Dr Stuart Myers

Pre-Operation Planning

Clothing

-  Wear clothes that you can put on yourself.

- Avoid buttons & zippers where possible.

- Avoid long sleeves if you will have a bulky dressing or cast.

- Slacks with elastic waistbands may be easiest to manage.

- Slip-on shoes will be easier than laced shoes

- Women should consider bras that fasten down the front & avoid pantyhose

- Avoid jewellery especially in hospital

- You may want to replace contact lens with eyeglasses until you hand is able to manage contacts

 

Diabetic Ketoacidosis

Euglycaemic Diabetic Ketoacidosis

 People with type 2 diabetes are urged to check medications before their operation

Anaesthetists are warning people with type 2 diabetes that a particular type of medication prescribed in Australia for some patients with the condition may affect their recovery after an operation.

People taking the medication can occasionally become unwell with a condition called euglycaemic diabetic ketoacidosis (a potentially dangerous build-up of acid in the blood) during or after their operation and diagnosis can be delayed or missed because the patient’s blood sugar level does not increase.

Diabetic ketoacidosis is a serious complication when the body does not have enough insulin. This leads to the body using fat to produce energy and this process leads to the accumulation of acids (ketones) in the body.

“The stress on the body of surgery combined with prolonged fasting can increase the risk of diabetic ketoacidosis,” 

If diabetic ketoacidosis is not diagnosed and treated, more serious signs and symptoms including dehydration, confusion and coma can potentially develop. Some patients need Intensive Care Unit admission.

To try to avoid this complication, patients may be advised to stop these drugs one to three days before more major procedures such as a knee replacement, and one day before more minor procedures such as a colonoscopy.

These medications include dapagliflozin (Forxiga), empagliflozin (Jardiance), ertugliflozin (Steglatro) as well as fixed dose combinations with metformin (Xigduo, Jardiamet, Segluromet) or with gliptins (Glyxambi, Qtern, Steglujan).

Medication

Continue to use your regular medications as instructed with a sip of water on the day of surgery.

 

Aspirin:

If you are taking aspirin under your doctor’s orders (e.g. you have
previously had a blood clot, stroke, heart attack, etc) it is preferable that you
continue taking your aspirin unless specifically asked to cease it by me.

Vitamin E:

You should avoid medicines containing vitamin E for four weeks after surgery.

Warfarin:

In most circumstances I do not stop Warfarin for straight forward hand surgery if the INR is around 2.

I am more concerned about the rare but catastrophic complications of Heart attack or Stroke than the small increased risk of bleeding or bruising after surgery.

Note most hand surgery is performed with a tourniquet which stops any bleeding at the time of surgery. For major bone surgery it should be ceased 2 - 3 days prior to your surgery after consultation with your treating Physician / Cardiologist.

Xarelto (rivaroxiban) and Eliquis (apixaban)

inhibit blood clotting factor Xa.
They should be stopped 2 days before major surgery ( eg Bone surgery, FCR Interposition arthroplasty ) and withheld one day before minor surgery (eg Trigger finger).
These can be resumed the day after surgery if there is no bleeding.

Diabetics:

Take ½ your dose of insulin on the day of surgery.

Notify hospital staff that you are diabetic on admission to hospital. You may need regular monitoring of your blood sugar while you are fasting.

Where possible Diabetic patients will be operated on at the start of an operating list

 

For Specific Drug questions I have found this Website to be very useful. 

 

Diabetics

The following guidelines are for patients with Diabetes Mellitus presenting for surgery.


1. Omit the following medications 48 Hours prior to your surgery. Notify your general practitioner and / or your diabetes specialist of these plans.
- Dapagliflozin (Forxiga),
- Empagliflozin (Jardiance),
- Ertugliflozin (Steglatro)
- Xigduo, Jardiamet, Segluromet
- (Glyxambi, Qtern, Steglujan).


These medications have been associated with an increased risk of diabetic ketoacidosis. For more information.


2. Omit All Oral hypoglycaemic medications (including metformin) on the day of surgery.   eg

- Gliclazide  ( Diamicron )

- Metformin   ( Diabex)


3.. You will have to FAST for 6 hours prior to your operation. You may drink WATER up until 3 hours prior to your surgery

4. . Bring your medications with you to the hospital.

5. Every attempt will be made for your surgery to be performed at the start of the operating list.


6. Notify nursing staff upon your arrival in the hospital that you are Diabetic so that your blood sugar can be monitored every 2 hours.

7. For Patients on Insulin.


- Notify your GP or Diabetic specialist that you are having surgery.
- In general Take a HALF of your usual morning dose of insulin.
- If your planned surgery is likely to be > 1 hour duration (moderate to major surgery) you may need an IV dr1p with 5% Dextrose inserted on admission to hospital


8. All patients with Diabetes Mellitus are to RESUME NORMAL DIET AND USUAL DIABETES TREATMENT as soon as possible post surgery.

Operation On Dominant Hand

-It may be difficult to write after the operation so consider completing important documents prior to the surgery

-Initially it may be difficult to toilet yourself so consider practising with your other hand prior to the operation