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HANA PM4B 3 > Surgery - NBM > Flashcards

Surgery - NBM Flashcards

1
Q

NBM

A

Patients advised not to eat and drink pre- and sometimes post operatively for a defined length of time.

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2
Q

Why does pt have to be NBM for surgery

A
  • Hazardous to induce anaesthesia in patients with a ‘full’ stomach.
  • Risk of regurgitation and subsequent pulmonary aspiration (Mendelson’s syndrome)
  • This can lead to aspiration pneumonia.
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3
Q

Things to consider during NBM period

A
  1. Medications to stop.
  2. Medications to continue.
  3. Length of NBM period.
  4. Interactions with anaesthetic medications.
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4
Q

Medication to stop in NBM period

A

Know the t1/2 of drug.

  • Long half-life = missing a few doses is minor
  • Short half-life = higher risk of adverse effects e.g. withdrawal
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5
Q

Medication to continue in NBM

A
  • Alternative routes/formulations are available e.g. iv/pr/topical
  • Know the equivalent iv/pr/po dose.
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6
Q

Levothyroxine (NBM)

A
  • Long t1/2
  • In prolonged NBM period give IV levo
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7
Q

Steroids (NBM)

A

Must give IV if patient is on regular prednisolone care/high dose inhalers.

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8
Q

Hypoglycaemic medicines (NBM)

A
  • Withold
  • Check renal function before restarting metformin
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9
Q

HRT/OCP (NBM)

A
  • VTE risk
  • Risk vs. Benefit
  • OCP = increased DVT risk.
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10
Q

Carbamazepine (NBM)

A
  • Not available as IV
  • Can be given PR, if not rectal surgery.
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11
Q

Phenytoin (NBM)

A
  • IV
  • ECG monitoring
  • Give in equivalent doses to oral
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12
Q

Isosorbide mononitrate (NBM)

A

GTN topical patch

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13
Q

Immunosuppressant (NBM)

A
  • Withold, if appropriate in light of the underlying condition
  • Impairs wound healing
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14
Q

Pethidine (NBM)

A
  • Opioid
  • Acute pain (po, s/c, i/m)
  • Pre-medication or post-op pain
  • Interaction with tramadol
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15
Q

Warfarin (NBM)

A
  • Stop 5 days prior to major surgery.
  • Restart when haemostasias has been achieved
  • Consider the risks of not anticoagulating
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16
Q

Warfarin and bridging

A
  • Warfarin takes a while to come out of the system
  • Whilst warfarin levels are reducing the risk of clotting increases so need to bridge
  • Stop warfarin and allow the INR to stabilize
  • Start LMWH (used due to shorter half-life)
17
Q

DOACs (NBM)

A
  • Short half-lives
  • Bridging is not required
  • Stop 24-96 hours prior to surgery depending on bleeding risk and eGFR/ CrCl.
18
Q

Aspirin (NBM)

A

Stop 10 days prior to surgery (10 days for platelets to regenerate).

19
Q

Clopidogrel (NBM)

A
  • Stop 10 days prior if low risk patient.
    • Must consult cardio/stroke team.
20
Q

Beta Blockers (NBM)

A
  • Anesthesia and surgery may provoke tachycardia and high bp in hypertensive patients.
  • Beta-blockers may help to suppress these effects
  • Reduce cardiovascular complications
  • Usually continued peri-operatively.
21
Q

Alternative routes of administration

A
  • Buccal
  • Gastronomy tubes
  • Parenteral
  • Rectal
  • Transdermal
22
Q

Never crush the following:

A
  • Enteric coated
  • Modified release
  • Cytotoxic
23
Q

Anticoagulation and antiplatelets considerations

A
  • Bleeding risk of surgery vs thrombosis risk.
  • Indication for anticoagulant use and VTE risk.
  • Bridging therapy.
  • Optimum time for re-starting post-operatively.
24
Q

Time to discontinue DOACs before surgery: minor or low risk procedure

A
  • Re-introduce 6-12 hours post-op when haemostasis is secured
25
Q

Time to discontinue DOACs before surgery: High risk procedure or when increased bleeding risk is not acceptable

A
  • Re-introduce 48 hours post-op.
26
Q

Fluid management inappropriate fluid therapy

A

Inappropriate fluid therapy leads to:
- Increased mortality
- Prolonged hospital stay

27
Q

Assessment of fluid status: indicators that pt may need fluid resuscitation

A
  • Observations:
    • BP systolic <100mmHg
    • Heart rate >90bpm
    • Capillary refill >2s
    • Respiratory rate >20 breaths per min
    • NEWS ≥5
28
Q

Fluid resuscitation

A

Decide whether to provide
- fluid bolus

29
Q

Routine maintenance in fluid status

A

Normal daily fluid requirements of 25-30ml/kg/day water with electrolytes.

HANA PM4B 3 (67 decks)

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