06/07/2021
NOTES
Conditions/Drugs and their optimizations pre-operatively
- Hypertension
- All antihypertensive medications should be continued till the day of surgery except
- ACEi & ARBs
- In chronic hypertensive patients the auto-regulation curve shifts to
- Right
- Diabetic Mellitus
- All signs and symptoms of hypoglycemia are masked in GA
- Oral hypoglycemic agents and Insulin in Diabetic patients
- All OHA and insulin stopped before surgery
- Since, they can cause hypoglycemia
- In DM-1 patients, dose of long-acting insulin reduced to
- One-third of the dose
- In DM-2 patients, dose of long-acting insulin reduced to
- Half of the dose
- Target blood glucose level to be maintained
- 200 mg/dl (100-200 mg/dl) by using regular insulin
- Epilepsy
- Provoked by Hypoxia, Hypercarbia, Acidosis
- Decreases the threshold for next seizure
- Can cause status epilepticus
- Status epilepticus is said to occur when a seizure lasts too long or when seizures occur close together and the person doesn't recover between seizures.
- All antiepileptic drugs should be continued till the day of surgery
- Drugs like: Enflurane &Methohexital should be avoided
- Drugs like: Thiopentone sodium, Propofol can be used
- If patient on anti-epileptics
- LFT should be done
- Thyroid Disorders
- Hypothyroidism
- Delayed recovery
- Hyperthyroidism
- Thyroid storm
- All antithyroid/thyroid medications should be continued till the day of surgery.
- Psychiatry Problems
- All antipsychotics continued till the day of surgery
- Older MAO inhibitors stopped
- Continue Mg
- With recent development of short-acting anesthetics
- Atracurium, Cis-atracurium, Mivacurium
- Stoppage of Lithium not advocated
- Old-books: stop for 24-48 hours
- Past history of MI
- All blood thinners increase chances of bleeding in closed cavity spaces during regional anesthetic procedures
- Spinal cord, eye cavity, brain
- Aspirin discontinued 3 days prior to surgery. However, Aspirin continued even on the day of surgery to reduce the chance of Thrombosis, MI, Death in the following
- Prior PCI
- Coronary artery disease
- Stroke
