Discover and read the best of Twitter Threads about #periop

Most recents (3)

#Periopmedicine #Medthread!
Based on requests (esp @JenniferBrokaw), a long over-due #tweetorial with my advice & pearls for providing patient-centered care for the surgical patient with #ParkinsonsDisease
1/x
@JenniferBrokaw Caveats
1⃣I’m not an anesthesiologist & don’t care for pts w PD #intraoperatively
2⃣I practice outpatient #PREoperative medicine, so I am not providing inpatient postop care
3⃣There are several high yield publications/resources, & much of this is pulled from my own experience
2/x
@JenniferBrokaw Caveats out of the way, let’s chat about why understanding #periop #ParkinsonsDisease management is so foundational.
Remember how Osler said to know syphilis is to know all of internal medicine?
Yeah…PD meets #periopmedicine is potentially THAT informative.
3/x
Read 28 tweets
Followup #Medthread #Tweetorial about #periop med management as promised!
Thank you to all who voted.
So...the answer was an MAO-I.
all the agents are ones to stop pre-op, but why was MAO-I the answer I was going for?? 1/x
First choice was Ephedra--definitely something to stop pre-op given it's sympathetic effect and risk of cardiovascular instability.
HOWEVER, Ephedra was banned by the FDA in 2/2004, so I haven't seen a patient on this in the preop setting in years 2/x
thinking about Ephedra is a good opportunity to this about herbal/nutraceutical/supplement management periop, given hypothetical or KNOWN risk of:
✅cytochrome up/down regulation
✅cardiovascular instability
✅changes to platelet/coagulation function
✅drug/drug interactions 3/x
Read 13 tweets
A quick, spontaneous Saturday #tweetorial #Medthread about periop OSA inspired by @cacace_frank's journal catch up (w my first response below). Going to make this interactive (& tag #periop hospitalists & anesthesiologists along the way)... 1/x
@cacace_frank rightfully so, #periop OSA is getting more and more attention. It, and the company it keeps (OHS, PHTN, R heart failure) are driving periop risk factors, for respiratory events (resp failure, esp with opioids on board) AND cardiac events 2/x
@cacace_frank society guidelines recommend screening for OSA pre-op (ex. STOP-BANG), but what do you do with a positive screen? recall, it only takes 3/8 points on STOP-BANG to get to "high risk". It's a patient risk/benefit AND systems-based Q re utilization of/access to sleep studies...3/x
Read 19 tweets

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