Anaesthesia Guide - 3rd med study notes PDF

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3rd med study notes
disease
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Pre-Operative Medications grel& Ticagrelor  

Ask about allergy to any drug, antiseptic, adhesive bandage & latex Consider IV options for pts NPO

Drugs you CAN take the morning of surgery ACE Inhibitors  No special action required if BP & U&E are okay  Many prefer to omit the morning dose due to risk of peri-op hypotension & kidney injury Antibiotics  Aminoglycosides, colistin & tetracyclines prolong neuromuscular blockade, even depolarising neuromuscular blockers B-blockers  Continue  Reduced risk of a labile CV response Digoxin  Continue up to & including morning of surgery  Check for toxicity  Check plasma K+ o Suxamethonium increases serum K+ by ~1mmol/L -> ventricular arrhythmias in the fully digitalised Statins  Continue, especially in those at high risk of CV events  Discontinue non-statin hyperlipidaemic drugs Bronchodilators  Continue & consider supplementing w/ nebulisers PPIs 

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Steroids  If pt is on or has recently taken steroids at an equivalent dose of >10mg prednisolone per day, give extra cover for the peri-op period

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Stop 5-7 days before surgery

Dual anti-platelet therapy (often aspirin + clopidogrel)  In pts already on DAPT for coronary stents, all elective non-cardiac surgeries should be postponed until the min duration of DAPT (~1 yr)  If possible, defer surgery for at least 6 wks after bare metal stents & 6 months after drug-eluding stents NSAIDs  Discontinued due to renal & anti-platelet effects Diuretics  Beware hypokalaemia & hypovolaemia  Check U&E Insulin  Continue long-acting (basal) insulin, even when on a sliding scale  Omit oral hypoglycaemics on morning of surgery

Drugs you should consider ceasing earlier OCP & HRT  Stop 4 wks before major/leg surgery  Restart 2 wks post-op if mobile  Use heparin thromboprophylaxis & stockings SSRIs  

Stop 3 wks prior to certain high-risk CNS procedures due to increased risk of bleeding In majority of pts can be continued

Ophthalmic drugs  Anticholinesterases used to t/t glaucoma may cause sensitivity to & prolong the duration of drugs metabolised by cholinesterase’s e.g. suxamethonium  Beta-blocker eye drops may cause systemic symptoms of bronchospasm/hypotension  Stop alpha-blockers as they can cause floppy iris syndrome making cataract surgery challenging

Anticonvulsants  Give usual dose up to 1hr before surgery  Give drugs IV (or by NGT) post-op, until able to take PO Levodopa  Possible arrhythmias when the pt is under GA

Drugs you DON’T take the morning of surgery Anticoagulants  Know the indication  Check the INR  If needed switch warfarin to heparin preop, leaving sufficient time for INR to drop to Peri-op risk Post-op chest infections are x6 more likely in smokers

1) 2) 3) 4) 5) 6)

Identity Procedure Consent Equipment checks Site marked? Allergies?

7)

Aspiration risk?...