Pre and post operative care Flashcards
Fluids and food before surgery
- No food 6 hrs
- No clear fluids 2 hrs
Approach to insulin prior to surgery
- If missing more than one meal OR DM poorly controlled = VRIII
- Continue long acting insulin
Action on metformin prior to surgery
- Morning surgery : take as normal, unless TDS = miss lunch time
- Afternoon : Take as normal, unless TDS = miss lunch time
Action of gliclazide before surgery
- Morning surgery : omit morning dose
- Afternoon surgery : Omit morning dose or both doses if taken BD
Action of SGLT2 inhibitors for surgery
Omit on the dayA
Action of once daily insulins for surgery if no VRIII
- Day before reduce by 20%
- Reduce dose that day by 20%
Action on twice daily biphasic or ultra-long acting insulins pre sugery
Halve morning dose, leave evening dose unchanged
VTE prophylaxis in elective hip replacement
- LMWH for 10 days followed by aspirin (75/150) for further 28 days
- LMWH for 28 days with compression stockings
- Rivaroxaban
VTE prophylaxis with Elecetive knee replacement
- Aspirin (75 or 150 mg) for 14 days
- LMWH for 14 days combined with anti-embolism stockings until discharge
- Rivaroxaban
VTE prophylaxis for fragility fractures of pelvis, hip and proximal femur
- Offer VTE prophylaxis for a month to people with fragility fractures of the pelvis, hip or proximal femur if the risk of VTE outweighs the risk of bleeding.
- Choose either:
- LMWH , starting 6-12 hours after surgery or
- fondaparinux sodium, starting 6 hours after surgery, providing there is low risk of bleeding.
Presentation of anastomatic leek
- Follows surgery involving anastomes
- Hypotension, tachycardia,fever
- Distended and diffusely tender abdomen with evidence of peritonism
- Feculent matter in wound drain
Management of anastomotic leak
Immediate theatre
When would post operative ileus present
Very soon after
Presentation of post operative ileus
Abdo distention an bloating
N&V
Abdo pain
what will be derranged in post operative ileus ?
Electrolytes
