Info

tolerated

UFH: unfractionated heparin.

resulted from administration of pethidine to patients treated with MAOI. Hypertensive crises may occur when vasopressors are administered to patients on MAOIs. If surgery in patients on ongoing MAOI therapy is necessary or for emergency surgery, the following guidelines should be employed: Preoperative consultation with the treating psychiatrist. Benzodiazepine premedication. Avoid halothane, pethidine.

If vasopressors are necessary, avoid indirect-acting pressors (metaraminol) and use fluids and posture wherever possible. Carefully titrate small doses of direct-acting vasoconstrictors (methoxamine or phenylephrine) if necessary. Suxamethonium effect may be prolonged due to decreased cholinesterase levels.

Oral contraceptives

The use of the progesterone-only pill poses no documented problems during surgery. However, the combination oestrogen-progesterone pill should be discontinued 6 weeks prior to elective surgery because of the increased risk of DVT, especially in women who smoke. When emergency surgery is necessary, additional thomboembolism prophylaxis is required. In all cases, the patient must be advised to use alternate forms of contraception as the reliability of oral absorption is affected by fasting, perioperative nausea and vomiting and any antibiotic-induced diarrhoea (Table 1.8).

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