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Clinical - Rosie > Surgery > Flashcards

Surgery Flashcards

1
Q

What are the risks associated with poor glycemic control?

A

significant impact on the risk of postoperative

infection

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2
Q

Give contraindications to use of antiembolism stockings?

A

Peripheral vascular disease and neuropathy.

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3
Q

Diabetic patients should be well controlled before surgery, what HbA1c value are we aiming for?

A

<69 mmol/l

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4
Q

T or F - all medication which reduces gastric acid should be given on the day of surgery?

A

True

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5
Q

T or F - all asthma drugs and inhalers should be given before surgery?

A

True

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6
Q

How many days before an operation should clopidogrel be stopped?

A

7 days

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7
Q

If a patient is taking dual antiplatelet therapy and requires surgery, what should we try and do and why?

A

Try and delay the surgery until it is safe to stop one of the antiplatlets

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8
Q

Should lithium be taken before surgery?

A

NO- omit 24 hours pre-op unless minor surgery

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9
Q

How long before surgery should the COC be stopped?

A

4 weeks

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10
Q

What general monitoring is required during and after surgery?

A

Fluids
Blood pressure
Renal function
Pain control

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11
Q

What non pharmacological advice is very important for patients with Ulcerative colitis?

A

Stopping smoking!

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12
Q

Should mesalazine be taken the day of surgery?

A

No should discontinue the day before surgery

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13
Q

How do we ensure patients who are taking long term steroids have adequate glucocorticoid levels to cope with the stress of surgery?

A

Give IV hydrocortisone 25mg-50mg at induction and afterwards (how long afterwards will depend on surgery)
Dose depends on patients normal daily dose

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14
Q

How can we manage pain in a patient with UC following a colectomy?

A

Paracetamol

Dihydrocodeine or morphine

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15
Q

Why is codeine not a suitable analgesic in patients with UC?

A

Risk of toxic megacolon

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16
Q

Why is dihydrocodeine preferred to codeine as a post-op analgesic?

A

Approx. 20% of patients are unable to metabolise codeine and obtain its analgesic effects

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17
Q

What analgesic should never been given to patients with UC?

A

NSAIDS

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18
Q

T or F - smoking is protective against PONV?

A

True - non smokers are more likely to experience PONV

19
Q

Are men or women more likely to experience PONV?

A

Female

20
Q

Which antiemetic is not useful for PONV?

A

Metoclopramide

21
Q

When should antiemetics be given to prevent PONV?

A

30 mins before the end of surgery

22
Q

Outline the management of patients taking warfarin who have a planned surgery

A

Need to assess the reason patient is taking warfarin and this will determine there risk of VTE.
Last dose of warfarin needs to be taken 6 days before surgery.
Whether we bridge or not with LMWH or UFH depends on VTE risk

23
Q

What INR are we aiming for before surgery?

A

<1.5

24
Q

If a patient taking warfarin is at low risk of VTE how should we manage this pre-operatively?

A

No LMWH is required
Stop warfarin, take the last dose 6 days before
Use non-pharmacological methods

25
Q

If a patient taking warfarin is at moderate risk of VTE how should this be managed pre-operatively?

A

Stop warfarin 5 days before
Start therapeutic-dose LMWH at 8 am 2 days after stopping warfarin
Take last LMWH dose 24 hours before surgery is planned (i.e. at 8 am the day before surgery)

26
Q

If a patient taking warfarin is at high risk of VTE how should this be managed pre-operatively?

A

Stop warfarin 5 days before
Start therapeutic dose of LMWH at 8 am 2 days after stopping warfarin
Take last dose LMWH 24 hours before surgery
Start patient on UFH and this should be stopped 6 days before surgery

27
Q

Should aspirin for secondary prevention of CVD be omitted before surgery?

A

Should continue unless very high bleeding risk

28
Q

What dose of exogenous steroids and within what time period might mean patients require additional glucocorticoids during surgery?

A

Patients on >10mg/day of prednisolone within 3 months of surgeyr

29
Q

If patients stop taking COC before surgery what are the risks associated with this?

A

Pregnancy - also has a vte risk

30
Q

Should tamoxifen be stopped before surgery?

A

Patients taking tamoxifen are at increased risk of VTE, but need to discuss with oncologists whether safe to stop. if we can stop then try and stop 3 weeks before.

31
Q

What are the two main issues associated with MAOIs and surgery?

A

Potentially fatal drug interactions and with anaesthesia

and risk of hypertensive crisis

32
Q

What is very important that we ensure in patients taking lithium during surgery where we havent been able to stop the lithium 24 hours before?

A

Need to ensure hydrated - Li is renally excreted and want to avoid accumulation.
Should monitor fluid balance and Li levels

33
Q

In terms of VTE prophylaxis post-op how do we classify patients in terms of risk and how does their managemnet vary accordingly?

A

Either classified as low or high risk. One risk factor puts patient in the high risk category

If low risk - use non pharmacological methods
if high risk - use LMWH or NOACs

34
Q

Extended VTE prophylaxis is required following surgery on a fractured neck of femur, how long should VTE prophylaxis be continued?

A

4 weeks

35
Q

Extended VTE prophylaxis is required following abdominal/pelvic cancer surgery, how long should VTE prophylaxis be continued?

A

4 weeks

36
Q

How do we managed pain post-op?

A

Use the WHO pain ladder in reverse

37
Q

Outline the Apfel scoring system

A

Female- 1
History of PONV or motion sickness - 1
Post op use of opioids - 1
Non-smoker - 1

38
Q

What is meant by a clean surgical procedure? Are antibiotics required prophylatically?

A

Clean: No break in sterile technique, site not inflamed or infected e.g. breast surgery
Generally no prophylaxis is needed

39
Q

What is meant by a clean-contaminated procedure? Are antibiotics required prophylatically?

A

Clean – Contaminated – at induction and up to 24 hours post op
Used at induction and up to 24 hours post op

40
Q

What is meant by contaminated surgery?

A

Contaminated: Major break in sterile technique, spillage from GI tract or acute inflammation encountered

41
Q

What is the preferred route for antibiotic prophylaxis?

A

IV

42
Q

What time should antibiotic prophylaxis be given and why?

A

Dose / infusion completed just before incision if iv – to be effective we want the concentration of antibiotic to be highest at the time of incision.

43
Q

should atorvastain be taken the morning of surgery?

A

Yes

Clinical - Rosie (16 decks)

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