Source / episode info
- **Episode:**613
- **Title:**DIP Ep 613: Peri-operative Medicine (Social Sciences)
- **Published:**2025-07-13
- Source:Episode page
One-liner
Episode 613 is a comprehensive review of perioperative medicine, covering diabetic management (insulin use), screening for atlantoaxial instability in RA patients, managing anticoagulation and antiplatelets, administering stress doses of steroids for HPA axis suppression, preventing aspiration pneumonia, and recognizing critical intra- and pre-operative complications like thyroid storm and malignant hyperthermia.
High-yield summary
- Diabetic Management: For preoperative glucose control, use insulin; maintain blood glucose levels < 180 mg/dL. Hold oral hypoglycemic agents (e.g., Metformin) due to risk of lactic acidosis or kidney injury.
- Musculoskeletal Risk: Patients with Rheumatoid Arthritis, Down Syndrome, or Ankylosing Spondylitis require screening for Atlantoaxial Instability (C1-C2 subluxation) via a preoperative cervical X-ray before intubation/surgery.
- Endocrine Stress Dosing: Any patient undergoing surgery who has chronic steroid use (e.g., GCA) or primary adrenal insufficiency requires a stress dose of corticosteroids to prevent iatrogenic adrenal crisis due to HPA axis suppression.
- Anticoagulation Protocol: Preoperative antiplatelet/anticoagulant agents (Warfarin, Aspirin, Clopidogrel) should generally be held due to bleeding risk, but the patient must be bridged with Heparin. Exception: Continue aspirin if a coronary stent is present.
- Aspiration Risk: Increased risk factors include altered mental status (alcoholism, stroke), chronic opioid use, diabetic gastroparesis, and high-diverticulum hernia; NPO status prevents aspiration.
Learning objectives
- Identify specific preoperative screening tests for patients with connective tissue disorders (RA, Down Syndrome).
- Determine appropriate glucose management strategies in the perioperative setting using insulin protocols.
- Select correct prophylactic antibiotics and timing for dental/cardiac surgery based on risk factors.
- Recognize indications for stress dosing of corticosteroids in HPA axis suppression states.
- List critical contraindications to TPA (e.g., SBP > 180 mmHg) and manage high-risk bleeding patients with anticoagulation bridging.
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