Download The Washington Manual® of Outpatient Internal Medicine by Washington University School of Medicine Department of PDF
By Washington University School of Medicine Department of Medicine
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Polanczyk CA, Marcantonio E, Goldman L, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001; 134:637-643. 23. Reilly DF, McNeely MJ, Doerner D, et al. Self reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med 1999;159:2185-2192. 40 24. Backer CL, Tinker JH, Robertson DM, Vlietstra RE. Myocardial reinfarction following local anesthesia for ophthalmic surgery. Anesth Analg 1980;59:257-262.
Patients undergoing major procedures will typically require an insulin drip perioperatively. • Glucose and potassium will need to be administered concomitantly to avoid hypoglycemia and hypokalemia, respectively. • The usual insulin treatment can be resumed once oral intake is established postoperatively. PERIOPERATIVE ANTIPLATELET AND ANTICOAGULATION MANAGEMENT Antiplatelet Agents • Some controversy exists over the use of aspirin in the perioperative period. • Traditionally, aspirin is withheld for approximately 1 week prior to invasive procedures to minimize bleeding risk.
Colonoscopy, cataract surgery, and inguinal hernia repair): Give 25 mg hydrocortisone or 5 mg methylprednisolone IV on the day of the procedure only. , cholecystectomy and hemicolectomy): Give 50 to 75 mg hydrocortisone or 10 to 15 mg methylprednisolone IV on the day of the procedure and taper quickly over 1 to 2 days to the usual dose. , major cardiothoracic surgery, Whipple procedure, and liver resection): Give 100 to 150 mg hydrocortisone or 20 to 30 mg methylprednisolone IV on the day of the procedure and taper to the usual dose over the next 1 to 2 days.