthermia or hyperkalaemia

used for rapid sequence induction and intubation

Question 10

non depolarising neuromuscular blocking drugs

Answer 10

competitively antagonises nAChR - tubocurarine, atracurium, vecuronium

may cause hypotension

reversal with acetylcholinesterase inhibtiors e.g., neostigmine