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Flashcards in Pre-Op Deck (77)
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1

What can the trauma of surgery lead too

Stress
Fluid shift in body
Blood loss
CVS / respiratory / renal failure
Decreased FRC due to GA so post-op oxygen

2

What is pre-op important for

Assess and identify high risk patients and minimise risk
Establish baseline
Establish severity of disease
Exclude any serious issue that will affect analgesia
Dx unknown or suspected conditions
Inform and support patient decisions
Get consent
Guide management

3

What do you want to know in the Hx

Known co-moridities
- Exacerbations / Ax / home oxygen / use of steroid

Unknown co-morbid

Ability to withstand stress
- ETT
- Cardio / resp disease

Drugs and allergy

Previous surgery and anaesthesia

FH - malignant hyperthermia or cholinesterase

SH - drug / smoke / alcohol

Potential anaeshteitc problems - is neck / jaw immobile / teeth stable

4

What increases likelihood of airway issue

Reflux
Obesity
Pregnancy
FH

5

What do you want to confirm before op

How have they been in time leading up
Confirm drug and allergies
Fasting

6

What happens for an elective operation

Assess CVS system and exercise tolerance
Bloods
- FBC, U+E, LFT, finger tip blood glucose in most
- G+S
- DO clotting in liver / renal / DIC / anti-coagulation
- Blood glucose if DM
Drug levels as appropriate
Urinanalysis
Pregnancy test
Sickle cell if from area
TFT if thyroid disease
Assess for DVT risk
Thromboprophylaxis plan
MRSA screen - decolonize carrier
CXR = not routine - if cardiorespiratory disease
ECG if >65 / DM / renal or poor ETT
Lateral Spine X-ray if RA / Down's / AS as risk of atlanto-axial instability

7

Risk assessment tools

OK

8

What are NICE guidelines for risk

ASA grade
Surgery grade
Co-morbid

9

ASA 1

Otherwise healthy
No smoking or alcohol

10

ASA 2

Mild - mod systemic disturbance
No functional limitation
Current smoker / social alcohol / obesity / well controlled DM or high BP

11

ASA 3

Severe systemic disturbance / disease
Functional limitation
Poor controlled DM / BP
COPD / asthma / end stage renal
Previous MI

12

ASA 4

Life threatening
Recent MI / CVA or severe reduction n EF

13

ASA 5

Moribund
Not expected to survive without operaiton
Rupture AAA / ischaemic bowel

14

ASA 6

Organ retrieval

15

What does cardiac risk index look at

High risk surgery
IHD
CCF
Cerebrovascular
DM
Renal failure

16

If cardio procedure what do you get / what other tests can be done

ECG
ETT
ECHO +- stress
May have angio prior
PFT

17

If CVS issue what are options

GA = high risk of myocardial depression
Regional - may not cover
Spinal - watch for CI

18

If resp procedure what do you get

O2 sats
ABG
CXR or CT chest - not routine
Peak flow
FVC and gas transfer

19

E+D prior to surgery

Foods / solid >6 hours
Clear fluid >2 hours

20

What do you do if DM prior to surgery

If diet or tablet controlled = omit and check BG regularly
If poor control or insulin = sliding variable rate IV insulin infusion
Put first on list
May need K supplementation
Treat as hypo if <4

21

Pre-op meds

Most continue as normal
esp inhalers / angina / epilpesy

22

If on steroids what do you need to do

Supplement with hydrocortisone as surgery will increase stress

23

What do you do if on anti-coagulant

VTE risk assessment
Withhold warairn
Use short acting e.g. LMWH
Withold LMWH the evening before and use TEDS

24

Anaemia pre-surgery

Blood transfusion to correct
IV iron will take too long
If refuse then can give IV iron
Oral iron is possible but will take 2-4 weeks to work

25

Operations with high risk of transfusion needing X-match 4-6 units

Total gastrectomy
Oophorectomy
Oesophagectomy
Elective AAA reapir
Cystectomy

26

Operations which may need transfusion so X-match 2 units

Salpingectomy for rupture
THR

27

Operations unlikely to need transfusion so G=S

Hysterectomy
Appendectomy
Thyroid
ELective LSCS
Lap chole

28

How does paralytic ileus present post surgery

Vomiting
Absent bowel
CRP raised anyway as post surgical response

29

What causes and what is associated

No peristalsis
Chest infection
MI
Stroke
AKI

30

What are nutrition options post surgery

Oral - early feeding good
NG
- If entubated soon
NJ
Feeding jejunostomy
PEG
TPN