Pre-op Flashcards
When should the Oral contraceptive pill be stop before elective surgery and when can it be restarted?
Stop 4 weeks before
Restart 2 weeks after, provided the patient is mobile
When should Aspirin be stopped before elective surgery?
5 days before
When should aspirin not be routinely stopped before elective surgery?
If the patient has a recent (< 1 year) history of cardiac stents
Liaise with cardiologist and surgeon about risk
When should Clopidogrel be stopped before elective surgery?
5 days before
When should Clopidogrel not be routinely stopped before elective surgery?
If the patient has a recent (< 1 year) history of cardiac stents
Liaise with cardiologist and surgeon about risk
When should MAO-inhibitors be stopped before elective surgery?
Stop 4 weeks before surgery
Advise regarding lithium before surgery
Stop 24 hours before if major surgery, otherwise continue
Monitor U&Es if decide to keep patient on lithium during surgery
Advise regarding ACE-inhibitors and Angiotensin 2 Blockers before elective surgery
Stop 24 hours before surgery
Associated with severe hypotension on induction of anaesthesia
Advise regarding potassium sparing diuretics before elective surgery
Stop on morning of surgery
Risk of hyperkalaemia if there is renal impairment or significant tissue damage during surgery
Advise regarding Warfarin before elective surgery
Major surgery = stop 2-5 days pre-op - check INR
Minor surgery: may be able to continue – check INR pre-op, liaise with surgeon
Advise regarding medication of a Type 1 diabetic before elective surgery
Give an injection of the patient’s normal insulin on the night before surgery and then stop any further doses
Patient should be NBM on night before surgery
Make first on surgery list - use sliding scale
Advise regarding medication of a Type 2 diabetic before elective surgery
Stop short acting drugs on the day of surgery.
Stop long acting drugs 3 days before.
Stop metformin 2 days before until 2 days post-op
When should metformin be stopped before elective surgery and when can it be restarted?
Stop 2 days before
restart 2 days post op
How often should BM be monitored during surgery whilst the patient is on a sliding scale?
Take capillary glucose 2 hourly
When can diabetics resume their normal medications post op?
As soon as they start eating
apart from metformin - 2 days after
Recommended tests for an ASA I patient before minor elective surgery
No routine tests
Recommended tests for an ASA I patient before intermediate elective surgery
No routine tests
Recommended tests for an ASA I patient before major elective surgery
FBC
Consider: ECG - if over 65 and no ECG for 12 months
Kidney function for people at risk of AKI
Risk factors for AKI during elective surgery that may make you consider kidney function tests?
Over 65 eGFR < 60 ml/min/1.73m2 Diabetics Heart failure Liver disease Nephrotoxic drug use during pre op period Intraperitoneal surgery
Recommended tests for an ASA II patient before minor elective surgery
No routine tests
Recommended tests for an ASA II patient before intermediate elective surgery
No routine tests but consider:
ECG - if over 65 and no ECG for 12 months
Kidney function for people at risk of AKI
Recommended tests for an ASA II patient before Major elective surgery
FBC, Kidney function & ECG
Recommended tests for an ASA III or IV patient before minor elective surgery
No routine tests - but consider:
ECG - if over 65 and no ECG for 12 months
Kidney function for people at risk of AKI
Recommended tests for an ASA III or IV patient before intermediate elective surgery
Kidney function & ECG
Consider:
FBC - if new symptoms of CV or renal disease
Clotting screen - if chronic liver disease
Lung function - if known or suspected respiratory disease
