Pre-op preparation Flashcards
Types of transfusion preparations
RBC
- Additive solutions
- Washed
Platelets
- Bleeding out/ thrombocytopenia
Fresh frozen plasma
- Clotting factor deficiency
Cryoprecipitate
- More concentrated for clotting factors
- For: DIC, severe liver disease low fibrinogen
Transfusion indications
Severe anaemia
- <70 Hb, consider with <80.
Severe bleeding
Blood
Compatibility procedures
Pre-transfusion sample
- Determines blood group (ABO, Rh, alloantibodies)
Group and save
- Two samples,
Life threatening transfusion reactions
Acute haemolytic reactions
Allergic rection/ anaphylactic
Transfusion related lung injury
Hypotensive reactions
Transfusion of blood containing bacteria
Delayed transfusion reactions
Delayed haemolytic transfusion reactions
Transfusion-associated graft-vs-host disease
Alternatives to transfusion for surgical procedures
IV/ oral iron
Cell salvage, tranexamic acid
- If minor blood loss expected
- Cell salvage for high blood loss expected
Major haemorrhage definition
Loss of blood 70mL/ kg
- > 5 L in 70kg adult
- 50% of total blood volume loss in less than 3 hours
- Bleeding in excess of 150mL/ min
- Bleeding that leads to BP <90, HR >110
Preparation and anaesthesia for gastroscopy
Starvation for 4h before procedure
Local anaesthesia
- Lidocaine throat spray
- IV midazolam sedation
Risk and complications of gastroscopy
Oesophageal perforation
- 1:3000, highest in elderly
Bleeding
Respiratory depression/ arrest
- Sedative, esp in the elderly and frail.
Preparation and anaesthesia for ERCP
NIL for 4 hrs pre-procedure
- LFTs and INR needed before procedure
Local anaesthetic
- Lidocaine throat spray
- IV midazolam sedation
- Analgesia may be used: fentanyl, pethidine
- May be done under GA
ERCP complications
Perforation (1:1000)
- Oesophagus
- Duodenum
Pancreatitis, cholangitis
Respiratory depression/ arrest
Bleeding
