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Surgery > Preoperative Preparation > Flashcards

Preoperative Preparation Flashcards

1
Q

Complications during past surgery and anesthesia to be asked during history

A

1- intraabdominal adhesions
2- suxamethonium apnea
3- family history of problems with apnea

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2
Q

Laparoscopic procedures are inappropriate in which patients

A

Those who cannot tolerate
1- pneumoperitoneum
2- head down positioning

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3
Q

Infections to be checked and treated in the preoperative period

A

1- infected toes
2- pressure sores
3- teeth
4- urine (if surgery is not elective but emergent give antibiotics and maintain urine output throughout)
5- chest infections (delay elective surgery for 4-6 weeks)

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4
Q

Prep investigations to be done in all patients

A

1- FBC
2- sickle cell trait in patients of afrocarribean origin
3- urea and electrolytes
4- urinalysis (dipstick test)

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5
Q

In which patients preop ECG is done

A 
Patients over the age of 60 
Cardiovascular 
Renal 
Cerebrovascular involvement 
Diabetes 
Patients with severe respiratory problems
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6
Q

Preop management of patients with systemic disease

A

1- check baseline organ function capacity
2- optimisation
3- alternative
4- theatre preparations

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7
Q

Echo is done in which patients

A

Symptomatic valvular disease or poor left ventricular output

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8
Q

Critical ejection fraction

A

Less than 30 percent

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9
Q

Refer patient to cardiologist if

A

1- murmur and patient is symptomatic
2- poor left ventricular output or known cardiomegaly
3- silent MI on ecg
4- abnormal rhythm on ecg

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10
Q

Blood pressure ideal for surgery

A

160/90

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11
Q

New antihypertensive should be given how much time

A

Atleast 2 weeks

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12
Q

How long to delay surgery after MI

A

3-6 months

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13
Q

How long to delay surgery after stent placement

A

After the stoppage of dual antiplatelet therapy
1- 6 weeks in metal stent
2- 12 months in drug eluting stent

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14
Q

If surgery cannot be postponed can antiplatelets be continued during it

A

Yes.
Better to discontinue clopidogrel
And continue aspirin.
But if possible stop aspirin 7 days before and clopidogrel 10 days before

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15
Q

How long before surgery should warfarin be stopped (patients of A fib, mechanical heart valves)

A

Atleast 5 days.

Unfractionated heparin is given in this time period and it is also discontinued 2 hours before surgery

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16
Q

Consequences of the use of bipolar diathermy in pacemaker patients

A

Pacemaker detects it as ventricular fibrillation. So turn pacemaker off preoperatively or set it to VOO mode(ventricle pacing. Not sensed with no response to sensing)

17
Q

If patient found to have heart block preoperatively

A

Temporary pacemaker insertion is required

18
Q

Jehovah’s Witness and blood transfusion alternatives

A

1- cell salvage

2- reinfusion from drains

19
Q

Asthmatic Patients prior to surgery require

A

Additional dose of bronchodilators and additional steroid coverage (esp if already taking 10 mg or more of prednisolone) and are ‘Brittle asthmatics’

20
Q

Critical FEV1

A

Less than 30 percent

21
Q

Can patients still take medications in the NPO period

A

Yes with sips of water

22
Q

Which patients are at extra risk of pulmonary aspiration despite NPO

A 
Hiatus hernia patients 
Obese 
Pregnant 
Diabetes 
(Give them antacids, h2 blockers and omeprazole)
23
Q

Preop prep of renal disease patients

A

Acidosis
Hypocalcemia
Hyperkalemia of greater than 6mmol/l need to be corrected

24
Q

Patients on dialysis before surgery

A

Dialysis should be discontinued a few hours before surgery and after last dialysis send patient for FBC and urea and electrolytes

25
Q

Acute renal failure patients undergoing surgery

A

Concomitant medical and surgical management

26
Q

Management of malnutrition before surgery

A

BMi less than 15. Give nutritive support for 2 weeks.
BMi greater than 35. ask patients to reduce weight. Check for sleep apnea via perioperative sleep apnea prediction scoring. Give CPAP device

27
Q

Diabetic patients going for surgery

A

Check blood sugar every 2 hours.
Put them first on list.
If morning surgery. Skip breakfast and morning dose.
If evening surgery. Breakfast with half dose of insulin or full dose of oral antidiabetic drugs can be given

28
Q

Can you give contraceptive pills in the perioperative period

A

Progerestone only. Yes
Combined. Do risk benefit analysis.
HRT stop 6 weeks before surgery.

29
Q

Risk factors for thrombosis during surgery

A 
1 - age greater than 60 
2- BMi greater than 30 
3- anesthesia for greater than 90 minutes 
4- reduced mobility for 3 days 
5- pregnancy 
6- varicose veins 
7- contraceptive pills 
8- known active cancer 
9- deficiency in antithrombin 3. Protein C or S
30
Q

Which neurological medications can be given perioperatively

A

Anticonvulsants

Antiparkinson drugs

31
Q

Which psychiatric medication has to be discontinued

A

Lithium atleast 24 hours before and check blood levels to exclude toxicity.
If patient is on tricyclics or monoamine oxidase inhibitors inform anesthesia as these may interact

32
Q

Preoperative preparation in rheumatoid arthritis patients

A

There is possibility of spinal cord injury during intubation so get flexion and extension lateral cervical spine x rays

33
Q

Problems likely to be encountered in anklyosing spondylitis patients preoperatively

A

Spinal or epidural anesthesia can be challenging

34
Q

SLE patients in surgery

A

Increased risk of thrombosis and airway obstruction

35
Q

Risk of death

A

Doubles with every 7 years of life lived.
MI. Heart failure. Stroke. Peripheral vascular disease. Renal failure. Each independently increases risk of death by 1.5 times.

36
Q

Gillicks competence

A

Patients under 16 who seem to understand the risks of surgery and are deemed competent for consent

37
Q

Which patients should be prioritised on the list

A

Children
Diabetics
Life and limb threatening surgery
Cancer patients

38
Q

Consent - LED TO REASON

A 
Lead on 
Explore
Diagnosis
Treatment 
Options 
Results 
Eventualities 
Adverse events 
Sound mind 
Open questions
Notes

Surgery (10 decks)

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