pre operative complications Flashcards
does cortisol agonist or antagonist insulin?
antagonist insulin
what tests should be done for a diabetic before surgery?
dipstick for proteinuria
venous glucose
K levels
how should insulin be altered for IDDM?
stop long acting insulin the night before and don’t give insulin in the morning if surgery is in the morning
start a sliding scale
what is a sliding scale for insulin for IDDM?
5% Dex with 20mmol KCl 125ml/hr
start infusion pump with 50units of actrapid with checking capillary plasma glucose hourly with adjusting the rate of infusion
what is the aim of hourly plasma glucose with the sliding scale ?
7-11mM
after the operation how should IDDM be managed?
continue the sliding scale until they can tolerate food
is diet controlled diabetes usually a problem with surgery
no
what are some risks of being on steroids during surgery ?
poor wound healing
infection
adrenal crisis
what is the management of steroid use during surgery ?
increase steroid dosage
major surgery - hydrocortisone 50mg IV6-8hrs for 3 days
minor - same but only for one day
what are the risks of operating on a jaundice patient ?
can increase risk of post op renal failure (need to maintain good urine output)
coagulopathy
increase infection risk
what should be done pre op for a jaundice patient ?
avoid morphine
check clotting and consider Vitamin K
urinary catheter to measure urine output
abx prophylaxis (cef+met)
when should aspirin and clopidogrel be stopped before surgery ?
7 days before
for high thromboembolic risk patients when should warfarin be stopped?
stop warfarin 5days pre op and start LMWH stop LMWH 12 hrs before surgery restart LMWH 6 hrs post op restart warfarin the next day stop LMWH when INR >2
what is the risks of COPD and smoking for surgery ?
basal atelactesia
aspiration
chest infection
