Pre-Operative and Post-Operative Care Flashcards Preview

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Flashcards in Pre-Operative and Post-Operative Care Deck (41)
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1

What are 7 factors you should consider in the pre-operative management of a patient’s medications?

1. Infection risk (obesity, gender, diabetes status, immunosuppressants)
2. Flare-up of existing conditions
3. Bleeding risk
4. Blood glucose control (if relevant)
5. Renal function
6. Pain management
7. Thromboembolic risk

2

What are 4 factors you should consider in the post-operative management of a patient’s medications?

1. Pain management
2. Nausea/vomiting
3. Infection risk and wound healing
4. Blood glucose control (if relevant)

3

What is the main consideration of apixaban around surgery?

The risk of thromboembolism vs the risk of bleeding

4

What is the level of risk of thromboembolism in patients with atrial fibrillation having surgery?

Low-to-moderate

5

Does a patient with atrial fibrillation taking apixaban need bridging therapy when they have surgery? Why/why not?

They do not need bridging due to the rapid offset and onset of apixaban.

6

When should a patient’s last dose of apixaban be before morning surgery?

3 nights before

7

When should a patient restart apixaban after a procedure?

After 48 hours

8

What is the level of risk of thromboembolism in patients with a past TIA having surgery?

High

9

What is the level of risk of thromboembolism in patients with ischaemic heart disease having surgery?

High

10

What may you need to do in preparation for surgery in a patient at a high risk of thromboembolism who is taking antiplatelet medication(s)?

Consult their usual cardiologist for advice.

11

What are 2 benefits of continuing metoprolol through surgery?

1. Prevent/control arrhythmias
2. Reduce myocardial oxygen demand

12

How should metoprolol be used around surgery?

It should be continued.

13

How should irbesartan/hydrochlorothiazide be used around surgery?

If the patient’s blood pressure is well controlled, it should be continued. If they are at risk of hypotension, it should be held the morning of surgery

14

What is the benefit of using atorvastatin around surgery?

It may prevent vascular events in the perioperative period.

15

How should atorvastatin be used around surgery?

It should be continued.

16

Surgery increases the risk of what 3 complications in patients taking metformin?

1. Renal hypoperfusion
2. Lactate accumulation
3. Tissue hypoxia

17

When should a patient’s last dose of metformin be before surgery?

The night before

18

When should metformin be restarted after surgery?

Once patient is stable and eating (ensuring they have no renal impairment)

19

What is the main complication associated with gliclazide around surgery?

There is an increased risk of hypoglycaemia with the patient fasting.

20

When should the patient’s last dose of gliclazide (slow-release formulation) be before surgery?

Two nights before.

21

When should gliclazide be restarted after surgery?

Once the patient is stable and eating

22

What is the main complication of insulin glargine with surgery?

There is an increased risk of hypoglycaemia with the patient fasting.

23

What does the decision around the use of insulin glargine around surgery depend on?

The patient’s blood sugar control.

24

If a patient has high risk of hypoglycaemia, how should insulin glargine be used around surgery?

Halve or omit the dose the night before surgery.

25

If a patient has a low risk of hypoglycaemia, how should insulin glargine be used around surgery?

They should not change their dose.

26

What is the main complication of insulin aspart with surgery?

There is an increased risk of hypoglycaemia with the patient fasting.

27

When should a patient’s last dose of insulin aspart be before surgery?

The night before

28

When should insulin aspart be restarted after surgery?

Once the patient is stable and eating

29

What is the main consideration regarding methotrexate around surgery?

There is a risk of infection due to its immunosuppressive effects, but the risk of decompensation of the disease may be worse than potential infection risk

30

How should methotrexate be used around surgery?

It should be continued.