Surgery Flashcards
Which medicines can be beneficial before surgery?
Drugs which affect gastric pH - H2 receptor antagonists can be given before surgery in individuals with Mendelson’s syndrome to prevent complications caused by general anaesthesia reducing acidity and volume of gastric fluid.
Antimuscarinic drugs - can be used pre-operatively to dry bronchial and salivary secretions which are increased by intubation, upper airway surgery, or inhalational anesthetics.
Sedative drugs - benzodiazepines can be used pre-op to reduce fear and anxiety surrounding surgery, as well as providing a degree of pre-operative amnesia.
Respiratory depression antagonists (naloxone) - reverse opioid-induced respiratory depression.
What is flumazenil?
A benzodiazepine antagonist to reverse the central sedative effects of benzodiazepines.
Why are patients NBM before surgery?
Patients are NBM 6 hours pre-op for food and milk, and 2 hours pre-op for fluids. This is because patients are at risk of aspirating their stomach contents under general anaesthesia.
What does NBM mean for medicines administration?
Follow local guidelines.
Critical medicines such as anti-parkinsonians and anti-epileptics should continue as per regimen with a small drink of water.
Some medicines will be stopped on the day.
Other medicines, including oral anticoagulants and oestrogen-containing hormonal contraceptives, may require stopping far in advance.
What is first-line post-operative pain management?
Oral non-opioid analgesics such as paracetamol and ibuprofen.
Ibuprofen not suitable for hip fracture surgery.
What can be given if non-opioid oral analgesics are not sufficient for post-operative pain.
Oral opioid analgesics - cocodamol, codeine, oramorph.
What is PCA?
Patient controlled analgesia.
When is PCA used post-operatively?
When patients are unable to take oral doses.
What are common opioid side effects?
Constipation
Drowsiness
What are signs of an opioid overdose?
Respiratory depression i.e., slow and/or shallow breathing.
Pinpoint pupils.
Reduced consciousness.
What can be given in the case of an opioid overdose?
Intranasal naloxone.
What is the main cause of post-operative nausea and vomiting?
General anaesthesia.
How is post-operative nausea and vomiting treated?
2 or more antiemetics.
How is a person’s fracture risk assessed?
A fragility fracture risk assessment such as QFracture or FRAX which indicates a person’s 10-year fracture risk.
What does a 10 year fracture risk if 10% warrant?
A dual-energy X-ray absorption (DXA) scan. This measures bone mineral density and provides a T-score.
What does a T-score of -2.5 or lower mean?
Osteoporosis. Drug treatment to prevent fractures required.
What is given for fracture prevention?
Bisphosphonate.
10mcg vitamin D.
1000mg calcium (only if intake inadequate).
What does T-score actually mean?
The T-score is the number of standard deviations below the mean bone mineral density (BMD) of young adults at their peak bone mass.
Name 3 bisphosphonates.
Alendronic acid/aldendronate
Risedronate
Zoledronic acid
How do bisphosphonates work?
Inhibit farnesyl pyrophosphate synthase promoting attachment of the osteoclast to the bone. As a result, the osteoclast detaches from the bone surface, thus inhibiting bone resorption and degradation.
What conditions are bisphosphonates contraindicated/cautioned in?
Hypercalcaemia
CKD
People who cannot sit upright or stand for at least 3 minutes.
Upper GI issues
What are the common side effects of bisphosphonates?
GI discomfort
Bone, joint, and muscle pain.
Oesophageal reactions
What are the main counselling points for bisphosphonates.
Usually taken once a week.
Take first thing on a morning on an empty stomach.
Swallow whole with a full glass of tap water.
Take and remain upright for at least 30 minutes.
Do not eat, drink, or take any medication for at least 30 minutes, as will reduce absorption.
Avoid use of NSAIDs as can contribute to GI irritation.
If miss a dose, take on day it is remembered but continue weekly on normal day.
What is the mechanism of action of enoxaparin?
Activates antithrombin which accelerates the inhibition of clotting factors thrombin and FXa.
