Surgery ppt

Question 1

Surigical site infection is within ___ days

Answer 1

30

Question 2

Causes of post op delerium *(4)

Answer 2

U&E imbalence
dehydration
meds
infection

Question 3

why avoid bowel prep in surgery?

Answer 3

Dehydration

Question 4

Role of colloids e.g. in road traffic accident

Answer 4

Colloids stay in the intravascular compartment longer. So if BP drops following blood loss you may use colloids to maintain BP.

Question 5

Why do we tend to stop metformin perioperatively?

When would you restart?

Answer 5

risk of AKI post op

When they eat and drink (consider dose reduction if eating less)

Question 6

Grades of elective surgery

Answer 6

1 Minor Removal of skin lesion/drainage of breast abscess
2 Intermediate Removal of varicose vein/ Tonsillectomy
3 Major Full hysterectomy/Thyroidectomy
4
Complex/
Major + Total Joint replacement/ Neuro or cardiac surgery

Question 7

ASA (american society of anethesiologists) rating of patients risks

Answer 7

1 A normal healthy patient, (i.e.- without any clinically important
comorbidity & without a clinically significant past/present medical
history)
2 A patient with mild systemic disease
3 A patient with severe systemic disease
4 A patient with severe systemic disease that is a constant threat to life
5 A moribund patient who is not expected to survive without the operation
6 A declared brain-dead patient whose organs are being removed for donor purposes

Question 8

Surgical wound cleaness ratings

Answer 8

I) Clean: An uninfected operative wound in which no inflammation
is encountered & in which the respiratory tract, alimentary, genital,
or uninfected urinary tracts are not entered.
• II) Clean-contaminated: Operative wounds in which the respiratory,
alimentary, genital, or urinary tract is entered under controlled
conditions & without unusual contamination.
• III) Contaminated: Open, fresh, or accidental wounds; operations
with major breaks in sterile technique or gross spillage from the
gastrointestinal tract; & incisions in which acute, non-purulent
inflammation is encountered.
• IV) Dirty or infected: Old traumatic wounds with retained
devitalised tissue & those that involve existing clinical infection.

Question 9

preop anaemia causes a host of post op complcations, what are the target levels

Answer 9

WHO 2011- Hb <130g/dl (male) Hb <120g/dl (female)

Question 10

FLUID REQUIREMENTS:

Sodium

Answer 10

1-2mmol/kg/day

Question 11

FLUID REQUIREMENTS:

Potassium

Answer 11

• Potassium = 0.5 – 1 mmol/kg/day

Question 12

FLUID REQUIREMENTS:

Glucose

Answer 12

• Glucose = 50-100g/day (glucose 5%=50g/litre)

Question 13

How does surgery cause AKI

Answer 13

Peri op- severe blood loss= hypovolaemia =

underperfusion of kidneys

Question 14

Direct action in AKI & what action to take:

NSAIDS

Answer 14

• Underperfusion and reduced eGFR
• Acute interstitial nephritis

AVOID

Question 15

Direct action in AKI & what action to take:

Opioids

Answer 15

Accumulation of metabolites

Avoid - or use fentanyl / oxycodone

Question 16

Direct action in AKI & what action to take: Aminoglycacides

Answer 16

Ototoxicity

Tubular cell toxicity

Avoid (or TDM, reduce dose or increase interval)

Question 17

Direct action in AKI & what action to take:

Metformin

Answer 17

Lactic acidosis
Acumulation

Avoid (if egfr <30 or 45 depending on sources)

Question 18

Direct action in AKI & what action to take: contrast media

Answer 18

Direct tubular toxicity

Action - ensure well hydrated pre-exposure

Question 19

Maintaining reg meds when NBM:

Digoxin

Answer 19

IV digoxin

Question 20

Maintaining reg meds when NBM:

Carbemazapine

Answer 20

PR carabemazapine

Question 21

Maintaining reg meds when NBM:

Diuretics

Answer 21

IV furosemide

Question 22

Maintaining reg meds when NBM:

Amlodipine

Answer 22

S/L nifedipine or IV hydralazine

Question 23

Maintaining reg meds when NBM:

Warfarin/noac

Answer 23

LMWH

Question 24

Maintaining reg meds when NBM:

Metformin

Answer 24

Insulin

Question 25

Maintaining reg meds when NBM:

PD meds

Answer 25

rotigotine patch

Question 26

What hba1c should we attempt to achieve in diabetes pre surgery

Answer 26

69mmol/mol

Question 27

Oral antidiabetic meds in surgery should be

Answer 27

Gernerally taken as normal and omit morning dose for sulfonyureas and gliptins (DDP4)

Question 28

When to step down from VRIII

How to step down?

Answer 28

once eating and drinking without nausea

Discontinue 30mins after SC dose given. Long acting insulin should be continued throughout.

Question 29

When do we usually stop post op VTE?

Who gets extended to 28 days?

Answer 29

Usually when mobile (~5 days)

Extended VTE for 28 days in major caner surgery.
MONITOR ZEE PLATELETS

Question 30

3 Reasons that the peri-operative period is a pro thrombotic state

Answer 30

Increased levels of fibrigen and C reactive protein
hypercoaguability
artheromas plaque instabiltiy

(preature discontinuation of anticoagulant can increase these effects in some freaky reabound phenomenom)

Question 31

Suggested bridging therapy depending on high or low bleed risk and clot risk

Answer 31

If CLOT risk is HIGH then bridge
If CLOT risk is LOW then don’t

If CLOT risk is moderate cosider bridging if BLEED risk is low. If BLEED risk is high then best not.

Question 32

How to bridge warfain

Answer 32

Stop warfarin 5 days before

(Give PO vit K if INR >1.5 the day before)

Bridge with LMWH (stop 24 hours before)