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minor surgery - on OHA, give normal regime on insulin, omit on day of surgery DXT QID major surgery - on OHA, omit long acting (glibenclamide) If RBS >15, to start insulin sliding scale DXT QID

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How to prepare DM pt for elective surgery

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SURGERY: PERIOPERATIVE CARE - Leaderboard

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SURGERY: PERIOPERATIVE CARE - Details

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1) Chapter 1 View

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Minor surgery - on OHA, give normal regime on insulin, omit on day of surgery DXT QID major surgery - on OHA, omit long acting (glibenclamide) If RBS >15, to start insulin sliding scale DXT QID

How to prepare DM pt for elective surgery

If DKA, treat DKA Postpone surgery until RBS <20 unless life threatening Aim 7-11mmol/L during surgery Give D5% or DS+20mmol KCl 8 hourly + IVI Insulin sliding scale

How to prepare DM pt for emergency surgery

- hypoventilation - secretion retention - mental unrest

What happen if pt didnt given enough analgesia?

Mild T. PCM 1g QID moderate T. PCM 1g QID + Cap Tramal 50mg QID severe S/C Morphins 5-10mg 4 hourly +- T.PCM/ Cap Tramal (morphine can used for rib injury) oth opts: T Arcoxia (Etoricoxibe) 90/120mg OD (also for head injury) T Ponstan (Mefenemic Acid) 500mg TDS IV/IM Voltaren (Diclofenac Na) 75mg TDS

Pt complain of PS 0-3 PS 4-6 PS 7-10 what analgesia to give?

1. Take consent 2. Hx - prev surgery, GA?, cx of prev surg, comorbidities, meds 3. PE: short neck (difficult intubate), obese, CVS-respi status 2. Inform anaest -anest preop assessment 3. Pre-op ix - fbc, coag, cxr, lft, rp, rbs, ecg 4. Prophylactic abx 5. Correction of coag disorder, electrolytes, DXT, BP 6. Current medication - withold aspirin/warfarin

What are the preoperative care for pt

1. IV cefobid 2g 2. IV Flagyl 500mg

Preferred antibiotic in our department

1. IV cefobid 2g 2. IV Flagyl 500mg

Preferred prophylaxis antibiotic

1. POD - fever - prevention of fever 2. D1 - Atelectasis - incentive spirometry, chest physiotherapy, ambulate 3. D3 - UTI/pneumonia - early off CBD, prop up pt, hand washing on handling, RT insert, oral/trachy toileting 4. D5 - DVT - encourage ambulation, s/c ckexane 0.4mg OD, TED stocking 5. D7 - Wound infection, abscess - preop shower, skin prep, cont abx post op, dressing of wound

Post operative complications

1. Once evidence of bowel movement (bowel sounds, flatus, BO) - encourage orally ASAP 2. Identify risk - malignancy, anorexia, alcoholism, GI surgery, starvation 3. Close monitoring during period of refeeding with involvement of nutritionist 4. Parenteral phosphate administration 18mmol/day in addition to oral supplement as in starved body, there is breakdown of fat and muscle, which leads to losses in some electrolytes like K, Mg, Phosphate

Refeeding syndrome is caused by rapid refeeding after a period of under nutrition. The syndrome occurs because of reintruducing of glucose or sugar. As body digest and metabolises food again, this can cause sudden shift in balance of electrolytes and fluids. How do prevent this in post op pt?