Surgery

Question 1

What are the main things that pharmacists should consider for all surgical patients?

Answer 1

Analgesia
AntiBiotics
Clotting - VTE prophylaxis
Diet
Emesis 
Fluid status 
General - all other medications/co-morbities

Question 2

Why are patients kept nil by mouth peri-operatively?

Answer 2

To prevent pulmonary aspiration of stomach contents while under GA
Dysphagia
To rest the gut following FI surgery - when patients eat this can generate acid production and can break down the amitosis, causing a leak

Question 3

What is the general nil by mouth guidance

Answer 3

Adults - clear fluids and water up to 2 hours before. Food up to 6 hours before

Children - breastmilk up to 4 hours before

Question 4

Why is diclofenac not recommended post-op?

Answer 4

Cardiac side effects

Question 5

Outline management of anticoagulation and epidural

Answer 5

Risk of epidural haematoma
Patient should be free of anticoagulant 12 hours before the procedure i.e. if LMWH is administered on day 1 at 6pm, duration of action is 24 hours so until day 2 at 6pm. Therefore 12 hours anticoagulation free would be 6am on day 3.

Can restart 4 hours after epidural

Question 6

Gabapentin vs pregabalin pharmacokinetics

Answer 6

gabapentin has non-linear pharmacokinetics meaning careful dose titration is needed whereas pregabalin possesses linear pharmacokinetics, which means dosing regimens are more straightforward

Question 7

Define clean surgical procedure

Answer 7

Generally elective procedure

No break in sterile technique, site no inflamed or infected. Generally no abx prophylaxis needed

Question 8

Define clean-contaminated surgical procedure

Answer 8

Respiratory, gut or genito-urinary tract entered by no contamination encountered e.g. appendectomy. Give abx at induction and up to 24 hours post op

Question 9

Define contaminated surgical procedure

Answer 9

Major break in sterile technique, spillage from GI tract or acute inflammation encountered. May need 5-7 days of abx

Question 10

Define dirty surgical procedure

Answer 10

Acute inflammation with pus encountered, GI tract perforation/old dirty wounds

Question 11

How often should VTE assessments be completed?

Answer 11

Must be risk assessed within 24 hours of admission and then reassessed every 72 hours