preparation for surgery Flashcards
(16 cards)
how long can patients drink clear fluids prior to surgery
2hrs before operation
- water
- fruit juice without pulp
- coffee or tea without milk
- ice lollies
how long should patients fast from non-clear liquids/food prior to surgery
at least 6 hrs
diabetic management in patients with good glycaemic control (HbA1c <69) undergoing minor procedure
managed during operative period by adjustment of their usual insulin regimen
management of diabetics havingsurgery requiring a long fasting period of more than one missed meal or whose diabetes is poorly controlled
variable rate intravenous insulin infusion (VRIII)
diabetics taking oral drugs, management prior to surgery? what are the exceptions to this?
manipulate the medications of day of the surgery
exceptions to this;
- if more than one meal missed
- poor glycaemic control
- risk of renal injury
–» in these cases use variable rate IV insulin infusion
when should warfarin be stopped prior to surgery
5 days before
- check INR, give vit K if >=1.5
when can warfarin be restarted after surgery
usual dose in evening or next day
warfarin around surgery if at high thromboembolic risk (VTE <3mnths, mechanical valve, AF with prior stroke)
bridge with treatment dose LMWH
–> stop this 24hrs prior to srugery
management of warfarin if emergency surgery required
if can be delayed 6-12hrs –> give IV vit K
if cant delay –> dried prothrombin complex with IV vitK
- check INR before surg
when should DOACs be stopped prior to surg
low/mod bleeding risk surg -> 24hrs before
high bleed risk surg (cardiothoracic) -> 48hrs before
renal impairment -> stop 72hrs before high risk surg
when can DOACs be restarted
minor/low bleed risk = 6-12 hrs post op
high = 48hrs after
aspirin around surgery
continue in most cases
stop 7 days before high risk surgeries (neurosurgs)
clopidogrel / prasugrel prior to surgery
stop 7 days before
ticagrelor prior to surgery
stop 5 days before
those on long term steroids having surgery
can convert to IV hydrocortisone
ACEi + ARBs prior to surgery
stop 24hrs before
- can be assoc with severe hypotension after induction of anaesthesia
