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AS Surg RT > Perioperative / Pre op > Flashcards

Perioperative / Pre op Flashcards

1
Q

consent discussion 4 things

A

informed consent
explain risks vs benefits
optimise patient fitness and preparedness
check anaesthesia type and WHO doing

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2
Q

pre op checks to perform

A

Operative fitness (cardioresp comorbidities)
Pills taking
Consent
History (prev complications and surgery / significant PMH)
Ease of intubations (neck arthiritis, dentures)
Clexane (prophylaxis)
Site - marked + checked

OP CHECS

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3
Q

operation and anticoag

A

balance risk

avoid epidural, spinal and reigonal

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4
Q

antiepiletpics and operation

A

continue, ensure IV or NGT arranged if can’t do oral intake post op

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5
Q

OCP and HRT and operation

A

stop 4 weeks before major or leg surgery

restart 2 weeks after if mobile

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6
Q

beta blockers and surgery

A

give

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7
Q

typical pre op investigation bloods panel

A

routine = FBC, UE, G+S, clotting, glucose
do FTs if relevant
electrophoresis if at risk group

MRSA swabs

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8
Q

which ops need extra cross match

A

gastrectomy 4 units

AAA repair 6 units

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9
Q

special investigations pre op for certain conditions

A

any cardioresp comorbidities:
CXR, echo, ECG

any RA or anksond - lateral C spine

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10
Q

typical pre op prep

A

NBM 2 hours+ for clear fluids, 6 hours for solids

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11
Q

bowel prep for left sided bowel ops

A

macrogol or picolax

up to surgeon, follow advice

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12
Q

when is prophylactic antibiotic used?

A

GI surgery and joint replacement, give 15 mins pre op

biliary cef met
appendix cef met
vascular coamox
MRSA vanc

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13
Q

DVT prophylaxis by risk level

A

low early mobilise
medium TEDS + 20mg enoxaparin
high risk TEDS + 40mg enoxaparin with compression boots post op

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14
Q

ASA grade descriptors

A
  1. healthy
  2. mild systemic
  3. severe systemic
  4. severe systemic with constant threat to life
  5. <24 hours to live
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15
Q

diabetes op risk

A

more risk of infection and vascular disease
need change to insulin dose proabably due ot cortisol rise

do dipstick for proteinuria, venous glucose, check UEs and K+ pre op

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16
Q

insulin and operations type 1

A

stop long acting the night before
omit AM insulin if morning surgery
start sliding scale and check glucose hourly

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17
Q

post op diabetic type 1

A

continue sliding scale until tolerating food, switch to subcut around first meal

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18
Q

describe sliding scale insulin regime

A

actrapid infusion pump 50 units
check cap gluc hourly and adjust rate
5% dextrose + 20mmol KCl mixed in, rate of 125ml/hr

if in doubt, speak tot the diabetes specialist nurse!!!

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19
Q

type 2 diabetes and operation

A

manage as type 1 if fasting >10mM glucose

omit oral hypoglycaemics on AM of surgery

resume with first meal

if not eating after op do sliding scale and refer to specialists

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20
Q

on steroids and operation

A

poor healing, infection, risk of adrenal crisis

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21
Q

managing someone on steroids with op

A

up steroid

major surgery - hydrocortisone 50-100mg IV pre med then 8 hrly for 3 days

only for one day if minor surgery

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22
Q

jaundiced patient and op

A

avoid, only ERCP investigatio

23
Q

increased op risk of obstructive jaundice

A

higher risk of post op renal failure and coagulopathy and infection

24
Q

changes to pre op for jaundice and ERCP

A

avoid morphine, check clotting carefully and consider vit K
1 litre normal saline pre op unless heart failure
urinary catheter
abx prophylaxis

close urine moiniotirng in op and titrate fluids closely

furosemide, CVP if struggling with urine output after

25
Q

anticoagulated patients and operations

A

balance risk
don’t need to stop warfarin if INR <3.5 and minor procedure

avoid epidural and blocks

continue aspirin, clopidrogrel unless high bleeding risk - then stop one week pre op

26
Q

major op and warfarin

low clot risk

A

low clot risk

stop 5 days pre and get INR <1.5
restart warf next day

27
Q

major op and warfarin

high clot risk

A

stop warfarin 5 days prior and replace with LMWH

stop LMWH 12 hours pre op

restart LMWH 6 hrs post op

then warfarin next day, continue enox until INR>2

28
Q

emergency surgery and warfarin

A

stop taking
vit K 0.5mg slow IV

request FFP for surgery

29
Q

COPD surgery risks

A

atelectasis
aspiration
chest infection

30
Q

COPD pre op

A

CXR, pulmonary function tests, physio, stop smoking 4 weeks prior to op

31
Q

anaestheisa start/maintenance/end

A

induction with propofol

muscle relaxation
depolarising: suxamethonium

non depol: atracurium

airway: endotracheal tube or laryngeal mask airway (iGel)

maintaining anaesthesia:
gas- halothane, enflurane

ending anaesthesia
switch gas to 100% oxygen

reversal:
neostigmine
+ atropine to prevent muscarinic side effects

32
Q

typical pre-med for an operation

A 
temazepam
opioids, paracetamol, NSAIDs
antiemetics
 lansoprazole
glycopyrolate anti secretions
Abx
33
Q

complications of anaesthesia

A 
cardioresp depression
airway trauma
retention
palsies
atelectasis/pneumonia risk
malignant hyperpyrexia
anaphylaxis
34
Q

malignant hyperpyrexia

A

rare auto dominant reaction to halothane or suxamethonium

v high temp, masseter spasm

give danatrolene and cool

35
Q

pain relief principles with surgery

A

oral is always best if poss
regular / PCA
follow stepwise approach to increasing
if difficult ask acute pain service for advice

should have local in wound and regional nerves at end of surgery too

36
Q

stepwise pain relief

A

non opioids
paracetamol max 500mg every 6 hrs
ibuprofen max 400mg every 6 hrs
diclofenac max 50mg every 8 hours

weak opioids
codeine
dihydrocodeine
tramadol

opioids
morphine 10mg 4 hourly (max?)
oxycodone
fentanyl

37
Q

risks x2 of spinal or epidural anaesthesia

A

resp depression

neurogenic shock, low BP

38
Q

ERAS protocol

A

enhanced recovery after surgery

evidence based approach

used for colorectal/ortho surgery mainly

about optimising pt condition

39
Q

pre op, peri op, post op means of promoting fast recovery

A 
Pre-op: 
optimise BP, hydration, ensure not anaemic
stop smoking 4 weeks prior
admit on day if poss
carb-loading pre op
patient centred
peri-op: 
use shortest acting agents
limit op time
limit invasiveness
minimise drains
Post-op: 
mobilise early!!
good pain and nausea control
physio
off IV to oral ASAP
urinary cath + drains for minimum time possible
40
Q

immediate
early
late
surgical complications

A

Immediate (<24h)

  • tubing trauma
  • trauma to surrounding structures in surgery
  • bleeding

Early (1-30 days)

  • secondary bleed
  • clots
  • retention
  • atelectasis and pneumonia
  • wound infection / breakdown
  • abx complications (colitis)

Late (>1month)

  • scarring
  • neuropathy
  • op failure or recurrence of problem
41
Q

classify operative bleeding

A

primary - in op
reactive - immediately post op
secondary - 1 day + post op, usually infection

42
Q

urinary retention and surgery risk factors

A 
various drugs
BPH
male 
hernial/anorectal op
neuropathies
43
Q

categorising risk factors for surgical complications

same approach for preventing complications categorising

A

split into pre op
operative
and post op

44
Q

causes of early and late post op pyrexia

A 
within 5 days
atelectasis
sepsis 
transfusion reaction
drug reaction
sepsis not resolved by op
later
pneumonia
VTE
infection of wound
leaking anastomosis
collection formed
45
Q

approach to post op patient with a fever

A

obs, notes, drug chart
examine

wound 
abdo
DRE
legs
chest
lines
urine
stool

urine dip and culture
FBC, CRP, cultures, LFTs
wound swabs / line swabs
CXR

46
Q

presentation post op collections

A

swinging fevers
localised peritonitis
shoulder tip referred pain

47
Q

DVT

A

peaks 5 days post op

warmth, erythema, swelling, pain in calf

48
Q

post op SOB

A 
atelectasis
pain not controlled 
pneumothorax 
PE
pneumonia
49
Q

post op low UO

A

blocked or misplaced catheter

hypovolaemia

50
Q

vomiting post op

A

emetic drugs
ileus
obstruction

consdier NGT antiemetiics

51
Q

hypotensive post op

A

tilt head back
assess fluid status

hypovol
bleeding
sepsis
overload
neurogenic shock
52
Q

hypertension post op

A

may be drug omission

or urinary retention
pain

53
Q

acute confusion post op

A 
sedating drugs
sensory deficit
low oxygen states
infection
retention of stool or urine
hydration issues
electrolytes
glucose
withdrawal

AS Surg RT (15 decks)

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