postoperative increase in platelets coupled with venous endothelial trauma and stasis all contribute If no prophylaxis is given 30 of these patients will develop DVT and 0102 will die from pulmonary thromboembolism PTE ID: 1046359
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1. Thromboprophylaxis
2. Deep venous thrombosis (DVT) is most common in patients over 40 years of age who undergo major surgery. A postoperative increase in platelets coupled with venous endothelial trauma and stasis all contribute . If no prophylaxis is given, 30% of these patients will develop DVT and 0.1-0.2% will die from pulmonary thromboembolism (PTE)
3. Types of thromboprophylaxis (1).1-Mechanical devices :Thromboembolic deterrent stockings (TEDS). 2-Drugs acting on the clotting cascade :Heparin and Low molecular weight heparin (LMWH). Regimen :heparin 5000U SC 2h pre-op, then every 8-12h SC for 7d or until ambulant. Low molecular weight heparin (LMWH) may be better (less bleeding, no monitoring needed).: eg enoxaparin 20mg/d SC, increased to 40mg/d in major-risk surgery (2).Fondaparinux (a factor Xa inhibitor) and ximelagatran may be better than LMWH . (2).
4. Risk groups (1).All patients are -at risk of developing deep vein thrombosis just as is the general population. Certain factors increase this risk and warrant specific interventions. It is usual to divide patients according to estimated risk. 1-Low risk (TEDS only)Day case surgery, minor orthopaedic procedures, and surgery after which patients mobilize immediately.
5. 2-Medium risk (TEDS and prophylactic dose LMWH)Examples include minor surgery where mobilization is expected to be slow; abdominal, thoracic, upper limb orthopaedic surgery; low risk procedures with associated comorbid risk factors (diabetes, obesity, cardiorespiratory disease, malignancy, oral contraceptive pill, previous history of thromboembolic disease). 3-High risk (TEDS and treatment dose LMWH or IV heparin)Examples include pelvic surgery, major lower limb orthopaedic procedures, surgery for malignancy, medium risk procedures with associated comorbid risk factors (diabetes, obesity, cardiorespiratory disease, malignancy, oral contraceptive pill, previous history of thromboembolic disease).
6. Preoperative prophylaxis against aspiration pneumonia
7. Obesity, DM, pregnancy, peptic ulcer, stress, elderly, pediatric, trauma and emergency surgery are risk factors which may lead to delayed gastric emptying, increase gastric volume, and decrease esophageal sphincter result in regurgitation and aspiration of gastric contents causing potentially fatal condition called aspiration pneumonitis, therefore such patient require special pharmaceutical care to prevent aspiration by:
8. A- Antacid agents: they should be given as a single dose 30 ml approximately 15-30 min before induction of anesthesia, antacids has two major advantages: 1-Rapid onset of action .2-Effective on the fluid already present in the stomach.The major disadvantages are:1-Their effect may not last as long as the surgical procedure.2-Their administration adds fluid volume to the stomach.B- Gastric motility stimulants (prokinetic agents)They act by promoting gastric emptying therefore reducing gastric volume, these agents should be given 60min before induction of anesthesia when given orally, 30min when given IV.
9. C- H2 receptor antagonistsThey act by reducing gastric acidity and volume by inhibition of gastric secretion.H2 blockers has no action on gastric contents already present in the stomach therefore oral dose of H2 blockers is given at the evening before surgery followed by an oral or parenteral dose on the morning of surgery, these agents do not produce an immediate effect. D- Proton pump inhibitorsThey are effective in suppressing acid secretion .