2 - Perioperative Care

Question 1

What is the aim of perioperative planning?

Answer 1

To optimise patients before elective surgical procedures.

Question 2

What things are important to note from the Hx prior to surgery?

Answer 2

Key info - cardiac and respiratory fitness.

Question 3

Which score can be used to predict difficult intubation?

Answer 3

LEMON score

Question 4

Which scoring system assesses availability of access to the throat via the mouth?

Answer 4

Mallampati score
1-4

Question 5

When are U&Es requested prior to surgery?

Answer 5

Major ops
Elderly Ps

Significant blood loss anticipated or meds that affect electrolytes

Endocrine or comorbidities

Question 6

Which groups of medications affect electrolyte levels?

Answer 6

Steriods
NSAIDs
Diuretics

Question 7

When are ECGs done prior to surgery?

Answer 7

Over 65
Sig comorbidities
CVS Hx

Question 8

When do clotting screens need to be done prior to surgery?

Answer 8

Hx of bleeding disorder
Liver disease
Eclampsia
FHx bleeding disorders
Anthrombotic or anticoagulant meds

Question 9

When is a urinalysis dipstick done prior to surgery?

Answer 9

Done in all Ps to detect infection, biliuria, glycosuria and inappropriate osmolality

Question 10

When would you do LFTs prior to surgery?

Answer 10

Ps with
- Jaundice
- Cirrhosis
- Chronic liver pathology
- Malignancy
- Poor nutritional status
- Excess alcohol

Question 11

What testing can be done in preoperative care to assess cardiorespiratory function before surgery?

Answer 11

Cardiopulmonary exercise testing

Question 12

What is the anaerobic threshold in CPET?

Answer 12

The point at which anaerobic respiration begins in the tissues.

Question 14

What is a poor predictor of exercise tolerance?

Answer 14

Low ejection fraction

Less than 30% = poor patient outcome

Question 15

What should BP be below ideally before surgery?

Answer 15

180/110

Question 16

How does aortic stenosis affect surgical risk?

Answer 16

Aortic stenosis - fixes cardiac output.

During surgery - is increased demands for O2. This would normally be met by increased CO. AS prevents this from happening = increases surgical risk.

Question 17

If a patient has had a proven MI - how long should elective surgery be postponed for? Why?

Answer 17

Should be postponed for 3-6 months

Reduces the risk of perioperative MI.

Question 18

Which medication should be worried about starting pre-operatively?

Answer 18

Β-blockers - possibly inc risk of stroke in these Ps.

Question 19

Which medications
- should be stopped 5 days prior to surgery
- should be stopped 2-3 days prior to surgery
- should be maintained over perioperative period
- should be stopped 24 hours prior to surgery
0

Answer 19

Warfarin - stopped 5 days prior

DOACs - stop 2-3 days prior

Maintain - β blockers, statins and corticosteriods (can covert to IV steroids if oral absorption not available for a while)

Stop ACEIs and ARBs 24 hours prior to surgery

Question 20

For Ps on long term antiocoagulation - a risk/benefit assessment should be done to decide whether it is safe to stop their medications prior to surgery.

What can be given to high risk VTE patients?

Answer 20

Bridging therapy - unfractionated or LMWH

Question 21

Which patients are a high VTE risk?

Answer 21

Those with a metallic heart valve
Or those with recent drug eluting cardiac stent

Question 22

Which scoring system can be used to calculate stroke risk for Ps with AF?

Answer 22

CHA2DS2-VASC

Question 23

Which is the commonest family Hx coagulopathy in UK?

Answer 23

Factor V Leiden mutation