HTHSCI 2F03 Lecture Notes - Lecture 17: Orthopedic Surgery, Vascular Surgery, Urology
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26 Dec 2020
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2h for clear fluids, 6h for solids. Necessity is controversial as benefit of minimising post- op infection might not outweigh risks. Gi surgery (20% post-op infection if elective) Biliary: cef 1. 5g + met 500mg iv. Stratify pts according to patient factors and type of surgery. Med: early mobilisation + teds + 20mg enoxaparin. High: early mobilisation + teds + 40mg enoxaparin + intermittent compression boots perioperatively. May continue medical prophylaxis at home (up to 1mo) Asa grades: normally healthy, mild systemic disease, severe systemic disease that limits activity, systemic disease which is a constant threat to life, moribund: not expected to survive 24h even c op. Check anaesthesia / analgesia type c anaesthetist. Ease of intubation: neck arthritis, dentures, loose teeth. Post-op give iv or via ngt if unable to tolerate orally. Stop 4wks before major / leg surgery. Ecg: htn, hx of cardiac disease, >55yrs. Lat c-spine flexion and extension views: ra, as. Surgery stress hormones antagonise insulin.
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