Surgery/Operations/Procedures Flashcards
What is a laparoscope?
A thin tube with a video camera and light attached at the end used in surgeries.
What does ‘bridging’ refer to in the context of surgery?
Bridging in therapy refers to using enoxaparin while warfarin is being held to maintain anticoagulation closer to surgery.
On average, how long after holding warfarin does it take for a patient with a stable INR to fall to an INR of 2?
Two days
How long after holding warfarin should a patient start enoxaparin for bridging?
On day 3
What is a cystoscopy?
A urinary tract scope procedure.
What is an implication of COVID-19 vaccines in surgery?
COVID-19 vaccines should be spaced by at least 7 days from any procedure.
Why are ACE inhibitors/angiotensin-II receptor blockers usually held on the morning of surgery?
As they can lead to prolonged hypotension.
What are 2 examples of reasons we would not hold an ACE inhibitor or angiotensin-II receptor blocker on the morning of surgery?
- Uncontrolled hypertension
- Heart failure
How should escitalopram be used around surgery?
Escitalopram can be continued through surgery
How should oxybutynin be used around surgery?
Oxybutynin can be continued through surgery
How should phentermine be used around surgery?
Phentermine should be held for 5 days prior to surgery.
Ideally, how long should aspirin be held for before surgery?
7 days
Laparascopy
TBC
What is a laparoscopic appendicectomy?
A minimally invasive surgery to remove the appendix using several small incisions.
Cholecystectomy
TBC
Septoplasty
TBC
What is a polyp?
Abnormal tissue growth on a mucous membrane.
Describe the expected follow-up for all surgical patients at Flinders Medical Centre.
All patients should have follow-up either with their surgeon and/or general practitioner.
What percentage of opioid naïve patients continue using opioids for more than 90 days post surgery?
4 to 10%
Describe the role of opioids in post-surgical pain relief
We always want to use multimodal pain relief rather than relying solely on opioids
Can opioid-induced pruritis be treated with antihistamines? Why/why not?
Opioid-induced pruritis is not histamine-mediated and thus will not respond to antihistamines
What is the best resource to use to determine morphine equivalence for dose of opioids greater than 100 mg morphine equivalent?
The ANZCA calculator
When is active recreational drug use relevant in surgery?
Active recreational drug use is always relevant in surgery.
Describe the role of parecoxib
Parecoxib is often used intra-operatively
How should parecoxib be used in relation to other NSAIDs?
No other NSAIDs should be used 12 hours either said of parecoxib.
What is the opioid of choice in surgery?
Morphine
Why is morphine the opioid of choice for surgery?
As it has the best retention in the cerebrospinal fluid.
What is the time limit on the use of epidurals?
Epidural use is limited to 5 days.
Why is the use of epidurals limited to 5 days?
Due to the infection risk.
Describe the size of intrathecal and epidural doses.
Intrathecal and epidural doses are always very small.
Describe the use of antihypertensives around surgery.
Antihypertensives are usually held around surgery to reduce the risk of hypotension.
Describe the use of IV opioids on the wards.
IV opioids are not used on the wards.
How is clonidine used in surgery?
Clonidine may be used to manage anxiety (for example about pain) in the recovery room.
Describe the recommendation about benzodiazepines post-operatively.
Benzodiazepines are not recommended post-operatively except for in pre-existing chronic use.
In which patient cohort is ketamine particularly useful?
Opioid-tolerant patients.
Describe the relationship between regional anaesthetics and postoperative opioid use.
Use of regional anaesthetics tend to be associated with lower post-operative opioid use.
How can pregabalin and amiTRIPTYLine be used in surgery?
Pregabalin and amiTRIPTYLine are both options post limb amputation.
Which is preferred post limb amputation: pregabalin or amiTRIPTYLine?
Pregabalin
As a rule of thumb, how is postoperative pain managed by Flinders Medical Centre?
We manage acute postoperative pain, chronic pain is the role of the community general practitioner.
Trapeziectomy
TBC
Arthrotomy
TBC
Sternal debridement
TBC
Mastectomy
TBC
What is a Sapling Oopherectomy?
Surgery to remove the ovaries and fallopian tubes
What is a colostomy?
A colostomy is an operation that creates an opening for the colon through the abdomen.
What is Type 3 Diabetes?
Diabetes induced by the removal/injury of the pancreas.
Which antihyperglycaemics can be given to patients with a full pancreatectomy?
Patients with a full pancreatectomy must be given insulin as their pancreas has no function and thus oral agents will be ineffective.
What is the major implication of a splenectomy?
Patients who have had their spleen removed will have a compromised immune system.
How is the immunosuppression caused by spleen removal treated?
Patients typically require lifelong antibiotic prophylaxis with amoxicillin 250 mg once daily (roxithromycin is used in penicillin allergy).
Colonoscopy
TBC
Describe the use of immunosuppressants around surgery.
Immunosuppressants are often held around surgery as they inhibit wound healing and increase the risk of infection.
What may a patient be prescribed if they are refusing a colonoscopy and why?
They may be prescribed pantoprazole 40 mg twice daily in case there is a bleed.
What is an anastomosis?
A surgical connection of two structures in the body which are not normally connected (such as blood vessels).
What are surgical adhesions?
Bands of scar tissue that bind two parts of tissue or organs together in the body.
What is a seroma?
A build up of bodily fluids in a tissue or organ after a surgery, usually at the site of the surgery. The skin appears as a swollen lump.
What is a cystectomy?
Surgical removal of the urinary bladder
What is an endarectomy?
Surgical procedure to remove the plaque in arteries that obstructs blood flow, causing heart disease.
What is a laminectomy?
A surgical operation to remove the back of one or more vertebrae
What is the most common purpose of a laminectomy?
Usually to give access to the spinal cord or to relieve pressure on nerves.
What is an oopherectomy?
The removal of the ovaries
What is a total knee arthroplasty also called?
A total knee replacement
What is a total knee replacement (total knee arthroplasty)?
A surgery that removes a diseased knee joint and replaces it with an artificial joint (prosthesis)
What is Posterior Lumbar Interbody Fusion (PLIF) Surgery?
A surgery to fuse painful vertebral segments in order to stop the painful motion.
What is anterior cervical discectomy and fusion (ACDF) surgery?
A type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure.
What is open reduction and internal fixation (ORIF) surgery?
A type of surgery used to stabilise and heal a broken bone.
What is a total shoulder replacement?
Shoulder replacement removes damaged areas of bone and replaces them with parts made of metal and plastic (implants)
What is a craniotomy?
The surgical removal of part of the bone from the skull to expose the brain
What is a mini craniotomy?
Mini-craniotomy is defined as an opening in the skull of diameter of the bone flap limited to 3 to 4 cm
What is a lumbar disectomy?
A surgery to remove a degenerative or herniated disc in the lower spine.
