Periperative conditions and medical cessations Flashcards
How long should one wait before performing surgery in a patient with ichemic heart disease?
Wait at least 6 months before elective surgery
What additional testing must be considered when performing surgery on a smoker?
Must perform pulmonary function tests
Arterial blood gases.
Look out for post operative atelectasis
What aditional testing must be considered when performing surgery on an alcoholic?
Must perform liver function tests and kidney function tests.
What must be consdered in patients undergoing surgery with kidney disease specifically with meds?
Muscle relaxants and enfluranes are contraindicated
How does anesthesia effect hypoglycemia?
It masks hypoglycemia!!
Less insulin is released during anesthesia thus these patients need 1/2 the morning dose of insulin and use 5% IV dextrose.
What needs to be considered in patients with gout undergoing surgery?
Surgery may cause another gout flare.
These patients can be prophylaxed with cholchicine 2-3 days before and 4-5 days after.
What must be obtained in patients with rheumatoid arthritis undergoing surgery?
Cervical films!!
Do diuretics have a negative effect before surgery?
Yes!!
The can cause hypokalemia leading to a prolonged non-depolarizing muscle relaxant activity an heart abnormality.
diuretics should be discontinued.
Should arrythmia medications be continued?
Yes
Should antihypertensive medications be continued?
Yes
Should psychotropic medications be continued?
Yes
Should bronchodilators be continued?
Yes
Describe anticoagulation discontinuation
coumadin should be stopped 3-6 days before surgery.
ASA should be d/c 2-3 weeks before.
What effects do Reglan and tagament have?
Reglan (dopamine) and tagament (H2) both decrease gastric fluids and motility.
What are the contraindications for spinal anesthesia?
Hypovolemia Anticoag tx peridural hematoma Spinal compression COPD Obesity
