Surgery Book

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Preoperative Examination

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  1. See Also
    1. Preoperative Cardiovascular Evaluation
    2. Perioperative Beta Blocker
    3. Perioperative Cardiovascular Risk
    4. Perioperative Diabetes Management
    5. Deep Vein Thrombosis Prevention
    6. Perioperative Anticoagulation
    7. Endocarditis Prophylaxis
    8. Postoperative Nausea and Vomiting Prevention
  2. NPO guidelines
    1. No Solid foods within 6 hours of surgery
      1. Includes Orange juice, Soda, and Milk
    2. No clear liquids with 2 hours of surgery
      1. Includes water and apple juice
    3. Medications to still take on morning of surgery
      1. All Cardiovascular medications (except Diuretics)
      2. Anti-reflux medications (e.g. Omeprazole, Ranitidine)
      3. Seizure and anti-parkinson medications
      4. Bronchodilators
      5. Oral Contraceptives
      6. Corticosteroids or immunosuppressants
      7. Levothyroxine (Synthroid)
      8. Pain medications
        1. Acetaminophen or opiates
        2. Not Aspirin or NSAIDS
    4. Medications to not take on morning of surgery
      1. See perioperative medication guidelines below
      2. Diabetes medications
        1. See Perioperative Diabetes Management
      3. Diuretics or weight loss medications
      4. Potassium supplements or vitamins
  3. Perioperative Medication Guidelines
    1. Medications recommended if Cardiac Risk Factors
      1. See Perioperative Beta Blocker
    2. Medications to avoid in perioperative period
      1. Medications associated with bleeding risk
        1. See Perioperative Anticoagulation
        2. Aspirin, Clopidogrel, Dipyridamole, Ticlopidine
          1. Stop 7 days before surgery
          2. May continue for dental surgeries and Cataracts
        3. NSAIDs (e.g. Ibuprofen): Stop 5 days before surgery
        4. COX2 Inhibitors (e.g. Celebrex, Vioxx)
          1. Does not need to be discontinued before surgery
      2. Miscellaneous
        1. Tamoxifen (associated with thromboembolism)
    3. Herbal preparations to avoid in perioperative period
      1. Echinacea
      2. Ephedra (should be avoided in general)
      3. Garlic (discontinue at least 7 days before surgery)
      4. Gingko (discontinue at least 36 hours before surgery)
      5. Ginseng (discontinue at least 7 days before surgery)
      6. Kava (discontinue at least 24 hours before surgery)
      7. St. John's Wort (stop at least 5 days before surgery)
      8. Valerian (slowly taper off before surgery)
      9. Ang-Lee (2001) JAMA 286:208
  4. Labs: Preoperative
    1. History and physical directs lab screening
    2. Otherwise healthy patient for a non-high risk procedure
      1. No routine laboratory testing indicated
      2. Consider a Pregnancy Test in all fertile women
    3. Hemoglobin indications
      1. Anemia History
      2. Blood loss anticipated with procedure
    4. Serum Potassium
      1. Diuretic (e.g. Furosemide) use
      2. Digoxin use
    5. ProTime and INR
      1. Coagulopathy history
      2. Anticoagulant use or anticipated use post-surgery
    6. Chest XRay
      1. Change in cardiopulmonary status
    7. Electrocardiogram within last year
      1. Cardiac Risk Factors
      2. Age over 55 years

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