Category Archives: Clinical

COVID-19 Resources

Here are some links to COVID-19 resources;







NOTE: I was planning for this to be a fairly short list, but it has grown quite by accident. I won’t be actively checking existing links so they may become outdated or broken over time.

SGLT2 Inhibitor Update Jan 2020


Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are oral medications that promote glucose excretion in the urine for the treatment of type 2 diabetes. Note that SGLT2i are not approved for use in the management of type 1 diabetes in Australia or New Zealand, although they are sometimes used off-label in this setting.

• Over the last few years there has been an increasing number of reports of patients with type 2 diabetes who are taking these medications developing severe acidosis requiring ICU/HDU admission during the peri-operative period.

• SGLT2i carry a small but definite risk of severe diabetic ketoacidosis (DKA). Sometimes this DKA is associated with near normal or only mildly elevated blood glucose levels (i.e. euglycaemic ketoacidosis [euDKA]).

• The risk is increased if the patient has been fasting or has very restricted dietary intake, has undergone bowel preparation and/or a surgical procedure, is dehydrated or has an intercurrent illness such as active infection.

• Blood ketone testing is strongly recommended to detect and monitor DKA as urine ketone testing may be unreliable

You can download the full document here: Download SGLT2 Jan 2020 PDF

Detection of Euglycaemic Ketoacidosis preoperatively

(Posted on behalf of Alison Herdman)

Pindara Admissions now finger prick test every preoperative patient on dapagliflozin (Forxiga), empagliflozin (Jardiance) or a combination with metformin (Xigduo, Jardiamet) with a ketone reagent strip.

They write the result on the Preop Check List.

If it is > 0.6mmol/l you will be notified by phone.

The Australian Diabetic Society (ADS) recommends that strong consideration to postponing non urgent surgery be given if SGLT2 inhibitors have not been stopped preoperatively and either the blood ketones are > 0.6 mol/l or the HbA1c is >9% .

Download ADS Alert and Recommendations here… ADS Alert and Recommendations

SPANZA Advisory on Tramadol

Recommendations Following FDA Warnings about Tramadol Use in Children
  1. Tramadol can have a useful role as part of a multimodal analgesic regimen for managing acute pain in children.
  2. Tramadol dose should be limited for acute pain after tonsillectomy (e.g., maximum dose 1 mg/kg 6-8 h, max 400 mg/day). We suggest starting with a lower dose of 2 mg/kg daily in divided doses (e.g., 0.5 mg/kg 6-8 h). Tramadol overdose is a greater danger than CYP variants.
  3. Children with obstructive sleep apnoea who have undergone tonsillectomy should continue to be monitored in hospital overnight to assess both response and sensitivity to opioids before discharge. While evidence is lacking, it may be prudent to observe any child given opioids during a period of sleep before discharge.
  4. The use of any opioid in children after day-stay surgery should be done so with caution.

The full document can be downloaded here.

Healthscope – blood transfusion prescriptions

(Posted on behalf of Julie Hopf, Anaesthetic/PARU Educator Gold Coast Private Hospital)

Healthscope have introduced the attached form for use with blood & blood products ‘Blood and Blood Products Prescription and Transfusion Record’ This is being used across all Healthscope sites. The blood product is prescribed on this form instead of the IV Fluids order form. The form includes the indications, pre-transfusion checks, information on observations, reactions & blood products all in the one place.

Download form here.


Kind Regards,