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Pre-operative Assessment and Preparation

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 ?.

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Pre-operative Assessment and Preparation

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  1. Pre-operative Assessment and Preparation By Dr.Rashad Al-Kashgari Associate Professor of Surgery 2001

  2. Pre-operative Assessment and Preparation • Why ? • How ? • When ? • What ?

  3. Pre-operative Assessment and PreparationWHY ? • 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 .

  4. Pre-operative Assessment and PreparationHOW ? • History • Physical exam • Investigation

  5. Pre-operative Assessment and PreparationWHEN ? • Out patient visit • Pre-operative ward round • ER

  6. Pre-operative Assessment and PreparationWHAT TO DO ? • Six tasks • To explain to the patient / relative the nature of theillness , 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 .

  7. Task one To explain to the patient / relative • Nature of surgery • Implication of surgery • Alleviate fear/anxiety of the patient • Prognosis

  8. Task two Identification of potential operative mortality and morbidity • Look for the risk factors?

  9. 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 Risk factors of mortality and morbidity

  10. Task three To assess the fitness for operation • Assessment of general condition • Assessment of metabolic state • Assessment of cardiovascular system • Assessment of respiratory system • Assessment of renal system

  11. Careful clinical exam. Pulse rate B.P. Full blood count Serum urea & electrolytes Blood group & save serum X-match blood if needed Assessment of general condition

  12. Height Weight Problems associated with obesity : Venepuncture Anatomical landmarks Respiratory problems Thromboembolism Wound infection Wound dehiscence Assessment of metabolic state

  13. Clinical exam of heart and vessels ECG Echocardiogram Assessment of cardiovascular system

  14. 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 Cardiovascular conditions

  15. Clinical exam of chest CXR Sputum for bacteriological exam Blood gases Pulmonary function tests: FEV1 FVC Assessment of respiratory system

  16. 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 Respiratory conditions

  17. Clinical examination Urinanalysis & microscopy Urine for microbiological examination Serum urea Serum creatinine Assessment of renal system

  18. Chronic retention Renal disorders

  19. 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 Identification of risks of potential post operative complications and prophylaxis Task four

  20. 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) Identification of risks of potential postoperative complications and prophylaxis (continue)

  21. Planning of the operation Task five • 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.

  22. 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

  23. Pre-operative orders Task six • Keep NPO (Nil per Oral) from ??:00 hrs • Medications • Essential • Prophylaxis • Prepare area for surgery • Cleaning • Shave • Enema • Etc

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