Pre-Op Assessment

Question 1

do all theatre patients require a group and save

Answer 1

not if a low risk proceudre

Question 2

NSIADS have a strong …… side effect profile

Answer 2

GI

Question 3

what are the two main cardiac drugs that should be stopped before surgery

Answer 3

anticoagulants

ACEI

Question 4

why do ACEI need to be stopped before surgery

Answer 4

they have the potential to contribute to renal failure and hypotension in teh acute setting

Question 5

Should patients take their tablets on the day of surgery even if they should be fasted

Answer 5

yes take with a small sip of water

Question 6

What investigatiosn to patients get in the preassessment clinic

Answer 6

FBC cardiac history U and E LFTs check for cholestasis ECG INR coag screen group and save

Question 7

when should warfarin be stopped before surgery

Answer 7

5 days preop

INR checked the day before to allow for correction if necessary

Question 8

what INR level is okay for surgery to go ahead

Answer 8

<1.5

Question 9

what should you do if the INR is 1.6/1.7

Answer 9

administer 1mg oral vitamin K

Question 10

what should you do if the INR is above 1.8

Answer 10

administer 2mg oral vitamin K

Question 11

which surgeries have an exception to the INR rules

Answer 11

dental work, cataract, endoscopy ERCP and biliary stenting (INR up to 2.5)
urological procedures (INR up to 2)

Question 12

when should clopidogrel be stopped prior to surgery

Answer 12

7 days preop - if the patient has a stent then this should be discussed with a cardiologist

Question 13

when do you restart warfarin after surgery

Answer 13

if no excess bleeding post op then start on day of procedure on maintenance dose

Question 14

what should be done as VTE prophylaxis

Answer 14

Heparin

Question 15

when do you recheck teh INR after surgeyr

Answer 15

48 hours

Question 16

which patients are considered high risk

Answer 16

afib or valvular heart disease which have been complovated with a previous arterial thrombotic event
a VTE less than 3 mths ago
a mechanical non bioprosthetic heart valve
multiple heart valve replacements

Question 17

describe the preop management of an insulin dependent diabetic

Answer 17

look for cardiac renal and neuro sequelae of diabetes - look for comrobidities - check they have had their eyes screened in the last year - measure HBA1C

Question 18

what is the tagrget hba1c prior to surgery

Answer 18

below 75

Question 19

why do you need to control sugars during surgeyr

Answer 19

hypoglycaemia - irreversible brain damage

hyperglycaemia - wound infection and cardiac complications

Question 20

if a long operation what should an insulin dependent diabetic get

Answer 20

50 units of act rapid in 50mls saline (1unit/ml) and infused at a rate according to teh sliding scale protocol and the blood glucose, 10% glucose with with KCL 10mmol/l

Question 21

are diabetics given insulin during a short minor op

Answer 21

no