Surgery - NBM Flashcards
1
Q
NMB
A
Patients advised not to eat and drink pre- and sometimes post operatively for a defined length of time.
2
Q
Why does pt have to be NBM for surgery
A
- Hazardous to induce anaesthesia in patients with a ‘full’ stomach.
- Risk of regurgitation and subsequent pulmonary aspiration (Mendelson’s syndrome)
- This can lead to aspiration pneumonia.
3
Q
Things to consider during NBM period
A
- Medications to stop.
- Medications to continue.
- Length of NBM period.
- Interactions with anaesthetic medications.
4
Q
Medication to stop in NBM period
A
Know the t1/2 of drug.
- Long half-life = missing a few doses is minor
- Short half-life = higher risk of adverse effects e.g. withdrawal
5
Q
Medication to continue in NBM
A
- Alternative routes/formulations are available e.g. iv/pr/topical
- Know the equivalent iv/pr/po dose.
6
Q
Levothyroxine (NBM)
A
- Long t1/2
- In prolonged NBM period give IV levo
7
Q
Steroids (NBM)
A
Must give IV if patient is on regular prednisolone care/high dose inhalers.
8
Q
Hypoglycaemic medicines (NBM)
A
- Withold
- Check renal function before restarting metformin
9
Q
HRT/OCP (NBM)
A
- VTE risk
- Risk vs. Benefit
- OCP = increased DVT risk.
10
Q
Carbamazepine (NBM)
A
- Not available as IV
- Can be given PR, if not rectal surgery.
11
Q
Phenytoin (NBM)
A
- IV
- ECG monitoring
- Give in equivalent doses to oral
12
Q
Isosorbide mononitrate (NBM)
A
GTN topical patch
13
Q
Immunosuppressant (NBM)
A
- Withold, if appropriate in light of the underlying condition
- Impairs wound healing
14
Q
Pethidine (NBM)
A
- Opioid
- Acute pain (po, s/c, i/m)
- Pre-medication or post-op pain
- Interaction with tramadol
15
Q
Warfarin (NBM)
A
- Stop 5 days prior to major surgery.
- Restart when haemostasias has been achieved
- Consider the risks of not anticoagulating
