Flashcards in Patient evaluation, informed consent, preoperative assessment and care Deck (28):
Lignocaine and prilocaine are the preferred anaesthetics for pregnancy.
There are no adverse effects associated with bupivacaine and mepivacaine use in pregnancy. .
Associated with increased risk of foetal bradycardia
Erythromycin estolate is safe to use during pregnancy.
Assoc with hepatotoxicity during pregnancy.
Intrapartum use of tetracycline may result in staining of foetal dental enamel.
Small volumes of adrenaline-containing anaesthetics cannot be given safely in patients with advanced heart disease.
must be max conc 1:200,000
The risk of cardiac conditions has been stratified into high, moderate, low or negligible risks by the American Heart Association
Patients with surgically repaired atrial or ventral septal defects are high-risk for developing bacterial endocarditis following a surgical procedure.
High-risk are pts with prosthetic valves, previous endocarditis, complex congenital heart disease, surgically constructed systemic-pulmonary shunts.
Patients with hypertrophic cardiomyopathy and mitral valve prolapse with regurgitation are medium-risk for developing bacterial endocarditis following a surgical procedure.
High-risk categories include patients with prosthetic valves, a previous history of endocarditis, complex congenital cyanotic heart disease, and surgically constructed systemic–pulmonary shunts
Patients with implanted pacemakers and defibrillators and patients with physiologic heart murmurs are low-risk for development of bacterial endocarditis following surgery.
Appropriate antibiotics to prevent bacterial endocarditis in at risk patients are amoxicillin or if allergic, cefalexin, axithro or clindamicin
60min pre op
- same for immmunosuppressed pts who have been advised they need prophylaxis
Procedures involving infected or eroded skin are associated with significantly higher infection risk and warrant the use of prophylactic antibiotics.
Heat electrocautery or bipolar coagulation should not be used in patients with implanted cardiac pacemakers.
These are advocated.
Antiviral prophylaxis for laser resurfacing should begin within 48hrs preoperatively and continue until re-epithelialisation is complete, generally within 7-10 days.
Electrocautery is the preferred method of haemostasis in patients with implanted deep-brain stimulators.
Inactivation of the deep-brain stimulator has never been necessary as effective hemostasis can be achieved with electrocautery in dermatologic surgery
Vitamin E (alpha-tocopherol) is a potential anticoagulant.
Garlic, ginseng, ginger, ginkgo, St John’s wort and feverfew are all potential anticoagulants.
Alcohol may result in an increased bleeding potential.
advise pts to avoid for 2 days prior to surgery and at least until day afterwards
Patients who have had organ transplants should have Abx prophylaxis with cefalexin 1g, dicloxacillin 1g or azithromycin 500mg orally just before the procedure
1 hour before
if their physician has advised it
The combination of non selective beta blockers (such as propranolol) and adrenaline may result in malignant hypertension, reflex bradycardia and even death
Selective beta blockers are ok
Cephalospirin Abx can usually be given safely to penicillin allergic patients who do not have anyphylactic response to penicillin
Alternatives to penicillins include macrolides
Lidocaine and prilocaine are the preferred anesthetics for use during pregnancy
cat A in Aus
(B in USA but stil preferred)
Consider delaying surgery in hypertensive patients with a systolic pressure of >170 mmHg and/or a diastolic pressure >100 mmHg
bleeding risk and stroke risk
send to GP for BP lowering
In pts with Hx of HSV undergoing facial resurfacing procedures antivral prophylaxis options include acyclovir 400 mg three times daily, valacyclovir 500 mg twice daily, and famciclovir 250 mg twice daily.
start 48 hrs before and continue until re-epithelialization 7-10 days after
Use of the hyfrecator is acceptable in pts with deep brain stimulators
Use Electrocautery (hot wire)
Fondaparinux and Rivaroxiban are factor 9 (IX) inhibitors
factor 10a (Xa) inhibitors