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Pre and Postoperative Care

Pre and Postoperative Care. Dept of Surgery Yong Loo Lin School of Medicine National University of Singapore. Preoperative Care. “The most important decision a surgeon can make is to operate on a patient” The decision is a Risk-Benefit Analysis. Goals(Why).

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Pre and Postoperative Care

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  1. Pre and Postoperative Care Dept of Surgery Yong Loo Lin School of Medicine National University of Singapore

  2. Preoperative Care • “The most important decision a surgeon can make is to operate on a patient” • The decision is a Risk-Benefit Analysis

  3. Goals(Why) • Recognize and Optimize the risk factors for surgery

  4. How to do it • History • Examination • Investigations

  5. History Taking • Past medical & surgical history • Cardiac, respiratory, renal, nutrition • Drug hx • Social Hx • Functional status

  6. ASA Classification

  7. Investigations • Basics (for all age>50) • FBC, urea/electrolyte • CXR, ECG • Specific (when indicated) • LFT; PT/PTT • ABG; Pulmonary function test • others

  8. Special Preparation • Management of Diabetes • DVT Prophylaxis • Bowel preparation • Prophylactic antibiotics selectively

  9. Postoperative Care • Recognize postop complications • Pain management • Postop fevers

  10. Postop Complications • General • Examples: AMI, CVA, pneumonia/atelectasis, renal failure • Specific • Examples: anastomotic leakage, abscess formation, wound infection, ileus, bleeding

  11. Postop Complications • General • Important examples: • AMI • pneumonia/atelectasis • renal failure • DVT/Pulmonary embolism • CVA

  12. Postop Complications • Specific • Examples: • anastomotic leakage • abscess formation • wound infection • ileus • bleeding

  13. Scenario

  14. Pain Management • Essential part of postop management • Pain can increase risk of complications • Pain relief- Multimodal • E.g. PCA, IM pethidine, oral analgesics

  15. Postop Fevers • An important sign of postop complications • Many possible DDX • Time of onset may guide the management

  16. Postop Fevers • First 48hrs • Atelectasis • Transfusion rxn • Pre-existing infection • 3-7 days: infections • UTI, wound infection, pneumonia, anastomotic leakage

  17. Postop Fevers • About 7 days onwards • Infections • Abscess formation • DVT/PE

  18. Postop Fevers • History • Examination • Investigations (to confirm the diagnosis)

  19. Summary • Pre and Postop care are essential parts of surgical treatment • Good History, physical examination and selected investigations are the key • Complications do occur, but many are preventable!

  20. Questions

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