Perioperative Meds Special Notes/CI/DOCs/Interactions

Minimal ASA Classification

conscious, intact reflexes, responds to commands; AIRWAY AND CV ARE BASELINE

Moderate ASA Classification

depressed consciousness, can respond, may not feel stimulation; AIRWAY AND CV ARE ADEQUATE

Deep Sedation ASA Classification

pt can't be easily aroused, but responds to repeated painful stimuli; AIRWAY MAY NEED SUPPORT/VENT HELP, but CV ADEQUATE

Gen Anesthesia ASA Classification

pt not arousable, even to pain; AIRWAY/CV OFTEN/FREQUENTLY NEED SUPPORT

Meds to Hold Pre-Op

-Anticoags
-Antiplatelets
-HTN Meds
-All OTCs (NSAIDs)
-GI Meds (Ozempic/Mounjaro)

Immediate Pre-Op Pain Meds

-Celecoxib
-Famotidine
-Acetaminophen

Make sure to check for _____ pre-op.

ALLERGIES
(specifically abx)

MC Pre-Op Antibiotic

Cefazolin
(or other 1st gen Cephalosporin)

Add _____ if deeper in GI tract.

Metronidazole

Pt will be _____ pre-transplant.

Immunosuppressed

Transplant Pts require ______ with Abx pre-op.

strong coverage

Benzodiazepines CI

-hypersensitivity to agent
-acute narrow-angle glaucoma
-<6 months of age, respiratory impairment
-hx of substance abuse

Benzodiazepines Warnings/Precautions

-Anterograde amnesia
-CNS depression
-sleep related activities

Benzodiazepines Drug Interactions

CNS Depressants

DOC for Benzodiazepines (Pre-Op)

Midazolam and Lorazepam

Alternative DOC for Benzodiazepines (Pre-Op)

Diazepam
(but CYP3A4)

Benzos are used pre/post-op for ____, ____, _____.

-Amnesia
-Procedural sedation
-Antispasmodic

Benzos Reversal Agent

Flumazenil

Two Types of NMBAs

Depolarizing and Non-Depolarizing

Two Types of Non-Depolarizing NMBAs

Steroidal and Benzylisoquinoliniums

**reversal agents: neo (BZIQs) and Sugammadex (steroidals)

Neostigmine/Sugammadex CI

Cardiac Conditions

Neostigmine/Sugammadex Warnings/Precautions

Cholinergic crisis (signs of OD)

Neostigmine/Sugammadex Drug Interactions

-Pretreat w/atropine/glyco
-Avoid in pregnancy
-Albuterol, amantidine

Meds for Induction of Sedation

-Propofol (DOC)

-Ketamine

-Etomidate

-Dexmedetomidine

Propofol CI

Pregnancy & Peds

Propofol Warnings/Precautions

Cardiac monitoring

Propofol Drug Interactions

-Terrific anesthetic
-Drug to drug int. w/ benzos and opiates (used for synergy)
-Short onset/elimination

Ketamine CI

-High BP
-Hx of seizures
-Pregnancy

Ketamine Warnings/Precautions

-Elderly d/t agitation and confusion
-CV effects

Ketamine Drug Interactions

-Depressant effects
-Increased BP
-Prolong NMBAs

Etomidate CI

Other sedatives

Etomidate Warnings/Precautions

-Adrenal suppression
-Pregnancy
-BP effects?

Etomidate Drug Interactions

-Used for synergy w/other meds
-Used for RSI

Dexmedetomidine CI

Hypotension

Dexmedetomidine Warnings/Precautions

-Bradycardia & Sinus Arrest
-Hypotension
-Tolerance

Dexmedetomidine Drug Interactions

-Other BP meds & sedatives
-Used alone to tx agitation

Anesthetics (Gas) Meds

-Desflurane
-Isoflurane
-Sevoflurane
-Nitrous Oxide

Gases are typically used as ______ to other anesthesia.

Adjunct

Anesthetic Gases CI

-Hx of malignant hypothermia
-Cardiac issues

Anesthetic Gases Warnings/Precautions

-Misuse/abuse
-COPD
-Nasal passage complications

Anesthetic Gases Drug Interactions

-Dose changes based on age
-Dosing is mixed in another gas to deliver (usually O2)

Meds that caused malignant hyperthermia

Sevoflurane, Isoflurane, Desflurane, and Sugamadex (d/t prolonged contractions and tissue bkdwn > Ca buildup)

Tx for Malignant Hyperthermia

-Stop Offending Agents
-Cool Pt
-Dantrolene
-Supportive Care

Hemostats are used to _____?

Chemically stop blow flow or form a clot.

You _____ combine hemostat agents based on severity/location.

CAN

Hemostat Meds

-Tranexamic Acid
-Fibrin/Thrombin
-Gelfoam/Gelatin

Tranexamic Acid CI

-Pre-existing thromboembolic disorder
-Renal failure
-Coronary stents

Tranexamic Acid Warnings/Precautions

-Take at same time each day
-Lab tests/monitoring required

Tranexamic Acid Drug Interactions

-Blood thinners
-Hormones

Medication for post-op symptoms depends on ______.

Severity
(especially for pain)

Main Concerns with PO Opioids:

-Constipation
-Itching
-Resp Depression

**give naloxone

Reversal Agent for Opioids

Naloxone

Be cautious with opioids when ______.

Converting from parenteral to oral or other agents.

Gabapentin treats:

-Withdrawal
-Decreases heavy drinking
-Promotes abstinence

Post-Op Diphenhydramine CI

Cardiac conditions

Post-Op Diphenhydramine Warnings/Precautions

-Anticholinergics
-Histamines
-Glaucoma

Post-Op Diphenhydramine Drug Interactions

-Helps with itching
-Anticholinergics

Post-Op Dexamethasone CI

Adrenal insufficiency

Post-Op Dexamethasone Warnings/Precautions

Renal function, infection

Post-Op Dexamethasone Drug Interactions

NSAIDs

Main concern of post-operative care?

Nausea/Vomiting
(PONV)

Meds for PO N/V

-Dexamethasone
-Ondansetron
-Promethazine
-Prochlorperazine
-Metoclopramide
-Benzodiazepines

Poor management of PONV can lead to:

-Prolonged hospital stays
-Increased costs
-Complications/injury

Best starting med for PONV?

Propofol

Tx Options for Premed Pain

-Gabapentin
-Celecoxib
-Acetaminophen

Tx Options for Premed GI

-Famotidine (Ulcers)

Tx Options for Hypotensive

-Ephedrine
-Epinephrine
-Phenylephrine

Tx Options for Bradycardia

Atropine

Tx Options for Anticholinergic

Glycopyrrolate

Tx Options for DVT

Enoxaparin

More time in the body (during Sx), the higher the risk for ______.

Anemia

Local Anesthetics (-canes) CI

Previous sensitivity rxns

Local Anesthetics (-canes) Warnings/Precautions

-Avoid eye contact
-Disposal

Local Anesthetics (-canes) Drug Interactions

-can be combined w/epi for faster acting
-Other topical locals
-Bupivacine can cause CV toxicity