Flashcards in 4: Peri-operative - Smith Deck (20)
ASA classification of physical status
I - normal healthy
II - mild systemic disease
III - severe systemic disease that limits activity but is not incapacitating
IV - incapacitating systemic disease that is a constant threat to life
V - moribund pt not expected to survive 24 hr with or without surgery
E - emergency surgical procedure
how does surgery affect DM?
- surgical stress creates endocrine metabolic rxn that results in glucagon, Ne, Epi and cortisol secretion
- blood glucose levels rise
- resultant insulin production in response to hyperglycemia inhibited by feedback loop
- albumin status inhibits healing
elective surgery should be avoided when blood sugar greater than ______
- schedule surgery in am
- get ECG if considering general anesthesia (increased insulin demand increases risk of silent MI)
dosing of insulin for surgery ***
give one half insulin dose preoperatively and second half of insulin after surgery and give 5% dextrose during surgery
who needs to be worked up for atlantoaxial subluxation
surgical candidate with RA
- present in 40% rheumatoid pts
- marked flexion of neck can cause fracture or neurological interruption
when do you stop ASA and NSAIDs before surgery?
stop ASA 2 wks prior to surgery
stop NSAIDs 3-5 d prior to surgery
corticosteroid use and the steroid suppressed pt: if oral cortisone used w/i last year ...
do not need to supplement if less than 5 mg/d or intra-articular injection
corticosteroid (hydrocortisone) supplementation for pt on long term steroid therapy
minor surgery - 25 mg/d 1 d
moderate surgery - 50-75 mg/d - 1-2 d
major surgery - 100-150 mg/d - 2-3 d
ex: hydrocortisone 100mg IV/IM evening prior to surgery, another dose directly before surgery, continue every 8 hr for next day postop
should a pt continue to take immunosuppressive drugs?
yes - benefits (decrease arthritic flare ups) outweigh risks
what uses prophylactic antibiotics?
joint replacement and immunosuppression
ancef 1-2 mg IV 30 min before surgery
vancomycin 1 mg IV 1 hr before surgery
what should you do if your surgical candidate is taking coumadin?
- stop coumadin 3-5 d prior to surgery
- may start on heparin or levonox
- post surg continue coumadin until PT is therapeutic with heparin
reversal of coumadin
vitamin K and/or FFP
reversal of heparin
risk of postop gout attacks due to trauma, dehydration and interruption of uricosuric meds during surgery. what should you do?
oral colchicine 0.6 mg BID for two days before surg and one day postop
colchicine 2 mg VI preop to avoid GI side effects
what should be evaluated preop for a pt with HTN
potassium (greater than 3.5 mEq)
- HTN is controlled by anestheis if the pt has not taken oral meds
avoid elective surg if pt has had an MI w/i _________
last 6 months
- cardiac consult for ANY surgery with pre-existing ischemic heart disease
why would you ask someone during your pre-op workup if they get prophylaxis at the dentist?
- rhematic heart disease and mitral valve prolapse prone to bacterial endocarditis
- need to be prophylaxed with antibiotics
- in office: amoxicillin
what sedatives should be avoid due to hepatotoxicity ?
halothane and amides
why do patients with renal/hepatic dz have increased bleeding tendency?
due to decreased platelets and extrinsic pathway