Pre-op 1/21 Flashcards
Test 1
What is the most common NMB allergy?
Rocuronium
What would be a way that you can tell that a patient is having an allergic reaction while under anesthesia?
Cant ventilate them
What are factors that increase your risk of latex allergy?
Multiple Sx
-occupation: healthcare workers; food handlers
-food allergies: mangoes; kiwi; avocado; passion fruit; banana; chestnut
-spina bifida
What adverse effects can local anesthetics cause?
Increased HR dt epi
Which local anesthetics have a lower risk of allergic reactions? Why?
Amides have a lower risk for allergic reactions than esters
Esters have a perservative para-aminobenzoic (PABA)
Amides: Lidocaine, Bupivcaine,
Esters: Procaine, chloroprocaine,
What allergies have cross activity with NMB?
Morphine
Neostigmine
What BP medication do we need to d/c at least 24 hrs prior to Sx? Why?
ACE inhibitors
Makes BP hard to manage
What consideration should we have for all contraceptives?
High risk pt for postop venous thrombosis should DC four weeks prior to Sx
If patient is already taking a opioid, what considerations should i have?
I can give opioid that works on different opioid receptors
What consideration should we have with patient taking aspirin prior to surgery?
Cont if significant CVS disease/event
if not, d/c 10-14 days prior to surgery
What consideration should we have with Cox-2 inhibitors?
They can affect bone healing, can DC prior to surgery
what consideration should we have with MAOIs medication’s?
Avoid meperidine and indirect acting vasopressors (ephedrine)
What consideration should we have with P2Y12 inhibitors? (Antiplatelets)
Do not d/c with stent for Sx until 6 months of dual therapy
What are the d/c time frames for P2Y12 inhibitors? (Antiplatelets)
Clopidogrel/ticagrelor: 5-7 days
-Prasugrel: 7-10 days
-Ticlopidine: 10 days
When should topical & diuretics medications be d/c? What is the exception?
The day of Sx
Continue Thiazide diuretics
Sildenafil is ______ and should be d/c ____ before Sx
viagra
24
What are all the medications you d/c before Sx?
ASA
P2Y inhibitors (clopidogrel)
Topicals
Diuretics (not thiazides)
Sildenafil
NSAIDS
Warfarin
Postmenopausal Hormone Replacement Therapy (HRT)
Non-insulin anti-diabetic medication’s
When do we d/c NSAIDs before Sx?
48 hours
When do we d/c warfarin before Sx?
5 days
When do we d/c Post menopausal HRT before Sx?
4 weeks
When do we d/c non-insulin anti-diabetic medication before Sx?
Day of Sx
When do we d/c SGLT inhibitors before Sx?
24 hours
What is the protocol for insulin the day of Sx for type 1 vs type 2?
Type 1: 1/3 or normal dose of long acting insulin in the morning
Type 2: none or up to 1/2 of normal dose of long acting insulin in the morning
What are the periop corticosteroid doses?
50 mg IV before incision
25 mgs q8h for 24 hours
Theres more but this should be all im worried about
OTC herbal considerations: Echinacea
Activation of cell mediated immunity:
Allergic reactions
-immunosuppression
OTC herbal considerations: ephedra
d/c 24h before Sx
Increases HR and BP through sympathomimetics:
-increase risk for CVS event
-ventricular arrhythmias with halothane
-hemodynamic instability
-interacts with MAOIs
OTC herbal considerations: garlic
d/c 7 days before Sx
-inhibits platelet aggregation
-antihypertensive activity
OTC herbal considerations: ginger
-antiplatelet
-antiemetic
OTC herbal considerations: Ginkgo
d/c 36h before Sx
-inhibits platelet activating factor
OTC herbal considerations: Ginseng
d/c 7 days before Sx
-inhibits platelet aggregation
-lowers blood glucose
-Decreases anticoagulant effect of warfarin
OTC herbal considerations: Green tea
d/c 7 days before Sx
-inhibits platelet aggregation
OTC herbal considerations: Kava
d/c 24h before Sx
-sedation/axiolysis
OTC herbal considerations: Saw Palmetto
-inhibits Cox: increase risk of bleeding
OTC herbal considerations: St. John’s wort
d/c 5 days before Sx
-inhibits neurotransmitter reuptake
-decreases serum digoxin levels
-delayed emergence
-interacts with a lot of things
OTC herbal considerations: valerian
-sedation
-may increase aesthetic requirements with long-term use
-may increase sedative effects
What are the NPO status guidelines?
Full meals: 8 hours
Light meals: 6 hours
Breast milk: 4 hours
Clear liquids: 2 hours
Can I give PO meds with NPO status?
Yes. Unless actively N/V, yes.
What is Mendelson syndrome? What does it indicate?
Gastric residual >25cc
-gastric pH <2.5
Increase risk of aspiration & increases mortality greatly
How can we decrease the risk of aspiration?
Decrease gastric volume or increase gastric pH
-antacids (sodium citrate)
-H2 receptor antagonist (famotidine, ranitidine, cimetidine)
-PPI (omeprazole, pantoprazole)
-dopamine two antagonist (metacloperamide-psychotic effects)
T/F: smoking decreases your risk of having N/V
T
What sedation helps with vomiting?
Propofol
What medications help with N/V?
Scopolamine: acetylcholine muscarinic antagonist
-apply night before Sx
-worsens narrow angle glaucoma
Pregabalin: GABA analogue
-reduces opioid requirements
-administer pre-induction
Ondansetron: serotonin antagonist
-administer before conclusion of surgery
-prolonged QTc
Promethazine: H1 antagonist
-causes sedation
Dexamethasone: steroid
-administer after induction
-may release endorphins or inhibit prostaglandin synthesis
most of these cause blurry vision, dry mouth, HA, visual disturbances
All patients should have received prophylactic antibiotics within ______ before surgical incision
1 hour
Which antibiotics allow to be given within 2 hours of surgical incision?
Vancomycin
Fluoroquinolone
What are the common Abx given for Sx? Which is the most common? What are the main differences in them?
Cefazolin: Most common
-Broad spectrum Beta-lactam
- PCN cross reactivity
Clindamycin: gram pos > neg
-alt for beta-lactam allergy or MRSA
Vancomycin: Gram positive
-alt for beta-lactam or MRSA
What Sx would we use Vancomycin for?
distal ilium
-colon
-appendix
What Sx/infections would we use Clindamycin for?
infections: head/neck
-respiratory tract
-bone
-soft tissue
-abdomen
-pelvis
Sx: hysterectomy
-appendectomy
-gastroduodenal tract
-biliary tract
-small intestine
-colon
-rectum
What is my dosing for Cefazolin?
Adult: 2g
-3g if >120 kg
Pediatric: 30 mg/kg
give over 30 minutes
What is my dosing for Clindamycin?
Adult: 900 mg
Pediatric: 10 mg/kg
give 30-60 mins
What is my dosing for Vancomycin?
Adult: 15mg/kg
Pediatric: 15mg/kg
Give 15mg/min
