Pre-operative Flashcards
What do NICE guidelines recommend for pregnancy testing and preoperative investigations?
On the day of surgery, all women of childbearing potential should be asked about the possibility they could be pregnant. Make sure those who are possibly pregnant are aware of the risks to the fetus and discuss about whether to carry out a pregnancy test.
What do NICE guidelines recommend for sickle cell disease/trait tests pre-operatively?
Ask the patient whether there is FH of sickle cell disease as testing is not routinely done pre-operatively. If the person is known to have SCD, then liaise with their specialised team before surgery.
Why is sickle cell and anaesthesia risky?
Associated with vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury.
What do NICE guidelines recommend about HbA1c testing for non-diabetics pre-operatively?
Not recommended.
What do NICE guidelines recommend about HbA1c testing for diabetics pre-operatively?
Offered to patients if their HbA1c has not been tested in the last three months.
Why are diabetics at risk in surgery?
Greater risk of post-operative infection and cardiac problems.
How are diabetics managed pre-operatively?
- Aim to achieve below 69 mmol/mol HbA1c
- Try to place patients first on list to minimise the fasting period (NBM)
- If diabetes is insulin treated, give all insulin the night before surgery
- If tablet-treated, give patient usual medications the night before surgery except those that cause prolonged hypoglycaemia e.g., sulfonylureas.
What do NICE guidelines recommend about urine tests pre-operatively?
Only considered if the presence of a UTI would influence the decision to operate e.g. in frail elderly.
What do NICE guidelines recommend about X-rays pre-operatively?
Not routinely offered.
What do NICE guidelines recommend about ECGs pre-operatively?
Considered if patient has a heart murmur AND any cardiac symptom (including breathlessness, pre-syncope, syncope or chest pain), OR signs or symptoms of heart failure.
Pre-operative management of patients on anticoagulants? (x4 parts)
Tell the surgeon as risk/benefit must be individualised. Avoid epidural, spinal, and regional blocks. Aspirin should probably be continued unless there is a major risk of bleeding. Warfarin can be continued in minor surgery but should be stopped 3-5d pre-op for major surgery.
What should you do to re-warfarinize patients?
Initially give LMWH as warfarin is initially prothrombotic.
Pre-operative management of patients on B-blockers?
Continue up to and including the day of surgery as this prevents a labile (easily altered) cardiovascular response.
Pre-operative management of patients on Diuretics? (x2 parts)
Beware hypokalaemia and dehydration. Do U&Es (and bicarbonate).
How is hypertension managed pre-operatively?
Treat if over 160/90 – disease optimisation.