Surgery Flashcards
Risk factors for PONV?
Young, female
Non smoker
History of PONV and motion sickness
Use of pre/post-op opioids
VTE risk factors?
Pregnancy
High BMI
Hormonal replacement therapy users
Family Hx
Varicose veins
Diabetes Mellitus
NICE Guideline NG89 (2018), VTE
Asses patient for risk of VTE
-assess for both bleeding AND thrombosis risk
-start prophylaxis as soon as possible
-surgical patient at risk if surgery is more than 90 nis or 60 mins if it involves the pelvis or lower limb
-acute surgical admission
-one or more VTE risk factors
Non pharmacological treatment for VTE prophylaxis?
-Intermittent pneumatic compression, (IPC)
-foot pumps
-flowtron universal
7 areas that pharmacists can intervene in surgically?
-Pain
-Post operative nausea and vomiting
-nil by mouth period (NMB)
-vte prophylaxis
-Fluid management
-anticoagulatiion in the peri operative period
-antibiotic prophylaxis
Advantages of patient controlled analgesia
-Patient Control of analgesia
-suitable for nil by mouth
-reduces patient anxiety
-patients do not have to use multiple injections
-fast acting
Disadvantage of patient controlled analgesia?
-accumulation of morphine metabolites
-can not be used with other opioids
-if patient sleeps not pressing PCA, the may wake up in pain
Pharmacological treatment for VTE prophylaxis?
Low molecular weight heparins
DOACs, rivaroxiban , dabigatran
Name the high risk groups in anaesthesia ?
-COPD/Asthma
-Co-morbidities
-Cardiovascular problems
-Elderly
Discuss the difference between morphine and fentanyl in terms of suitability as opioids in PCA
-fentanyl more suitable in renal impairment
-no accumulation of metabolites in fentanyl
-morphine has a longer duration than fentanly
-fentanyl more potent with 160-fold greater liposolubility
-fentanyl is more expensive
-background infusion required for both
Discuss the management of pain in substance misuse
-opioids are not contraindicated
-long acting are preferred
