Perioperative

Question 1

Timeline for pneumonia

Answer 1

1-2 days post-op

Question 2

Timeline for UTI

Answer 2

3-5 days post-op

Question 3

Timeline for PE, would infections and abcess

Answer 3

5-7 days post-op

Question 4

Timeline for drug reactions

Answer 4

7+ days post-op

Question 5

What are the three types of post-op haemorrhage?

Answer 5

Primary - intraoperatively, due to vessel damage
Reactive - within 24 hours, due to blood pressure rise and vasodilation
Secondary - 7-10 days post-op, due to vessel erosion from infection, dehiscence

Question 6

Beta blockers in the perioperative period

Answer 6

Continue

Can be initiated

Question 7

Clonidine (and other alpha-2 agonists) in the perioperative period

Answer 7

Continue

Do not initiate

Question 8

Calcium channel blockers in the perioperative period

Answer 8

Continue

Question 9

ACEi and ARBs in the perioperative period

Answer 9

Usually withhold on the morning of surgery - can prolong hypotension
Continue if used for heart failure or poorly controlled HTN

Question 10

Diuretics in the perioperative period

Answer 10

Withhold if used for hypertension

Depends with heart failure

Question 11

Nicotinic acid (B3), ezetemibe, bile acid binding resins and fibrates (non-statin lipid lowering drugs) in the perioperative period

Answer 11

Discontinue day before

Can cause rhabdomyolysis and myopathy

Question 12

Statins in the perioperative period

Answer 12

Continue

CVS benefit

Question 13

Digoxin in the perioperative period

Answer 13

Continue

Question 14

PPIs and H2 antagonists in the perioperative period

Answer 14

Continue

Benefit

Question 15

Steroids in the perioperative period

Answer 15

Continue

Question 16

Inhaled beta agonists and anticolinergics in the perioperative period

Answer 16

Continue

Question 17

Theophyllines in the perioperative period

Answer 17

Withhold evening before surgery

Question 18

Combined oral contraceptive pill

Answer 18

Cease for 4 week prior to major elective surgery with expected prolonged immobilisation. Can use POP instead. Restart 2 weeks after full mobilisation.

Question 19

HRT in the perioperative period

Answer 19

Stop HRT 4-6 weeks before elective surgery carrying high risk of VTE. Restart after full mobilisation.

Question 20

Aspirin in the perioperative period

Answer 20

Weigh up against risk of CVS event
Stop 7 days prior 
Dental procedures - continue
CABG - low-dose aspirin beneficial
Patients with coronary stents - continue

Question 21

NSAIDs in the perioperative period

Answer 21

Stop 2-3 days before surgery

CI post-CABG

Question 22

TCAs in the perioperative period

Answer 22

Taper in elective surgery 14 days prior

Question 23

Lithium and valproate in the perioperative period

Answer 23

Continue with special attention to fluid balance with lithium

Question 24

Benzodiazepines and buspirone in the perioperative period

Answer 24

Continue

Question 25

Naltrexone in the in the perioperative period

Answer 25

Withhold

Question 26

SGLT2 inhibitors (flozins) in the perioperative period

Answer 26

Stop 3 days prior to surgery

Question 27

Metformin in the perioperative period

Answer 27

Stop before surgery Monitor BGL and respond with insulin Restart when no longer fasting and renal function improves

Question 28

Sulfonylureas in the perioperative period

Answer 28

Replace with insulin

Question 29

Which medication need to be replaced with insulin in the perioperative period?

Answer 29

Metformin, sulfonylureas