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Pre-operative Evaluation part 2

Pre-operative Evaluation part 2. Investigation. Laboratory investigation should be ordered only when indicated by the patient’s medical status, drug therapy, or the nature of the proposed procedure. Investigation should not be ordered on a routine basis.

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Pre-operative Evaluation part 2

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  1. Pre-operative Evaluation part 2

  2. Investigation Laboratory investigation should be ordered only when indicated by the patient’s medical status, drug therapy, or the nature of the proposed procedure. Investigation should not be ordered on a routine basis. It should be selective and individualized.

  3. In general the result of many investigations may be predicted if a detailed history and physical examination have been performed. Before ordering extensive investigations, the following questions should be considered. • Will this investigation yield information not revealed by clinical assessment ? • Will the results of the investigation alter the management of the patient ?

  4. Important Investigations • Urine analysis • Complete blood count. • Sickle cell screen. • International normalized ratio (INR) • Activated partial thrombo-plastin time. • Electrolytes and creatinine levels. • Fasting glucose level. • Pregnancy (b-HCG). • Electro-cardiograph. • Chest radiograph.

  5. Urine analysis An inexpensive test it may occasionally reveal undiagnosed diabetes or the presence of urinary tract infection

  6. Complete blood count Indications: • Major surgery requiring group and screen or group and match • Chronic cardiovascular, pulmonary, renal, or hepatic disease • Malignancy • Known or suspected anemia, bleeding diathesis, • Patient less than 1 year of age

  7. Sickle cell screen Indication: • Genetically predisposed patient (hemoglobin electrophoresis if screen is positive)

  8. International normalized ratio(INR), activated partialthrombo-plastin time Indications: • Anticoagulant therapy • Bleeding diathesis • Liver disease

  9. Electrolytes and creatininelevels: Indications: • Hypertension • Renal disease • Diabetes • Pituitary or adrenal disease • Digoxin or diuretic therapy or other drug therapies affecting electrolytes.

  10. Fasting glucose level Indication: • Diabetes (should be repeated on day of surgery).

  11. Pregnancy (β-HCG) Indication: • Woman who may be pregnant.

  12. ECG Indications: • Heart disease, hypertension, diabetes. • Other risk factors for cardiac disease (may include age). • Subarachnoid or intracranial hemorrhage, cerebrovascular accident, head trauma.

  13. Chest X-ray Indications: • Cardiac or pulmonary disease. • Malignancy. • For older population (over 60 yrs of age).

  14. Other x- rays • Cervical spine x-ray should be done in any patient in whom there is a possibility of vertebral instability for example in the presence of rheumatoid arthritis. • Thoracic inlet x rays are required in patients with thyroid enlargement.

  15. Postponing surgery for clinical reasons There are several common reasons for postponing surgery for example: • Acute upper respiratory tract infection: • Non-urgent surgery should be postponed for a few weeks until the patient has recovered. • Emergency surgery for which the patient has not been resuscitated adequately. • For only 1-2h to permit restoration of circulating blood volume. • Recent ingestion of food. • Failure to obtain consent.

  16. Pre-Operative FastingGuidelines: The practice of pre-operative fasting aims to: • Minimize residual gastric volume and acidity prior to surgery or other procedures. This helps to prevent: • Regurgitation ,inhalation and aspiration of gastric contents which may otherwise occur during: • General anesthesia • Regional anesthesia • Intravenous sedation.

  17. However, prolonged periods of fasting are unnecessary as it may cause: • Distress, dehydration, biochemical imbalance and hypoglycemia, especially in children. • The tendency for gastric volume increase after a prolonged fast may occur. • Fasting policies should vary to take into account age and pre-existing medical conditions and should apply to all forms of anesthesia, including monitored anesthesia care.

  18. Minimum Fast for Clear Fluids • Clear fluids include: Water, diluting juice, black tea and black coffee. • Patients may drink clear fluids up to 2 hours • Be aware : • Milk (non-human) and milk-containing drinks NOT a clear fluid because they become semi-solid in the stomach and should be considered as solids. 6 hrs prior to surgery . • Breast fed infants should have their last feed 4 hours prior to surgery. • Alcohol containing drinks should not be consumed within the 24 hours prior to surgery as this may increase gastric emptying time.

  19. Minimum Fast for Solids • Solids and milk-containing drinks should not be consumed within 6 hours of the beginning of the operating list. • 8 hr after a meal that includes meat, fried or fatty foods, should be waited.

  20. Informed consent • Consent for anaesthesia is a vital part of preoperative preparation. • It must obtained by an individual with sufficient knowledge of the procedure and the risks involved. • In order for consent to be valid, it must include three elements: • The patient must have the capacity to consent to the treatment offered. • The patient must have sufficient infoto enable him to make a balanced decision to consent. • The consent must be voluntary.

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