preparation for surgery

Question 1

elective prep

Answer 1

Consider pre admission clinic to address medical issues.
Blood tests including FBC, U+E, LFTs, Clotting, Group and Save
Urine analysis
Pregnancy test
Sickle cell test
ECG/ Chest x-ray

Question 2

oral fluids and fasting

Answer 2

patients having surgery may drink clear fluids until 2 hours before their operation

drinking clear fluids before the operation can help reduce headaches, nausea and vomiting afterwards

clear fluids are water, fruit juice without pulp,
coffee or tea without milk and ice lollies

Question 3

rule of thumb for diabetes

Answer 3

good glycaemic control (HbA1c < 69 mmol/mol)

(surgery requiring a long fasting period of more than one missed meal) or whose diabetes is poorly controlled, will usually require a variable rate intravenous insulin infusion (VRIII)

Question 4

what to do with metformin day of surgery?

Answer 4

take as normal

if take 3 doses omit afternoon dose

Question 5

what to do with sulfonylureas on day of morning surgery

Answer 5

If taken once daily in the morning - omit the dose that day

If taken twice daily - omit the morning dose that day

Question 6

what to do with sulfonylureas on day of afternoon surgery

Answer 6

If taken once daily in the morning -
omit the dose that day

If taken twice daily - omit both doses that day

Question 7

what do you do with DPPIV inhibitors (-gliptins) and GLP-1 analogues (-tides) on day of surgery

Answer 7

take as normal

Question 8

what do you do with SGLT-2 inhibitors (-flozins) on day of surgery?

Answer 8

omit

Question 9

what to do with once daily insulins (e.g. Lantus, Levemir)?

Answer 9

reduce dose by 20% the day before, on the day of surgery

Question 10

what to do with biphasic or ultra long acting insulins (Novomix, Humulin M3)

Answer 10

nose dose change the day before

on day halve the morning dose and leave evening dose unchanged