General Surgery Flashcards
(30 cards)
Pre-medication implications
-drowsy, impaired coordination, impaired memory and learning
General anaesthesia
Adverse effects
Impaired ventilation
- respiratory inhibition
- Reduced FRC
- Atelectasis
- V/Q mismatch –> hypoxaemia
Impaired airways clearance
- loss of cough reflex
- Drying of cilia–> impaired mucociliary function
- secretion retention
GA
-greater respiratory effects to MV, intubation and loss of cough
Epidural anaesthesia
-Blocks sensation but muscle power intact
Imps
-reduced risk of respiratory comp as intubation and mech vent not reqd
Spinal anaesthesia
- Catheter placed into subarachnoid space
- Blocks sensory, motor, pain input
Imps
- reduced risk of resp comps as intubation and mech vent not reqd
- dura is punctured, may get headache due to CFS
Nerve Block
-injection of local close to nerve
Imps
-may have residual analgesia and loss of sensation and motor function in the innervated area
PCA
- IV delivered
- Usually narcotic medications are used
Adverse effects narcotics
- Respiratory depression
- Postural hypotension
- Drowsiness
- Nausea, vomiting
- Paralytic ileus
- Pruritis/itchiness
- Urinary retention
Imps
- Encourage patient to bolus before treatment
- Monitor RR and SpO2 to ensure breathing is not depressed
- nausea, follow Post-op protocol and take vomit bag
- monitor responsiveness- notify staff med may need to be reviewed
Epidural Analgesia
Side effects
- hypotension
- sedation
- Resp depression
- Motor and Sensory loss of upper and LL limbs
- Bowel and bladder disturbances (urinary retention)
- Infection, haemorrhage, inflammation, displacement of catheter
- Epidural haematoma
Imps
-Bolus prior to treatment
-pain over epidural, sensorimotor changes in limb and bladder signs of epidural haematoma or infection
-check epidural: leaking, redness, swelling, hepatoma, muscle strength in LL prior to mob
Full epidural assessment
NSAIDS
-reduce inflame and limit mild to moderate levels pain
Adverse
- bronchospasm
- peptic ulcer
- renal impairment
- reduced platelet
Opioids
mod to severe
- same IV narcotics
- IV, orally, IM
Simple analgesic
mild levels reduce body temp
Nitrous oxide
short period relief
- inhaled via mask
- removal painful dressings, physio treatment
Oesophagectomy
- removal of part or all, stomach pulled up and reanatomosed to end
- Ivor Lewis: upper ab to mob stomach and R) post-lat thoracotomy for resection of lesion and construction of anastomosis
- thorascopic-assisted: one ab incision & 4 or 5 ports
Imps
- avoid head down due to gastric reflux may lead to aspiration or infection
- care with suction
- neck motion limited to limit stress on anastomosis
- post-op ICC
Gastric/ Duodenal surgery
- Pyloroplasty
- Nissen Fundoplication
- Gastrectomy
gastic or duodenal ulcers or gastric carcinoma
A) pyloric muscle divided and defect is sutured transversely leaving a large gastric outlet
B) anti reflux, fundus mob and loosely wrapped around lower oesophagus. Prevents acid reflux and heals oesophagitis
C) removal of all or part of stomach, closure of duodenum and anastomosis of oesophagus to jejunum
Cholecystectomy
- removal of gall bladder
- Open via Koshers incision or R) paramedian incision
Whipples procedure
Cancer head of pancreas
-long incision removal of pancreas, common bile duct, part of the stomach and duodenum
Segmental/Partial colectomy
removal part of colon
- Hemicolectomy: segment of colon an end to end anastomosis, no stoma
- Anterior resection- lesions in upper rectum and lower sigmoid colon
- Abdominoperineal resection: removal of rectum and anus for malignancy 5cm of anal verge via mid-line and perineal incisions. Permanent colostomy
Imps
- supine, side-lying, high side-lying
- No sitting, avoid pressure on the perineal wound,
- Encourage mob day 1
- Sit out of bed with custom sitting cush
Total colectomy and protocolectomy
Excision of whole colon
Imps of colostomy
-check fluid level
Vascular general surgery : implications
- assess circulation and pulses, monitor signs of ischaemia
- care during treatment (skin)
- footwear walking
- patient with PVD has sheepskin or bootees during their stay
- comps include: post-op infection, aneurysm and thrombotic occlusion
Fem pop
- performed for acute or chronic ischaemia and treatment of non-healing arterial ulcers with superficial femoral or pop artery occlusion
- Xeno graft or autograft from femoral artery to po via long incision.
- day chest care and mob day 1 or 2
- ensure hip not 60 when extended
- blood rushing feeling
Aorto-bifemoral bypass
Y shared Dacron graft from aorta to two femoral arteries via midline ab incision and groin incision
Axilla-Femoral bypass
-Dacron graft from axillary artery to ipsilateral femoral artery
Imps
Avoid- shoulder flex >90
-Hip flex >60
-Sidelying
- avoid using overhead ring
- avoid constrictive clothing
- Avoid axillary crutches with mob
Abdominal Aortic aneurysm repair
-abdominal aortic aneurysm is an abnormal, weakened dilatation in the aorta
Usually present with other co-morbidities
Pre-op imps
- <6cm limit cough/FET
- > 6cm risk rupture therefore no cough
Post-op
- resp failure
- effective pain relief and wound support are essential
- no head tilt
- mob once CV stable
Naso-Gastric tube
- drain bile and gastric contents
- prevent asp or regurgitation
- Used post-op in patient with marked ileus to decompress the gut, unconscious/semi conscious patient to prevent aspiration, marked ab distension and vomiting post-op
