Pre-operative Flashcards
1
Q
Overview of pre-operative assessment
A
1. Summary core details Patient Operation Background 2. Current health Illness last 2 weeks Exercise tolerance Symptoms of sleep apnea Smoking stopped 6 weeks prior Obesity- 2 week crash diet 3. Medical conditions DM, CCF, COPD, IHD, asthma 4. Drug history 5. Anaesthetic 6. Examination/Diagnosis Neck movement, airway assessment inc Mallampati and note BMI Back General: GCS, movement, CV, Respiratory, Abdominal, hydration 7. Investigations Check previous + imaging inc FBC/INR/PLTs. Baseline: FBCm UEC, LFTs, clotting, G and H, urinalysis. Consider ECG >50, CXR, Echo, Spirometry 8. Documentation Regular medication Fluids, diabetic fluids if required (5% dextrose 1.2 NS? + KCL) Antibiotic prophylaxis Omit: ACEi, warfarin (clexane 5 days prior, cease warfarin), aspirin, clopidogrel, insulin, diuretics Paracetamol 500mg 4-6 hourly max 4g PRN, Codeine PRN 30-60mg 4 hrly, max 240, metoclopramide/ondansetron VTE prophylaxis: enoxaparin, TEDs Consent F/U bloods 9. Discussion with patient Ommision of medications Fasting 2-6 rules Staying in hospital Post-operative expectations 10. Discuss with surgeon, anaesthetics and theatre
2
Q
Post-operative general surgical patient review
A
1. Review notes Details Operation Plan 2. Check investigations Inflammatory Hb UEC Other relevant 3. Questions Any issues Eating and drinking Bowels opening, passing wind Pain Mobilising, pain in calf 4. Nursing charts Observations Fluid balance, oral intake Urine output NG/NJ output Drains 5. Tubes in situ Drains Wound catheters Urinary catheter Central line NG/NJ/TPN PCA 6. Examination Wound Drains Relevant systems 7. Review medications 8. Considerations Oral intake Analgesia Tubes Fluids/balance Nutrition Infection/post op Electrolytes Mobilising Medications Breathing 9. Document and plan
3
Q
Oral intake, step wise
A
- NGT/NJ tube with free drainage
- NGT with spigotted-> draining 2 hourly etc
- NBM
- Sips
- Prescribed fluids
- Free clear fluids
- Free fluids
- Soft
- Normal
- Encourage
4
Q
Specific requirements for specific groups during surgery: diabetes, steroids, liver
A
1. T1DM First on list NBM on night before Insulin sliding scale w/ 5% dextrose Check glucose Once post and eating- normal medication: stop sliding scale 30 minutes post meal 2. T2DM Stop short acting on day Stop long acting 3 days before Stop metformin 2 days before until 2 days post Other-as above 3. Long term steroids Liase with anaethetist->IV hydrocortisone 4. Liver Antibiotic prophylaxis IV dopamine renal dose Check clotting, have vit K Urine/fluid balance Nutrition 5. Stop OCP 4 weeks before, restart after 2 weeks and mobile 6. Stop aspirin and clopidogrel 5 days before unless liase with cardiologist 7. Warfarin Minor op: may continue, check INR Major->stop 2-5 days before, check INR Cover with enoxaparin, ensure have FFP and vit K in case INR ++ (emergency) 8. ACEi Stop 24 hours before
5
Q
Drugs not to be stopped during surgery
A
- Long term steroids
- Antiepileptic
- Antiparkinsons
- Antipsychotic
- Bronchodilators
- Glaucoma
- CV drugs aside from above
- Immunosuppressants
- Thyroid drugs
- Drugs of dependence
6
Q
Reversal of vitamin K if high INR for surgery
A
- Vitamin K
2. Thrombin X
