Preoperative care

Question 1

FBC

Answer 1

Emergency preop
elective preop >60yrs
elective Females
significant blood loss likely

Question 2

U/E

Answer 2

Preop >65
Urinanalysis positive
Cardiopulmonary/renal disease

Question 3

Contraindications to day surgery

Answer 3

ASA>II
obese BMI>35
>1hr op
operation/pathology
>1 hour distance from hospital
No one to look after at home
No suitable home to return to

Question 4

Preoperative steroid care

Answer 4

Minor use: 50mg hydrocortisone IM/IV
Intermediate use: 50mg hydrocortisone IM/IV with pre-med and 50mg Hydrocrotisone every 6hrs for 24hrs
Major use: 100mg hydrocortisone IM/IV with pre-med and 100mg hydrocortisone every 6hrs for 72 hrs after surgery

Question 5

Warfarin

Answer 5

vit ki reverese 10mg IV
stop 3-5 das before surgery and replace with heparin
INR <1.5 for invasive surgery

Question 6

Heparin

Answer 6

unfract
fractionated (LMWH)-only inhibits FXa
reverse by protamine

Question 7

Antiplatelet agents (aspirin, dipyridamole, clopidogrel, abciximab)

Answer 7

stop 7-14 days before surgery

Question 8

Fibrinolytics

Answer 8

Streptokinase and alteplase

acts by converting plasminogen to plasmin

Question 9

What patient require perioperative steroid cover?

Answer 9

Patients on >7.5mg for >1 week before surgery

Had a course of steroids within 6month

Question 10

Cardiac effects of GA

Answer 10

Systemic vascular resistance is reduced (induction reduces arterial pressure)
Intubation reduces blood pressure
Myocardial depression (>inhaled cf IV)
Increased cardiac irritability due to released catecholamines

Question 11

Hypertension before surgery

Answer 11

Diastolic >110mmHg review before surgery

Preop antihypertensives should continue

Question 12

AS

Answer 12

assess with echo
13% perioperative death
50mmHg gradient indicates critical AS

Question 13

MS

Answer 13

Predisposes to pulmonary hypertension
Right cardiac failure
Must be given prophylactic antibiotics

Question 14

AF

Answer 14

Always use bipolar diathermy if possible

Question 15

COPD

Answer 15

FEV1/FVC <50% risk of post op resp failure is increased
Give preop nebulisers
regional anaesthesia in lower extremity surgery
NO can rupture bullae-use opioids without resp depression

Question 16

Effect of anaesthetic agents

Answer 16

Increase ventilatory dead space
Reduce functional residual capacity
increase airway resistance and lung compliance
Atelectasis

Question 17

HbA1c

Answer 17

8 poor control

Question 18

NIDDM control

Answer 18

Continue normal oral hypoglycaemic agents until the morning of surgery apart from metformin nad chlorpropamide (may need to reduce or stop 48hrs before due to lactic acidosis)

Postop sliding scale

Question 19

IDDM

Answer 19

Admit night before
Sliding scale morning of surgery
restart regular insulin once patient is eating and drinking

Question 20

Preoperative jaundice

Answer 20

Attempt to treat beforehand
Hydration
PT time and give vit k 10mg daily (max effect achieved after 3 doses) or FFP within 2 hours post surgery
If surgery involved biliary tree prophylactic antibiotics to prevent cholangitis

Question 21

Upper GI surgery feeding

Answer 21

Feeding jejunostomy

water contrast study on day 10 of high risk anastomoses before oral feeding

Question 22

Maxillofacial and pharyngeal surgery

Answer 22

Gastrostomy tube