Pre-operative Care Flashcards
How do you monitor this medication pre-op?
Digoxin
Check U&Es regularly
How do you monitor this medication pre-op?
Diuretics and ACEi
Continue but measure U&Es regularly.
How do you alter this medication pre-op?
COCP
Stop 4 weeks pre-op as increased leg DVT risk, do not take 2 weeks post-op.
What ASA grade is this describing?
Healthy, non-smoking, no/minimal alcohol use.
I
What ASA grade is this describing?
Smoker, social alcohol, pregnancy, BMI between 30-40, well controlled DM, HTN, mold lung disease.
II
What ASA grade is this describing?
Poorly controlled DM, HTN, COPD, BMI >40, active hepatitis, alcohol dependence, pacemaker, ESRD with dialysis, >3 months since MI/CVA.
III
What ASA grade is this describing?
Recent (<3 months) MI/CVA, cardiac ischaemia, severe valve disease, sepsis, DIC, ESRD not undergoing dialysis.
IV
What ASA grade is this describing?
Ruptured AAA, massive trauma, intra-cranial bleed, ischaemic bowel and significant cardiac pathology, multiple organ dysfunction.
V
What ASA grade is this describing?
Brain dead patient whose organs are being removed for donor purposes.
VI
How do you manage a patient pre-op with these recent co-morbidities?
- MI
- HTN
- Valvular HD
- Delay op by 6 months, if you cannot then consider risk/benefit. Stent may reduce waiting time.
- Control as increased risk of MI/stroke during op. If DBP >110mmHg then cancel op.
- Echo and stop warfarin 3d pre-op. Abx (amoxicillin) prophylaxis.
How do you manage a patient pre-op with these recent co-morbidities?
- U/LRTI
- COPD
- Delay 6w as risk of spread of infection under GA.
2. Smoking cessation 8w pre-op + nebs + physio
What are the things to consider in an obese patient pre-op?
- Respiratory difficulties - intubation, aspiration and atelectasis (incomplete alveolar gas exchange due to partial collapse of fluid consolidation)
- Encourage weight loss pre-op
- Consider obstructive sleep apnoea (can cause pulmonary hypertension)
