MRCS PART A ESSENTIAL REVISION NOTES BOOK 1 - PasTest

More documents

Recommendations

Info

SECTION 2Preoperative management ofcoexisting diseaseCHAPTER 12.1 PreoperativemedicationsReview pre-existingmedicationIn a nutshell …If a patient is having surgery: Review pre-existing medication: Document preoperativemedications Decide which drugs need to bestopped preoperatively Decide on alternative formulations Prescribe preoperative medication: Prescribe prophylactic medication Prescribe medication related to thesurgery Prescribe premed if needed Be aware of problems with specificdrugs: Steroids and immunosuppressants Anticoagulants and fibrinolyticsPerioperative management ofpre-existing medicationDocument preoperative medicationsDecide whether any drugs need to bestopped before surgery Stop oral contraceptive (OCP) ortamoxifen 4 weeks before major orlimb surgery – risk of thrombosis Stop monoamine oxidase inhibitor(MAOI) antidepressants – they interactwith anaesthetic drugs, with cardiacrisk Stop antiplatelet drugs 7–14 dayspreoperatively – risk of haemorrhageDecide on alternative formulations forthe perioperative period For example, IV rather than oral,heparin rather than warfarin17
Perioperative CareCHAPTER 1Regular medications should generally be given– even on the day of surgery (with a sip of clearfluid only). If in doubt ask the anaesthetist. Thisis important, especially for cardiac medication.There are some essential medications (eganti-rejection therapy in transplant recipients)that may be withheld for 24 hours in thesurgical period but this should only be under thedirection of a specialist in the field.Prescribe preoperativemedicationMedication for the preoperativeperiodPre-existing medication (see above forthose drugs that should be excluded)Prophylactic medication For example, DVT prophylaxis For example, antibiotic prophylaxisMedication related to the surgery For example, laxatives to clear thebowel before resection For example, methylene blue toaid surgical identification of theparathyroidsAnaesthetic premedication (to reduceanxiety, reduce secretions, etc)Be aware of problems withspecific drugsSteroids and immunosuppressionIndications for perioperativecorticosteroid coverThis includes patients: With pituitary–adrenal insufficiency onsteroids Undergoing pituitary or adrenal surgery On systemic steroid therapy of >7.5 mg for>1 week before surgery Who received a course of steroids for>1 month in the previous 6 monthsComplications of steroid therapy in theperioperative period Poor wound healing Increased risk of infection Side effects of steroid therapy (eg impairedglucose tolerance, osteoporosis, musclewasting, fragile skin and veins, pepticulceration) Mineralocorticoid effects (sodium and waterretention, potassium loss and metabolicalkalosis) Masking of sepsis/peritonism Glucocorticoid deficiency in the perioperativeperiod (may present as increasingcardiac failure which is unresponsive tocatecholamines, or addisonian crisis withvomiting and cardiovascular collapse)Management of patients on pre-opsteroid therapyThis depends on the nature of the surgery to beperformed and the level of previous steroid use. Minor use: 50 mg hydrocortisone intramuscularly/intravenouslyIM/IV preoperatively Intermediate use: 50 mg hydrocortisoneIM/IV with premed and 50 mg hydrocortisoneevery 6 h for 24 h Major use: 100 mg hydrocortisone IM/IVwith premed and 100 mg hydrocortisoneevery 6 h for at least 72 h after surgeryEquivalent doses of steroid therapy: hydrocortisone100 mg, prednisolone 25 mg,dexamethasone 4 mg.18
Page 1: MRCS PART A ESSENTIALREVISION NOTES
Page 4: CHAPTER 1Perioperative CareTristan
Page 7: Perioperative CareCHAPTER 11. Ident
Page 11 and 12: Perioperative CareCHAPTER 1When to
Page 13: Perioperative CareCHAPTER 1Chest ra
Page 17 and 18: Perioperative CareCHAPTER 11.4 Iden
Page 19: Perioperative CareCHAPTER 11.8 Preo
Page 23: Perioperative CareCHAPTER 1Fibrinol

MRCS PART A ESSENTIAL REVISION NOTES BOOK 1 - PasTest

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?