Preparation For Surgery - pre-operative care Flashcards
Preparation for surgery regarding oral fluids/food
- fasting for 6 hours
- clear fluids for 2 hours
What is classified as clear fluids?
- water
- juice without pulp
- coffee or tea without milk
- ice lollies
Preparation for surgery regarding oral anti-diabetic medications
- SGLT2 inhibitors: stop day of surgery
- sulfonylureas: stopped until pt is E+D
- metformin: take as normal?
General Preparation for surgery regarding oral anti diabetics drugs
- continue with normal regime: patients with insulin who have good glycemic control + minor producers,
- variable rate IV insulin infusion: if poorly controlled or surgery requiring long fasting period
- most pts on oral anti diabetic drugs managed by manipulating meds on day of surgery
When should warfarin be stopped before surgery?
5 days before
What is bridging?
Putting high risk patients on LMWH whilst stopping warfarin before surgery, then stopping LMWH 24 hours before surgery
When is bridging needed?
If high risk for thrombosis
Mechanical valve replacement , AF with CHADVASC score >4 or VTE within last e months or recurrent VTE
What should you do if a patient needs emergency surgery but is on warfarin?
Based on how long you can wait before surgery is needed
- 5 hours?: IV vitamin K
- 50 mins: Beriplex prothrobin complex concentrate
- 15 mins?: FFP - contains the clotting factors that warfarin inhibits
When should DOACs be stopped before surgery?
- 24 hours before if low bleeding risk surgery
- 48 hours before if high bleeding risk surgery
Reversals of DOACs
andexanet alfa for Xa inhibitors
idarucizumab for dabigatran
Preparation for surgery regarding aspirin
Continue in most cases
Stop 7 days before high risk surgeries
Preparation for surgery regarding antiplatelets
- clopidogrel/prasugrel: stop 7 days before
- ticagrelor: stop 5 days before
Preparation for surgery regarding long term steroid use
- Additional to IV hydrocortisone
- Doubling normal dose once they are E+D for 24 hours
Preparation for surgery regarding ACEi/ARBs + why
Stop 24 hours before surgery
Associated with severe hypotension after induction of anaesthesia
Preparation for surgery regarding COCP + HRT
Stop 4 weeks before surgery
What score is used to assess VTE risk?
Modified AUTAR score
General VTE risk reduction principles
- limit starvation
- adequate hydration
- care during positioning
- early mobilisation
Preparation for surgery regarding LMWH
Stop 12-24 hours depending on dose
Therapeutic dose -24 hours
Prophylaxis dos - 12 hours
Reversals of LMWH + UFH
Protamine sulphate
Little reversal in LMWH
ASA grades
- ASA I: normal healthy patient
- ASA II: mild systemic disease
- ASA III: severe systemic disease
- ASA IV: severe systemic disease that constantly threatens life
- ASA V: expected to die without operation
- ASA VI: declared brain dead pt whose organs are being removed for donor
What mild systematic disease would make a patient ASA II?
- smoker
- social alcohol drinker
- pregnancy
- BMI 30-40
- well controlled diabetes/hypertension
- mild lung disease
What severe systematic disease would make a patient ASA III?
- poorly controlled diabetes/hypertension
- COPD
- BMI >40
- active hepatitis
- alcohol dependence
- pacemaker
- ESRD on regular dialysis
- history >3 months MI
What severe systematic disease that is a constant threat to life would make a patient ASA IV?
- recent (<3 months) MI
- ongoing cardiac ischaemia or severe valve dysfunction
- sepsis
- DIC
- ERSD without regular dialysis
What is Group and save?
Sending off a sample of pt blood to establish blood group
No blood is assigned to pt
