Preoperative Preparation Flashcards
Complications during past surgery and anesthesia to be asked during history
1- intraabdominal adhesions
2- suxamethonium apnea
3- family history of problems with apnea
Laparoscopic procedures are inappropriate in which patients
Those who cannot tolerate
1- pneumoperitoneum
2- head down positioning
Infections to be checked and treated in the preoperative period
1- infected toes
2- pressure sores
3- teeth
4- urine (if surgery is not elective but emergent give antibiotics and maintain urine output throughout)
5- chest infections (delay elective surgery for 4-6 weeks)
Prep investigations to be done in all patients
1- FBC
2- sickle cell trait in patients of afrocarribean origin
3- urea and electrolytes
4- urinalysis (dipstick test)
In which patients preop ECG is done
Patients over the age of 60 Cardiovascular Renal Cerebrovascular involvement Diabetes Patients with severe respiratory problems
Preop management of patients with systemic disease
1- check baseline organ function capacity
2- optimisation
3- alternative
4- theatre preparations
Echo is done in which patients
Symptomatic valvular disease or poor left ventricular output
Critical ejection fraction
Less than 30 percent
Refer patient to cardiologist if
1- murmur and patient is symptomatic
2- poor left ventricular output or known cardiomegaly
3- silent MI on ecg
4- abnormal rhythm on ecg
Blood pressure ideal for surgery
160/90
New antihypertensive should be given how much time
Atleast 2 weeks
How long to delay surgery after MI
3-6 months
How long to delay surgery after stent placement
After the stoppage of dual antiplatelet therapy
1- 6 weeks in metal stent
2- 12 months in drug eluting stent
If surgery cannot be postponed can antiplatelets be continued during it
Yes.
Better to discontinue clopidogrel
And continue aspirin.
But if possible stop aspirin 7 days before and clopidogrel 10 days before
How long before surgery should warfarin be stopped (patients of A fib, mechanical heart valves)
Atleast 5 days.
Unfractionated heparin is given in this time period and it is also discontinued 2 hours before surgery
Consequences of the use of bipolar diathermy in pacemaker patients
Pacemaker detects it as ventricular fibrillation. So turn pacemaker off preoperatively or set it to VOO mode(ventricle pacing. Not sensed with no response to sensing)
If patient found to have heart block preoperatively
Temporary pacemaker insertion is required
Jehovah’s Witness and blood transfusion alternatives
1- cell salvage
2- reinfusion from drains
Asthmatic Patients prior to surgery require
Additional dose of bronchodilators and additional steroid coverage (esp if already taking 10 mg or more of prednisolone) and are ‘Brittle asthmatics’
Critical FEV1
Less than 30 percent
Can patients still take medications in the NPO period
Yes with sips of water
Which patients are at extra risk of pulmonary aspiration despite NPO
Hiatus hernia patients Obese Pregnant Diabetes (Give them antacids, h2 blockers and omeprazole)
Preop prep of renal disease patients
Acidosis
Hypocalcemia
Hyperkalemia of greater than 6mmol/l need to be corrected
Patients on dialysis before surgery
Dialysis should be discontinued a few hours before surgery and after last dialysis send patient for FBC and urea and electrolytes
