PSA 7+ Flashcards
What is the preoperative INR target for patients on warfarin undergoing surgery?
For most surgeries: INR <1.5.
For high bleeding risk surgeries: INR <1.2.
How do you bridge warfarin with LMWH before surgery?
Stop warfarin 5 days before surgery.
Start LMWH (e.g., enoxaparin 1 mg/kg twice daily) 2 days after stopping warfarin.
Stop LMWH 24 hours before surgery.
When should aspirin be stopped before elective surgery?
Usually 7 days before surgery unless otherwise indicated (e.g., for high-risk cardiac patients).
How do you adjust insulin for a diabetic patient undergoing surgery?
Convert to variable rate insulin infusion (VRII) with glucose-potassium-insulin (GKI) infusion during the perioperative period.
What is the prophylactic antibiotic regimen for colorectal surgery?
Cefuroxime 1.5 g IV and metronidazole 500 mg IV at induction.
When should DOACs (e.g., rivaroxaban) be stopped before surgery?
24 hours before low-risk surgery.
48 hours before high bleeding risk surgery.
How do you manage a patient on steroids undergoing surgery (e.g., perioperative hydrocortisone)?
Double the usual daily dose of steroids for minor surgery.
For major surgery, give hydrocortisone 100 mg IV at induction, then 50 mg IV every 8 hours for 24 hours.
What is the dose of beta-blockers in a patient with stable ischemic heart disease undergoing surgery?
Continue the patient’s regular beta-blocker (e.g., atenolol 50 mg PO once daily).
What is the initial fluid bolus for hypotension during surgery?
500 mL of 0.9% sodium chloride or Hartmann’s solution over 15 minutes.
What is the management for hyperkalaemia detected during surgery?
Calcium gluconate 10% 10 mL IV over 5 minutes (to stabilize myocardium).
Insulin 10 units with 50 mL of 50% dextrose IV.
Salbutamol nebulizer 5 mg.
What is the dose of adrenaline in anaphylaxis during surgery?
0.5 mg IM (1:1000) every 5 minutes as needed.
How do you manage acute bradycardia during general anesthesia?
Atropine 0.5 mg IV, repeat every 3-5 minutes as needed (max 3 mg).
What is the dose of ondansetron for intraoperative nausea?
4 mg IV once.
What is the prophylactic dose of enoxaparin for DVT prevention post-surgery?
40 mg SC once daily (adjust for renal impairment).
How do you replace electrolytes (e.g., potassium) after surgery?
IV potassium chloride: Max rate 10 mmol/hour, diluted in saline or dextrose.
What is the dose of morphine for postoperative pain management in opioid-naïve patients?
5-10 mg PO every 4 hours PRN.
What is the duration of antibiotics for surgical site infections?
Typically 5-7 days, depending on severity and clinical response.
How do you manage postoperative nausea and vomiting?
Ondansetron 4 mg IV, or cyclizine 50 mg IV/PO every 8 hours PRN.
What is the maintenance fluid regimen for postoperative patients?
25-30 mL/kg/day water.
1 mmol/kg/day sodium, potassium, chloride.
50-100 g/day glucose.
How do you recognize and manage postoperative ileus?
Recognition: Absent bowel sounds, distension, no bowel movements.
Management: NBM, IV fluids, consider nasogastric decompression.
How do you treat postoperative urinary retention?
Insert a urinary catheter if unable to void within 6-8 hours post-surgery.
What is the antibiotic regimen for suspected perforated bowel?
Piperacillin-tazobactam 4.5 g IV every 8 hours.
How do you manage acute upper GI bleeding (e.g., PPI and fluids)?
IV omeprazole 80 mg bolus, then 8 mg/hour infusion.
IV fluids (0.9% saline or Hartmann’s).
What is the management of acute anaphylaxis postoperatively?
IM adrenaline 0.5 mg (1:1000).
IV fluids, antihistamines (chlorphenamine 10 mg IV).
Corticosteroids (hydrocortisone 200 mg IV).
