Anaesthetists Handbook - MEDICAL EDUCATION at University ...

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Management of patients with diabetes mellitus• Strokes (CVA)• Autonomic neuropathy (suggested by dizzy / fainting spells,irregular heartbeat, postural hypotension – see below).4. Other day surgical criteria to be fulfilled (see page 190).5. Investigations.• Urea and electrolytes.• HbA 1C levels.• ECG.• Blood pressure – lying down and standing (a drop in systolicblood pressure of > 20 mm Hg on standing is indicative ofpostural hypotension).Guidelines for the management of diabetic patients on the surgicalday unitAll diabetics to be scheduled first on their respective am or pm list.Aim to maintain blood glucose levels between 4-10 mmol L -1throughout the perioperative period.Measure capillary blood glucose levels on admission, intraoperativelyand postoperatively on the ward area.If the blood glucose is above 10 mmol L -1 on more than twooccasions start insulin sliding scale in accordance with Trust ClinicalGuidelines for the management of Diabetic Patients undergoingSurgery (UHCW 2005).Encourage oral intake as soon as possible. In case of 23-hoursurgery, delayed oral intake or postoperative nausea and vomiting(PONV), monitor blood glucose hourly till patient is eating anddrinking normally.Patient to take normal dose of insulin / OHA prior to evening meal.156 Anaesthetists Handbook January 2010
Patients who take insulinManagement of patients with diabetes mellitusFor morning surgery, omit the morning dose of insulin. For afternoonsurgery, take half the morning dose with breakfast.Patients who do not take insulinFor morning surgery, omit the morning oral hypoglycaemic agent. Forafternoon surgery, take the morning dose with breakfast.Inpatients[Guidelines devised by Dr Carol Ray (anaesthetic SpR), Dr A. Anwar(consultant diabetologist), Dr S. Radhakrishna (consultant anaesthetist), 2003;last revised January 2005; appraised by Dr S. Radhakrishna, February 2007].Good perioperative control of blood glucose reduces the risk ofinfection and promotes wound healing. Blood glucose levels shouldbe maintained between 4-7 mmol L -1 whenever possible.Flow chart for managing diabetic patients undergoing surgeryExclusions: cardiothoracic surgery, and eye surgery under localanaesthesia.See next page for flow charts.Anaesthetists Handbook January 2010 157
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Department of AnaesthesiaAnaestheti
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Document control for approved clini
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ContentsTrauma list anaesthetist (t
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ContentsStudy leave 81Junior doctor
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ContentsIndications for investigati
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ContentsRenal patients - clinical g
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Introduction and scope of guideline
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Introduction and scope of guideline
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Airway assessmentManaging difficult
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Managing difficult airways• Flexi
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Managing difficult airways• Manuj
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Resuscitation - advanced life suppo
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Resuscitation - advanced life suppo
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Duties of the on call anaesthetists
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Getting senior helpGetting senior h
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On call casesGetting senior helpYou
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Supervision for sick patientsGettin
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Calling the senior resident anaesth
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Perianaesthesia Care Unit (PACU)PAC
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PACUThe surgical team responsible f
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PACU6. Oxygen and intravenous thera
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Integration with the critical care
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Inter-hospital transfersInter-hospi
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Inter-hospital transfersConsultant
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Signing onAdministrative issuesYour
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Administrative issuesMobile phones
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Administrative issuesobstetrics, we
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Administrative issuesMain theatre r
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CLWrota processes• To complete ca
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Security rules:• Do not put confi
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Education and trainingthe Royal Col
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Education and trainingthe necessary
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Education and trainingarrive in the
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Education and traininginformation c
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Education and trainingexamination i
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Education and trainingAll consultan
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Presenting at seminars• Bring har
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Presenting at seminarsDOI advise yo
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Clinical adverse event reportingCli
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Clinical auditClinical audit[Apprai
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Clinical auditYour presentation sho
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Pain management and postoperative c
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Page 105 and 106: Pain management and postoperative c
Page 121 and 122: Signs and symptomsAgitation, anxiet
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Page 125 and 126: Epidural anaesthesia and analgesiai
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Page 129 and 130: IndicationsEpidural anaesthesia and
Page 131 and 132: Epidural anaesthesia and analgesiaH
Page 133 and 134: Assessment and treatment optionsEpi
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Page 143 and 144: Allergies and adverse drug reaction
Page 149 and 150: Awareness during anaesthesiaPrevent
Page 151 and 152: Fractured neck of femur:management
Page 153 and 154: Fractured neck of femurGuidelines f
Page 155: Management of patients with diabete
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Page 161 and 162: Management of patients with diabete
Page 163 and 164: Preoperative assessment and investi
Page 167 and 168: Indications for investigationsFull
Page 171 and 172: SevofluraneSevoflurane[Dr Mark Port
Page 173 and 174: Sevofluranemust be considered on it
Page 175 and 176: Gabapentin in acute painSide-effect
Page 177 and 178: Blood and blood productsBlood and b
Page 179 and 180: Blood and blood productsWhen the un
Page 181 and 182: Blood and blood productsCross match
Page 183 and 184: Blood and blood productsBlood Cool
Page 185 and 186: Blood and blood productsHaematology
Page 187 and 188: Blood and blood products25322 so th
Page 189 and 190: Blood and blood productsfactors, ha
Page 191 and 192: Day case anaesthesia6. Social crite
Page 193 and 194: ENT anaesthesiaENT anaesthesia{Dr C
Page 195 and 196: ENT anaesthesiaIntraoperative• In
Page 197 and 198: Miscellaneous issuesMiscellaneous i
Page 199 and 200: Miscellaneous issuesideally be cont
Page 201 and 202: Miscellaneous issuesinstruction man
Page 203 and 204: Miscellaneous issuesRemifentanilRem
Page 205 and 206: Miscellaneous issuesCentral neuraxi
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Miscellaneous issuesAnalgesia Fenta
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Miscellaneous issues• Diclofenac
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Miscellaneous issues• Associated
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Miscellaneous issues• Everyone wi
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Miscellaneous issues• If fasting
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Miscellaneous issueslabour ward ana
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Miscellaneous issuesThere is no cli
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Patient monitoring in and out of th
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Miscellaneous issuessuch as Hartman
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Miscellaneous issues• Abdominal a
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Miscellaneous issuesPrevention of p
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Miscellaneous issuesDifferent clini
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Recovery and patient handoverMiscel
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For afternoon list (pm)Diabetic Pat
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Miscellaneous issuestake part in th
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Miscellaneous issuesSee page 37 for
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Waiting list initiatives[Appraised
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Major Incident ProcedureStaff assem
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Major Incident Procedure• In coop
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Finding your way round theUniversit
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• Coffee room.• Quiet room (fiv
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Anaesthesia department lead clinici
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Trust organisational structureTrust
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Telephone numbersLabour ward……
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IndexIndexAabsence, 68adenotonsille
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Indexemergency department, 222emerg
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Indexmortality review, 93MRI scansa
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Indexstudy leave, 81applications, 6
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NotesAnaesthetists Handbook January
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NotesAnaesthetists Handbook January
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