5.preoperative assessment

Question 1

preoperative period

Answer 1

starts from the time the patient is admitted to the hospital
to time the surgey begins

Question 2

how ?

Answer 2

1.history
2.physical exam
3.investigation

Question 3

when?

Answer 3

1. out patient visit
2. emergency room
3. pre operative ward round

Question 4

what to do?

Answer 4

6 steps
1.explain to patient
2.identification of operative mortality and post-operative morbidity
3.assess the fitness of patient
4.identify risk of potential postoperative complications + prophylaxis
5.planning of operation
6.pre-operative orders

Question 5

step 1 - explain to patient

Answer 5

1.nature of surgery
2. implication of surgery
3. alleate fear
4. give prognosis

Question 6

step 2 - operative mortality and postoperative morbidity

Answer 6

1. assess risk factors
   e.g MI, pregnancy, allergies

Question 7

step 3- assess fitness of patient

Answer 7

by assessing
1. general condition
2. metabolic state
3. cvs
4. respiratory system
4. renal system

Question 8

how to assess the general condition of patients

Answer 8

by careful clinical examination
1.pulse rate
2.bp
3.full blood count
4.serum urea and electrolytes
5.blood group

Question 9

how to assess the metabolic state

Answer 9

weight and height
—because obesity is a risk factor for wound infections, venipuncturs, thromboembolism

Question 10

how to assess the CVS

Answer 10

ecg and echocardiogramm

1. Hypertension - increased risk of MI
2. MI - avoid techniques which increase the HR
3. hypovolemia - fluid restoration before operation

Question 11

how to assess the respiratory system

Answer 11

1.clinical examination of chest
2.CXR
3.blood gases
4.sputum for bacteriological examination
5.pulmonary functional test

-cold - cancel operation
-asthma - risk for postoperative respiratory failure

Question 12

how to assess the renal system

Answer 12

1.clinical examination
2.urinanalysis and microscopy
3.serum urea and creatinine

Question 13

step 4 - identify risk of postoperative complications

Answer 13

1.pulmonary collapse /infection - pre operative breathing exercises
2.cardiac ischemia - avoid fluids postop
3.acute renal failure - due to hypovolemia,sepsis
4.venous thrombosis - avoid leg compression
5.wound infection - give prophylactic antibiotics

Question 14

step 5- planning of op

Answer 14

1.operation should be properly named after full explanation to the patient
2.side of operation should be marked
3.consent must be taken
4.duration of hospital stay,convalescence and time off work should be indicated

Question 15

step 6- pre operative orders

Answer 15

1. nil per oral should be kept
2. prophylactic medications
3. prepare area for surgery
   -shaving
   -enema
   -cleaning

Question 16

ASA assessment

Answer 16

assess pathological changes that cause function reduction and systemic and organ capacity limitation

Question 17

patients ASA grade

Answer 17

correlates with risk of post-operative complication

Question 18

ASA grade

Answer 18

I - healthy patient
II - patient with mild systemic disease that does not limit acitivity
III - patient with severe systemic disease that limits acitivity
IV - patient with severe systemic disease that is constant threat to life
V - moribund (dying) patient that is not expected to survive 24hrs with or without surgery