Surgery Preop Flashcards
Surgeries during dual antiplatelet therapy period substantially increases risk for MI
WHAT 2 meds
Duration bare stent?
Duration drug eluting?
Plavix + Aspirin
Bare- 6 weeks
Drug eluting- 12 months
Postpone surgery of coronary artery revascularization is indicated
Patients with rheumatoid arthritis are at high risk for axioatlantial subluxation - Oreos test to obtain if they are scheduled for a surgery that requires intubation
Cervical spine film
C-spine imaging prior to intubations
Stop clopidogrel/ ticlopidine how many days prior to surgery
5-7 days
Stop NSAIDs how many days prior to surgery
1-3 days
Stop COX-2 agents how many days prior to surgery
2-3 days
Stop Dabigatran (Pradaxa) how many days prior to surgery
2-5 days
Stop Rivaroxaban (Xarelto) how many days prior to surgery
24 hours / 1 day
Medications to give prior to surgery
Usual dose steroids
Parenteral antibiotics 30 minutes prior
Long acting insulins the morning of surgery
How many days prior to surgery to stop Coumadin/ warfarin when low risk
Low risk: afib without MI X 12 mos
DVT >3 months out
Biological valves >3 months out
Stop 5 days preop restart postoperative when taking po
Warfarin preop management high risk
High risk- mechanical heart valve
DVT/PE with hypercoagulable state
History of DVT/PE
Stop 4 days preop start LMWH
Stop LMWH 12-18 hours preop
Restart LMWH 6 hours postoperative
Restart warfarin when taking po
Stop LMWH when INR 2
Patient presents prep clearance has been taking low dose aspirin for years. Do you stop Asa prior to surgery?
Safe to continue low dose aspirin. If history of MI or coronary stents discontinuation of aspirin results in a 3 fold increase in adverse cardiac events
Postoperative pulmonary complication risk factors
COPD
advanced age
Heart failure
Serum albumin
What is morphine dosing for abdominal pain
Morphine 0.1-0.2 mg/kg IV
Hernia more common in women located below the inguinal ligament and medial to femoral pulse
Femoral hernia
