Pre-Op Assessment Flashcards
do all theatre patients require a group and save
not if a low risk proceudre
NSIADS have a strong …… side effect profile
GI
what are the two main cardiac drugs that should be stopped before surgery
anticoagulants
ACEI
why do ACEI need to be stopped before surgery
they have the potential to contribute to renal failure and hypotension in teh acute setting
Should patients take their tablets on the day of surgery even if they should be fasted
yes take with a small sip of water
What investigatiosn to patients get in the preassessment clinic
FBC cardiac history U and E LFTs check for cholestasis ECG INR coag screen group and save
when should warfarin be stopped before surgery
5 days preop
INR checked the day before to allow for correction if necessary
what INR level is okay for surgery to go ahead
<1.5
what should you do if the INR is 1.6/1.7
administer 1mg oral vitamin K
what should you do if the INR is above 1.8
administer 2mg oral vitamin K
which surgeries have an exception to the INR rules
dental work, cataract, endoscopy ERCP and biliary stenting (INR up to 2.5) urological procedures (INR up to 2)
when should clopidogrel be stopped prior to surgery
7 days preop - if the patient has a stent then this should be discussed with a cardiologist
when do you restart warfarin after surgery
if no excess bleeding post op then start on day of procedure on maintenance dose
what should be done as VTE prophylaxis
Heparin
when do you recheck teh INR after surgeyr
48 hours
which patients are considered high risk
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
describe the preop management of an insulin dependent diabetic
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
what is the tagrget hba1c prior to surgery
below 75
why do you need to control sugars during surgeyr
hypoglycaemia - irreversible brain damage
hyperglycaemia - wound infection and cardiac complications
if a long operation what should an insulin dependent diabetic get
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
are diabetics given insulin during a short minor op
no
