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Flashcards in 7 Surgery Workshop Deck (32):
1

With opiate prescribe

Docusate and antiemetic

2

Frequency of DVT is ... In general surgery

25-33% and 45-70% in total hip replacements

3

Cardiac drugs

Give all except ACEi at2 antagonists and diuretics

( beta blockers help suppress tachy and BP increase from surgery)

4

Aspirin

Safe to continue unless high post op bleed risk.
If for primary prevention stop 7 days before.

5

Eplilepsy and Parkinsons drugs

Give

6

Asthma drugs

Give

7

Medication to reduce gastric acid

Give (reduces risk of aspiration)

8

Thyroid meds

Give

9

Steroids

Give

10

Immunosuppressants and Cancer drugs

Give

11

Tranquillisers and antidepressants

Give ((except maoi which should stop 2 weeks before)

12

Analgesics

Give

13

Antipsychotics

Omit unless otherwise instructed as may potentiate arrhythmias and hypotension

14

Oral hypogylcemic

Omit on morning of surgery

15

Clopidogrel

Stop 7 days pre op. But if post coronary stent or ACS ideally delay surgery until safe to stop clop (3-12 months)

16

Dipyridamole

Stop 24 before surgery

17

Lithium

Omit 24 hours pre-op as can cause electrolyte inbalance

18

ACHE for dementia

Galantamine and rivastigmine - Stop 24 hours pre op as they prolong the action of muscle relaxants
Donepazil - don't stop as its half life is too long

19

Orc /HRT

Stop 4 weeks prior , if not possible use stockings and LMWH prophylaxis

20

Diuretics and ace I

Discuss - as the can drop BP in surgery but local practice differs

21

Hyponatremia post surgery can lead to

Cognative impairment

22

Post surgery consider 5

Monitor renal func (and u and e)
Fluid replacement
Nutritional requirement
Pain control
Med review

23

Why is fluid replacement required3

Significant fluid loss (bleeding, burns patients)
Noble to take fluids
Resuscitation - going into shock from trauma

24

Signs of dehydration

Headache
Dry lips and skin
Confusion
Decreased urine output
Thirst
Constipation
Capillary refill time
Skin turgidity

25

How to evaluate response to fluid therapy

Urine output
Weight (but this doesn't tell where the fluid is)
Feeling better
U&e comes down

26

Do we give a pre op dose of LMWH in practice

Only when bridging therapy with warfarin.
You'd give post op and then usually stop on discharge.

27

Risk factors for PONV

Sex female
History of motion sickness
Opiate use
Previous PONV
Non smoker
Surgery type and duration

28

Eg of an antiemetic for PONV

Ondansetron - usually IM or IV at induction of 30 mins before end of surgery

29

Oran Diabetes control post surgery

She wouldn't eat much in the eve so omit.
Monitor and if BG levels risk over 12 give 0.1mg/kg soluble.

Restart in the morning, if she doesn't eat much use half dose

30

Summarise bridging warfarin to LMWH

Last warfarin dose 6 days pre surgery
Start LMWH two days after this
Stop LMWH 24hours before surgery
Depending on bleed risk start LMWH some time after surgery and warfarin ASAP.
Continue LMWH until INR therapeutic for 2 dans and min 5 days.

When to start LMWH again:
Prophylactic LMWH (low clot risk):
–Low bleed risk - evening post op
–High bleed risk - 24 – 48 hrs post-op
Therapeutic LMWH (high clot risk):
–Low bleed risk – prophylactic dose evening post op then therapeutic dose 24 – 48 hrs post-op
–High bleed risk - prophylactic dose 24 – 48 hrs post-op then therapeutic dose 48 – 72 hrs post-op

31

Summarise grinding warfarin with UFH

Last warfarin dose eve 6 days before
Admit for UFH once INR less than 3.
Stop UFH 6 hours before.

32

Risk factors in surgery

Age
Complexity
Duration of anaesthesia
Co pathologies (Obesity)
Clotting disorders
Concurrent medication/alcohol use