pre operative assessment Flashcards
why does obesity pose increased anaesthetic risk
why does diabetes pose increase anaesthetic risk
when should you stop warfarin
if possible stop 4 days pre op
aim for INR< 1.2-1.5
speak to haematology/whoever started the warfarin to ensure it can be safely stopped
what should you do in an emergency surgery if the patient is on warfarin
urgent: vitamin K 1-2mg PO
emergency: FFP 2-4 units +/- prothrombinex approx 2000U, vitamin K 5-10mg IV
when should you stop unfractionated heparin
usually stopped 4-6 hours before surgery or regional anaesthesia
has a half life 1-2 hours
what antagonises heparin
IV protamin
1mg antagonises 100U heparin
when should you stop LMWH
needs to be stopped 12 hours before or 24 hours for high dose
when should you stop aspirin
low dose aspirin is usually not a contraindication
high dose should be stopped 3-4 days prior
when should clopidogrel be stopped before surgery
very dangerous to stop this without consulting cardiology because this is usually a continuous medication after coronary stenting
should be stopped 7 days prior to RA
patients on steroids
there is elevated production of endogenous cortisol during stress (surgery)
patients on prednisolone have this increased production suppressed at the adrenal glands
this may cause addisonian type crisis
what should you do for patients on steroids
if on steroids within the last three months, add hydrocortisone to their routine steroids as prophylaxis
considerations for patients on SSRIs
avoid pethidine and tramadol
risk of serotonin syndrome
symptoms of serotonin syndrome
agitation, hyperreflexia, pyrexia, unstable BP, rhabdomyolysis, renal failure, death.
how long should a patient stop smoking before surgery
12 hours before surgery
why do patients need to stop smoking for 12 hours
to normalise carbon monoxide levels in the blood
this is back to normal after about 12 hours
what are the anaesthetic risks for smoking patients
increased CO concentration
increased HR, BP, vasoconstriction
hypercoagulability
mucus hyper secretion
increased analgesic requirements
immmunosupression
what should you do for patients with sleep apnoea
they should bring their sleep apnoea machines
essential things to prep before surgery
- keep warm
- keep hydrated - use IV drip
- rectify anaemia or coagulopathy
- keep BSL normal - consider dextrose/insulin
- try to keep normotensive (normal for individual patient
- continue all usual medication other than anti-diabetic drugs
- investigations: FBC, U+E, BSL, coags, ECG (if >50years or Hx)
should you stop statins before surgery
no
should you stop opioids or antihypertensives before surgery
no
