Lecture 20: Pre-Op Patient Assessment & Prep (Exam 2) Flashcards
Why is pre-op important
Allows for comparison of the animal’s status before & after surgery
What is included in the px history
- Signalment
- Presenting complaint
- Diet
- Exercise
- Environment
- Past medical problems
- Recent tx
- Evidence consistent w/ infection
What three questions should be asked when given the presenting complaint
- When did the current problem start?
- What did the problem look like when it first began
- Has the problem gotten better or worse, and if so how much & what is the associated therapy w/ that?
How should questions be asked to avoid vague responses & obtain specific information
Frame the questions (ask open ended questions)
What is one of the best determinants of the likelihood of cardiopulmonary emergencies during or after surgery
Eval of preanesthetic physical status
What lab data should young healthy animals undergoing elective procedures get before surgery
- PCV (hematocrit)
- Total protein (TP)
- Blood Glucose
- BUN
AKA the “Big 4” or “Quats”
What lab data should animals older than 5 to 7 years or having systemic signs should get before surgery
- CBC & Differential
- Serum Biochemical Profile
- Urinalysis
AKA “Minimum Data Base”
T/F: Age-related differences in hematologic & serum biochemical values have NOT been noted in dogs
False they have been noted
T/F: Growth & maturation of pups influence some of these lab values greatly from those for adults
True
Describe a #1 on the anesthesiologist physical status scale
- Healthy w/ no discernable disease
- Px comes in for an elective procedure
Describe a #2 on the anesthesiologist physical status scale
Px is healthy w/ a localized disease or mild systemic disease
What are some examples of a localized disease or mild systemic disease
- patellar luxation
- Skin tumor
- Cleft palate w/ pneumonia
Describe a #3 on the anesthesiologist physical status scale
Px has a severe systemic disease
What are some examples of a severe systemic disease
- Pneumonia
- Fever
- Dehydration
- Heart murmur
- Anemia
Describe a #4 on the anesthesiologist physical status scale
Px severe systemic disease that is life threatening (like heart or renal failure)
Describe a #5 on the anesthesiologist physical status scale
Px is moribund
Define moribund
Patient is not expected to live more than 24 hours w/ or without surgery
T/F: Risk of the surgical procedure may outweigh its potential benefits
True
What should always be considered for veterinary px
Quality of life
Describe an excellent surgical prognosis
- Potential for complaints is min
- High prob that the px will return to norm
Describe an Good surgical prognosis
- Some potential for complications
- High prob of a good outcome
Describe an fair surgical prognosis
- Serious complications are possible but uncommon
- Recovery my be prolonged
- May not return to its presurgical fxn
Describe an poor surgical prognosis
- Many, severe, or both complications
- Recovery is expected to be prolonged
- Death during or after is high
- Unlikely to return to its presurgical fxn
Describe an guarded surgical prognosis
Given when the outcome is highly variable or unknown
How should cost be communicated w/ the owner
- Cost cannot always be predicted b/c of unanticipated complications
- Owners should be keep apprised of the animals status & of procedures that may affect the
What stabilization tech should be done before induction of anesthesia
- Replacing fluid deficits
- Correcting acid-base
- Correcting electrolyte abnorms
What should be given for all animals undergoing general anesthesia & surgery (including healthy animals having elective sx)
IV fluids
What are the food restrictions for adult animals
Food intake restricted 6 to 12 hours before induction of anesthesia
What are the food restrictions for young animals
Food should not be withheld for longer than 4 to 6 hours
Why should food not be withheld from young animals for longer than 4 to 6 hours
B/c hypoglycemia may occur
What is an SSI
Surgical Site Infection
What is the most common source of SSIs
Endogenous microbial flora
What are the two types of endogenous microbial flora seen commonly as the source of SSIs
- Staphylococcus aureus
- Streptococcus spp
Define an incisional classifications of an SSI
Infection of the actual site of the surgical incision
what layers are affected by a superficial incisional SSI
Involving the skin & subQ tissue
what layers are affected by a deep incisional SSI
Involving deep soft tissue layers like incisional fascia & muscle
Define an organ/space classifications of an SSI
Infection of an anatomic part that was manipulated during the operation
What must occur for an infection to be considered an SSI
- Occur w/in 30 days of the surgical procedure
- Occur w/in 1 year if its associated w/ a surgical implant & the infection appears to be related to the sx
What are some normal or residential organisms living in the skin’s superficial cornified layers & the outer hair follicles of dogs
- Staphylococcus epidermidis
- Corynebacterium spp
- Pityrosporum
List some transient pathogens that can be associated w/ SSIs
- Staphylococcus aureus
- Staphylococcus intermedius
- Escherichia coli
- Streptococcus spp
- Enterobacter spp
- Clostridium spp
What is extremely important during surgery
Eliminating exposure to flora
T/F: It is possible to sterilize the skin w/out impairing its natural protective fxn & interfering w/ wound healing
False; it is impossible
What reduces the number of bacteria & the likelihood of infection
Pre op preparation
Define Antisepsis
The prevention of sepsis by preventing or inhibit the growth of resident & transient microbes
Define an antimicrobial agent
- A product w/ antimicrobial activity that formerly was referred to as an antimicrobial agent
- Agent capable of producing antisepsis
The current literature strongly suggests that (Chlorohexidine gluconate/Povidone Iodine) is superior to (Chlorohexidine gluconate/Povidone Iodine) for pre op antisepsis for px
Chlorohexidine gluconate; Povidone Iodine
List the 7 characteristic of an ideal pre op antiseptic
- Kills all bacteria, fungi, viruses, protozoa, tubercle bacilli, & spores
- Hypoallergenic
- Nontoxic
- Has residual activity
- Not absorbable
- Nontoxic & able to be used repeatedly
- Be safe to all parts of the body in all the body systems
Why is the prevalence of SSI in humans a major concern
B/c of the associated increased incidence of morbidity, mortality, length of hospitalization, & cost of care in post op px
List some preventive pre op measures that can reduce the risk of SSI
- Admin of antimicrobial prophylaxis
- Proper utilization of skin antiseptic agents for the surgical team & the px
How much more likely are infected px likely to die compared to uninfected px
Twice as likely
How can vets & their staff be proactive in preventing infections in surgery
By using proper techniques & solutions to prep the skin for surgery
Why should the px not be shaved the night before sx
It is associated w/ a significant increase in superficial skin infection rates
T/F: The px can shaved in the OR
NEVER
What is the purposes of the preoperative skin preparation
- Remove soil & transient microorganisms from the skin
- Reduce the resident microbial count to subpathogenic levels in a short time & w/ the least amount of tissue irritation
- Inhibit rapid rebound growth of microorganisms
What should be done if the abdominal incision extends to the pubis in males dogs
- Clam the prepuce to one side w/ a sterile towel clamp
- Placing a sterile 4x4 gauze sponge may decrease tissue trauma
T/F: The tips of the towel clamps are considered nonsterile once they have been placed through the skin & should be handled appropriately
True
What are some areas of emphasis Dr. T mentioned
- Px positioning is ultimately the responsibility of the surgeon
- Arrange you surgical table in the manner that is logical to allow you to find instruments quickly & accurately
- Assistants will wipe instruments when returning them to the table
- Soiled sponges will not be placed back on the instrument table
- Your px is nota table to place instruments, soiled sponges, etc on
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