Surgery and anaesthesia Flashcards
How long do you have to be fasted before surgery
6hrs solids
2 hrs liquids including black coffee and tea without milk
How long do you have to stop COCP before surgery
4 weeks
Which Diabetic drugs need to be modified for surgery
Metformin- normal- but omit lunch dose if TDS
Sulphonylureas- if morning omit morning, afternoon, both
SGLT2- omit on day
DVT prophylaxis
Low risk: early mobilisation
Med: early mobilisation + TEDS + 20mg enoxaparin 2 hrs pre
High: early mobilisation + TEDS + 40mg enoxaparin 12 hours pre surgery
Avoid in eGFR <15
ASA grades
1- normal
2- mild systemic disease
3- severe- limits
4- systemic this a constant threat
5- not expected to survive in 24 hrs
Insulin changes for surgery
Reduce long acting by 20% night before and day of
Omit other insulin
Start sliding scale
Continue until tolerating food
Risks of steroids during surgery
Poor wound healing
Infection
Adrenal crisis
Stopping warfarin and DOACs before surgery
Warfarin 5days bridge with LMWH
DOACs- 2 days
Drugs used in anaesthesia
Induction- propofol
Muscle relaxant- suxamethonium- depolarising
Vecuronium- non
Maintain- halothane
Sx of malignant hyperpyrexia
Complication of suxamethonium or sevoflurane
Rise in temp and masseter spasm
Tx of malignant hyperpyrexia
Dantrolene and cooling
VTE prophylaxis after surgery
LMWH 6-12/ Fondaparinux 6 hours after surgery
Cause of post op fever and their time line
Day 1-2 - wind- pneumonia, PE
3-5 water- UTI
5-7 wound - surgical site
5+ walking- DVT
Types of IV access
Peripheral- large 14G if emergency, small 20G if not
Hickman- long term - 3 lumens- better for chemo
PICC-2 cannulas
Swanz gauz- in heart measure pressure
ASA levels
1- normal
2- smoker, mild disease
3- substantial disease
4- severe
5- moribund
Alcoholics requirement for anaesthesia and post surgery seizure
Often require larger doses of induction agent
IV lorazepam for seizure IV 4mg
If raised ICP in ICU what factors can you do
Mannitol
Raise head to 30
Increase RR to hyperventilate
If low BP after propofol induction what should you start
Metaraminol
Why do you apply cricoid pressure
Occludes upper oesophagus
Prevents passive reflux
Induction given with no chest movements what are the next steps
Insert OPA
Then once neuromuscular blockade given
Intubate
Suxamethonium affects on electrolytes
Hyperkalaemia
Rapid sequence induction steps
Preoxygenate- 5 min
Paralysis- induction and paralysing agent
Protection- cricoid pressure
Placement- intubation
If patient with stent from MI what do you do regarding stopping medications
Speak to cardiology
AS stopping may cause stenosis
Analgesia for rib fratures
Transversus abdominal plane block
How to change steroids before surgery
Long term
Increase HC
Stop FC
Start again 48-72 hours post op if eating and drinking
Mx of spasmodic pain
Diazepamm
Mx of lactate acidosis after surgery
Fluid bolus
Can be caused by metformin
Local anaesthesia toxicity sx
Numbing
Tinnitus
Dizziness
Diabetic drugs and surgery
Metformin- if 3 omit lucch
sulph-omit morning
Gliptins, GLP- take normal
SGLT2- omit on surgery
Prescribing fluid
30ml/kg/day
Calculate fluid deficit and add it on
BMI ASA grading
30-40 ASA 2
>40- ASA 3
If on prednisolone and about to have surgery what do you prescribe
Hydrocortisone
End stage renal disease with dialysis ASA
3
What goes in ASA 4
Recent MI, stroke, severe valve disease, end renal disease with no dialysis
SE of etomidate
Adrenal suppression
Inducing agent in haemodynamically unstable patients
Ketamine
T2DM on gliclazide with HbA1c of 70 for morning surgery, what do you do
Omit morning gliclazide
VRII- since above 69
Inheritance of malignant hyperthermia
AD
When is suxamethonium CI
Eye injuries
Glaucoma
Since increases IOP
If hyperkalaemic
When to do tracheostomy instead of ETT
Severe upper airway obstruction
