Pre Op Care + Drugs

Question 1

Things to check in the Hx pre-op?

Answer 1

• Cardioresp system, existing illness, drugs, allergens
• Ask for: MI, diabetes, asthma, HTN, Epilepsy, Rheumatic fever, jaundice
• Specific risks: Pregnant? Neck stability? Teeth?
• Past anesthesia? any complications?

Question 2

What is helpful from the family history in anaesthetic preop?

Answer 2

• Malignant Hyperthermia
• Dystrophia myotonia
• Porphyria
• Sickle cell

Question 3

What effect can Abx have in ops?

Answer 3

Tetracyclines and neomycin may increase neuromuscular blockade

Question 4

What effect can anticoagulants have in ops?

Answer 4

Should avoid epidural, spinal and regional blocks
Aspirin probs continue unless massive bleeding risk
Clopidogrel discuss with specialist

Question 5

What should happen with anticonvulsants in ops?

Answer 5

Give as normal preop, IV post op until able to take PO. Phenytoin should be given slowly

Question 6

B-Blocker use periop?

Answer 6

continue as can help prevent labile cardiac response

Question 7

OCP use periop?

Answer 7

Stop 4 weeks before, restart 2 weeks after if patient mobile

Question 8

Digoxin use preop?

Answer 8

Continue but check for toxicity. check K+ and Ca2+ as suxamethonium can increase k+ and lead to arrhythmias

Question 9

Diuretics use periop?

Answer 9

Beware hypokalaemia and dehydration

Question 10

Eyedrops use periop?

Answer 10

B blockers are absorbed systemically so beware

Question 11

L dopa use periop?

Answer 11

Can cause arrhythmias under GA

Question 12

Lithium use periop?

Answer 12

Get help. Can cause arrhythmia and potentiate neuromuscular blockade

Question 13

MAOIs use periop?

Answer 13

Can cause hyper/hypotensive crises

Question 14

How long should pts be NBM?

Answer 14

2 hours clear fluids

6 hours solids

Question 15

What DVT prophylaxis can be used?

Answer 15

Stockings

Enoxiparin 20mg SC OD, 40mg if major risk

Question 16

What other prep may be needed pre op?

Answer 16

Write up prophylactic abx if needed
arrange imaging/physio post op
dvt prophylaxis
skin/bowel prep?

Question 17

What tests may be indicated preop?

Answer 17

U+Es, FBC, BM as standard usually
Group and save/cross match depending on op
LFT in jaundice, malignancy, alcohol
Clotting if liver disease, renal disease, DIC, valproate warfarin, heparin
Drug levels on digoxin/lithium
CXR,ECG,Echo, Pulm. fx as indicated
Spine xray if RA, ANK SPond, Downs
MRSA Screen

Question 18

is MRSA colonisation an abs C/i?

Answer 18

No, operate last and cover with vanc

Question 19

what is ASA grading?

Answer 19

1-normal
II- mild systemic disease
III- Systemic disease that is not incapacitating
IV- Systemic disease that presents threat to life
V Moribund, will not survive 24hr even with op