Peri-operative

Question 1

adrenaline use w local anaesthetic is contraindicated in patients using with medications

Answer 1

maoi and tca

Question 2

how do you monitor unfractionated heparin therapeutic efficacy

Answer 2

APTT

Question 3

why is unfractionated heparin preferred in surgical patients that may need a rapid return to theatre

Answer 3

LMWH longer duration or action and harder to reverse

Question 4

how long does it take to clear unfractionatde heparin from system

Answer 4

2hours

Question 5

when do you stop unfractionated heparin prior to surgery

Answer 5

6h

Question 6

what is the reversal agent of unfractionated heparin

Answer 6

Protamine sulphate - rarely used, may be if immediate reversal of anticoag needed like coming off bypass

Question 7

Local anaesthesia for scalp wounds

Answer 7

1% lignocaine + 1 in 200,000 adrenaline

Question 8

indications for coronary bypass

Answer 8

Left main stem stenosis or equivalent - proximal LAD or circumflex
Triple vessel disease
Diffise disease unsuitable for PCI

Question 9

Preparation for elective surgery - tests

Answer 9

Bloods - FBC, UE, LFT, Clotting, G+S (if EBL .>500ml)
HbA1c if not in last 3/12
Urine analysis
bHCG
Sickle cell test
ECG
CXR
VBG if high risk of OSA