Specific cases in surgery

Question 1

Pre-op management of insulin dependent diabetic or poorly controlled tablet diabetic

Answer 1

1st on list
Normal medication night before
If PM list - normal rapid or half mixed dose of insulin
Check glucose regularly
If eating and drinking post op - normal medication with evening meal
If not eating and drinking post op - start on variable rate insulin infusion 2 hours before surgery

Question 2

How to manage diabetic patient on a variable rate IV insulin infusion

Answer 2

Omit all rapid and mixed doses

Once able to eat/drink - give normal insulin dose with meal and stop infusion 30-60mins later

Question 3

How to use VRIII

Answer 3

Prescribe 50 units short acting insulin in 50ml of 0.9% saline
Infuse at rate depending on capillary glucose

Question 4

Risks of surgery on jaundiced patient

Answer 4

Vitamin K deficiency
Sepsis
Risk of renal failure

Question 5

Why may jaundiced patient get renal failure following surgery

Answer 5

Less bile reaching intestine so increased endotoxins absorption
ATN and renal vasoconstriction

Question 6

Specific needs for surgery patients on regular steroids

Answer 6

Give hydrocortisone before induction and maintenance doses during surgery
Hypotension with no obvious cause - give stat dose of hydrocortisone