Pre-operative Assessment and Preparation By Dr.Rashad Al-Kashgari Associate Professor of Surgery...
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Transcript of Pre-operative Assessment and Preparation By Dr.Rashad Al-Kashgari Associate Professor of Surgery...
Pre-operative Assessment and Preparation
By
Dr.Rashad Al-Kashgari
Associate Professor of Surgery
2001
Pre-operative Assessment and Preparation
Why ? How ? When ? What ?
Pre-operative Assessment and Preparation WHY ?
Elective operation should be performed under optimal condition with full physical and psychological preparation of a fully informed patient.
Emergency operation may have to be done in less than ideal circumstances .
Pre-operative Assessment and Preparation
HOW ?
History Physical exam Investigation
Pre-operative Assessment and Preparation
WHEN ?
Out patient visit Pre-operative ward round ER
Pre-operative Assessment and Preparation
WHAT TO DO ?
Six tasks To explain to the patient / relative the nature of the illness ,
implications of surgery and prognosis Identification of potential operative mortality and
postoperative morbidity To assess the fitness for operation Identification of the risks of potential postoperative
complications and prophylactic measures . Planning of operation and consent .
Task one
Nature of surgery Implication of surgery Alleviate fear/anxiety of the patient Prognosis
To explain to the patient / relative
Task two
Look for the risk factors?
Identification of potential operative mortality and morbidity
Risk factors of mortality and morbidity
Myocardial infarction
Pregnancy
Thrombogenic drugs Smoking Previous anesthetics Allergies
Avoid op.whenever possible for at least 6 months
Elective op. is avoided.Risk of miscarriage & teratogenicity
Steroids & pills
Suxamthonium/halothane Penicillin/Iodine-containing drugs
Task three
Assessment of general condition Assessment of metabolic state Assessment of cardiovascular system Assessment of respiratory system Assessment of renal system
To assess the fitness for operation
Assessment of general condition
Careful clinical exam. Pulse rate B.P.
Full blood count Serum urea & electrolytes Blood group & save serum X-match blood if needed
Assessment of metabolic state
Height Weight
Problems associated with obesity :
Venepuncture Anatomical landmarks Respiratory problems Thromboembolism Wound infection Wound dehiscence
Assessment of cardiovascular system
Clinical exam of heart and vessels
ECG Echocardiogram
Cardiovascular conditions
Hypertension Myocardial ischaemia
Cardiac arrhythmias Valve disease/septal
defect Hypovolemia
Increase risk of CVA/MI Avoid techniques /drugs which
increase heart rate/diastolic B.P/perfusion gradient
Discuss with cardiologist pre-op Cover with antibiotics
Restore blood volume pre-op
Assessment of respiratory system
Clinical exam of chest CXR Sputum for bacteriological
exam Blood gases Pulmonary function tests:
FEV1 FVC
Respiratory conditions
Chronic bronchitis
Asthma
Brochiectasis
Common cold
Suffer HYPOXEMIA.DO blood gases High risk patients-consider only for urgent op
. At risk of post-op respiratory failure.Give
bronchodilator. Best index: FEV1/FVC X100
Physiotherapy + Antibiotics (use local blocks instead of general anaesthesia)
Cancel op. in acute phase
Assessment of renal system
Clinical examination Urinanalysis & microscopy Urine for microbiological
examination Serum urea Serum creatinine
Renal disorders
Chronic retention
Identification of risks of potential post operative complications and prophylaxis
Pulmonary collapse and infection
Cardiac complications
Acute renal failure characterized by: (oliguria, dilute urine , & urea conc.<300 mmol/l)
Pre-op breathing exercises
Avoid excessive fluid post-op in all patients with cardiac ischemia or valvular disease
Major causes are hypovolemia, sepsis, jaundice and mismatched blood
Task four
Identification of risks of potential postoperative complications and prophylaxis (continue)
Venous Thrombosis
Wound infection
Avoid compression of legs during and after op.
If necessary,use graded compression stocking / low dose heparin 5000 I.u Q.12 hrs OR a single dose of LMW heparin
Prophylactic antibiotics (Bactericidal best guess for offending organism,high doses,three doses..when?
Task four (continue)
Planning of the operation
The operation should be properly named after full explanation to the patient and the side of operation is marked in case of bilateral parts.
He/she should consent for it. The duration of hospital stay,convalescense
and time off work should be indicated.
Task five
CONSENT
Explain to the patient in simple non medical language what is going to be done.
Alleviate his/her fears. Do not deceive the patient. Reassure the patient
Pre-operative orders Keep NPO (Nil per Oral) from ??:00 hrs Medications
Essential Prophylaxis
Prepare area for surgery Cleaning Shave Enema Etc
Task six