pre-operative assessment

Question 1

pre-op anaemia

Answer 1

associated with increaces hosp stay, inc morbid and mortal.

should be picked up and treated with oral iron beforehand, if less than 4 weeks to surgery treat with iv iron.

use threshold of 70g/l - needs transfusion

80 and symptomatic - transfusion.

can always check ferritin- if less than 30– Iron def anaemia.

Question 2

what drugs to stop before surgery and when

Answer 2

CHOW

clopidogrel- 7 days before surg (aspirin is ok)

Hypoglycaemics- e.g insulin- switch to variable rate infusion. on another card

oral contraceptive- stop 4 weeks before surgery- same with HRT (DVT risk)

warfarin- stop 5 days before surg.
INR NEEDS to be below 1.5- may need to reverse evening dose.

other things to consider- double hydrocortisone if on addisons treatment.

dont suddently stop steds- use IV

Question 3

investgiations to order before surgery, how long should people fast for before surg

Answer 3

HBA1C if considering DM

ECG if hx of CVD
ECHO- if hx of heart murmur, cardiac symptoms or heart faliure

cross match blood.
pregnancy test

6hrs no food, tea coffie, dairy
2 hrs clear liquids.

Question 4

diabetic control in surgery

Answer 4

night before- reduce basal subcut by 1/3

day of surgery- omit morning dose, commence IV variable rate.

whilst NBM- 125ml hr 5% dextrose

check bm 2hrly.

continue untill eating drinking talking, overlap the regemes slightly.

20mins before meal subcut insulin, + stop Iv infusion 30-60 after a meal.

t2dm
stop metformin morning of surg
all others 24hrs before surg

put onto IV variable rate insulin.

Question 5

considerations for anaesthesia in valvular heart disease

Answer 5

avoid over or under filling

keep hr slower to allow for filling

epidural prefered over spinal anaesthesia as slower onset.

avoid brady as this worsens regurgitent flow.

avoid spinal anaesthesia in pulmonary stenosis.