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ACC > Pre-op > Flashcards

Pre-op Flashcards

1
Q

When should the Oral contraceptive pill be stop before elective surgery and when can it be restarted?

A

Stop 4 weeks before

Restart 2 weeks after, provided the patient is mobile

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2
Q

When should Aspirin be stopped before elective surgery?

A

5 days before

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3
Q

When should aspirin not be routinely stopped before elective surgery?

A

If the patient has a recent (< 1 year) history of cardiac stents

Liaise with cardiologist and surgeon about risk

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4
Q

When should Clopidogrel be stopped before elective surgery?

A

5 days before

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5
Q

When should Clopidogrel not be routinely stopped before elective surgery?

A

If the patient has a recent (< 1 year) history of cardiac stents

Liaise with cardiologist and surgeon about risk

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6
Q

When should MAO-inhibitors be stopped before elective surgery?

A

Stop 4 weeks before surgery

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7
Q

Advise regarding lithium before surgery

A

Stop 24 hours before if major surgery, otherwise continue

Monitor U&Es if decide to keep patient on lithium during surgery

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8
Q

Advise regarding ACE-inhibitors and Angiotensin 2 Blockers before elective surgery

A

Stop 24 hours before surgery

Associated with severe hypotension on induction of anaesthesia

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9
Q

Advise regarding potassium sparing diuretics before elective surgery

A

Stop on morning of surgery

Risk of hyperkalaemia if there is renal impairment or significant tissue damage during surgery

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10
Q

Advise regarding Warfarin before elective surgery

A

Major surgery = stop 2-5 days pre-op - check INR

Minor surgery: may be able to continue – check INR pre-op, liaise with surgeon

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11
Q

Advise regarding medication of a Type 1 diabetic before elective surgery

A

Give an injection of the patient’s normal insulin on the night before surgery and then stop any further doses

Patient should be NBM on night before surgery

Make first on surgery list - use sliding scale

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12
Q

Advise regarding medication of a Type 2 diabetic before elective surgery

A

Stop short acting drugs on the day of surgery.

Stop long acting drugs 3 days before.

Stop metformin 2 days before until 2 days post-op

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13
Q

When should metformin be stopped before elective surgery and when can it be restarted?

A

Stop 2 days before

restart 2 days post op

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14
Q

How often should BM be monitored during surgery whilst the patient is on a sliding scale?

A

Take capillary glucose 2 hourly

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15
Q

When can diabetics resume their normal medications post op?

A

As soon as they start eating

apart from metformin - 2 days after

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16
Q

Recommended tests for an ASA I patient before minor elective surgery

A

No routine tests

17
Q

Recommended tests for an ASA I patient before intermediate elective surgery

A

No routine tests

18
Q

Recommended tests for an ASA I patient before major elective surgery

A

FBC

Consider: ECG - if over 65 and no ECG for 12 months
Kidney function for people at risk of AKI

19
Q

Risk factors for AKI during elective surgery that may make you consider kidney function tests?

A 
Over 65 
eGFR < 60 ml/min/1.73m2
Diabetics
Heart failure 
Liver disease
Nephrotoxic drug use during pre op period 
Intraperitoneal surgery
20
Q

Recommended tests for an ASA II patient before minor elective surgery

A

No routine tests

21
Q

Recommended tests for an ASA II patient before intermediate elective surgery

A

No routine tests but consider:

ECG - if over 65 and no ECG for 12 months
Kidney function for people at risk of AKI

22
Q

Recommended tests for an ASA II patient before Major elective surgery

A

FBC, Kidney function & ECG

23
Q

Recommended tests for an ASA III or IV patient before minor elective surgery

A

No routine tests - but consider:

ECG - if over 65 and no ECG for 12 months
Kidney function for people at risk of AKI

24
Q

Recommended tests for an ASA III or IV patient before intermediate elective surgery

A

Kidney function & ECG

Consider:
FBC - if new symptoms of CV or renal disease
Clotting screen - if chronic liver disease
Lung function - if known or suspected respiratory disease

25
Q

Recommended tests for an ASA III or IV patient before Major elective surgery

A

FBC, Kidney function & ECG

Consider:
Clotting screen - if chronic liver disease
Lung function - if known or suspected respiratory disease

26
Q

What should you consider when anaesthetising a patient who’s on long term steroids?

A

Patients may need extra cover during surgery and post surgery with IV hydrocortisone

Watch out for hypotension which may indicate you have not given enough hydrocortisone to cover for the stresses of surgery

27
Q

What advise should be given to patients for after a general anaesthetic?

A

Someone should be with them for the following 24 hours

No driving, No operating heavy machinery, No alcohol

ACC (4 decks)

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