Pre-Op management

Question 1

Management of fasting

Answer 1

• No food up to 6hrs before
• Clear fluids only up to 2 hrs before

Question 2

Drugs to stop prior to surgery

Answer 2

CHOW
* Clopidogrel - 7 days, aspirin and other antiplatelets can often be continued
* Hypoglycaemics
* OCP or HRT - stop 4 weeks before due to DVT risk
* Warfarin - stop 5 days before and commence therapeutic LMWH

DOACs will need to be stopped too but depends on type as to when

Question 3

What happens if after stop warfarin INR is still 1.5 or above?

Answer 3

• Surgery will only go ahead if less than 1.5
• May need to reverse wtih PO vitamin K

Question 4

Drugs to alter prior to surgery

Answer 4

• Subcutaenous insulin - may be switched to VRIII
• Long term steroids - must be continued, if cannot take orally switch to IV (5mg PO pred = 20mg IV hydrocortisone)

Question 5

Drugs to start before surgery

Answer 5

• LMWH - completed VTE assessment
• Anti-embolic stockings - some patients have IPC flowtrons during op
• Antibiotic prophylaxis

Question 6

How does management of diabetic patient differ to others?

Answer 6

• Should be first on list - avoid prolonged fasting
• Check blood glucose regularly during op

Question 7

Bowel preparation - what is this?

Answer 7

• Laxatives or enemas to clear colon out pre-op

Question 8

When is bowel prep used?

Answer 8

• Upper GI, HPB or small bowel - NONE
• Right hemi - NONE
• Left hemi, sigmoid colectomy, abdominal perineal resection - phosphate enema morning of surgery
• Anterior resection - 2 sachets picolax day before