MP&S - Pre/Post Op Management Flashcards
When do you choose surgery?
– Re-think surgery → high risk & low benefit
– Surgery → High benefit & low risk
– Operate → Even if risk is high, the risk of not operating is certain death
What are some RED FLAGs for surgery?
- Cardiac/Vascular/Lung/Liver/ Endocrine Dz
- Bleeding d/o
- Infection
- DM
- (NPO pre op –> hold or reduce hypoglycemic agents – better if the glucose is high rather than low)
What labs should you order before Surgery?
- CBC/BMP (lytes/BUN/Creat/glucose)
- LFT’s (in older pts or when indicated)
- CXR if indicated
- Surgical Consent
- Clotting studies (only if indicated)
- EKG (pts w/ cardiac Hx or > 40yo)
- Type & Cross PRN (should include number of units & should be >2unit min)
What is the Difference between T&C vs T&S?
- T & C (Type & Cross):
- Determines blood type & blood is made available before the surgery begins - T & S (Type & Screen):
- Determines blood type, but blood is not made available, it as to be ordered after.
What are some of the risks of GENERAL Anesthesia?
- ↓Sys vascular resistance
- ↓Myocardial contractility
- ↓Stroke volume
- ↑Cardiac irritability
What the key difference between general and local anesthesia?
Local anesthesia carries the least risk
What is the most problematic Post-Op Cardiac Risk?
Post-op MI carries a 50% mortality risk
- Related to age & pre-existing conditions
What are some HIGH Post-Op Cardiac Risks?
- Emergent surgery in elderly pt,
- Aortic surgery,
- Periph vascular surgery,
- Procedures w/prolonged blood loss
> 5% risk of MI or death
What are some INTERMEDIATE Post-Op Cardiac Risks?
- Carotid endarterectomy,
- GU
- Ortho
- Uncomplicated abd
- H&N
- Thoracic surg
What are some MINOR Post-Op Cardiac Risks?
- Cataracts
- Endoscopy
- Superficial procedures
Cardiac tests prior to Surgery?
- EKG
- Dobutamine → stress echo
- Dipyridamole thallium imaging
- Coronary angiography
- Exercise stress testing not always used
What group of drugs can reduce Absolute risk of cardiac event Po-Op by ~15%?
BB
What is dangerous about post op Ischemia?
It can be asymptomatic in up to 90% of cases
It usually occurs 1-2 days post-op
What is THE MC Post-Op complication?
Pulm Complication
What ARE MC Pulm Post-Op complicates?
Atelectasis & PNA
What IS MC Pulm Post-Op complicates?
Atelectasis
- MC post-op complication in pts who have received GENERAL anesthesia
What are some of the Post-Op Pulm Risk Factors?
o Age, Obesity
o Smoking/COPD/Asthma
o Sleep apnea
o Thoracic or upper abd surgery
*****2X higher in smokers even w/o COPD
How do you reduce plum risks?
o Stop smoking > 8 wks prior to surgery
o Delay elective surgery in pts w/ poorly ctrl COPD
o Prevention of MC pulm complication (atelectasis)
- Deep breathing - Incentive spirometry - Preoperative teaching - Avoid supine positioning
Post-Op - Resp/Cardiac Status?
o Good pulmonary toilet
- use of spirometer
o Good cough/deep breathing techniques
o D/C vents & ET tubes ASAP
o Chest PT PRN
o CXR PRN
- r/o atelectasis, PNAWhy is there a high risk of DVT Post-OP?
o Blood loss during surgery
o Combined w/ decreased activity
How does Anemia cause complications during surgery?
Extensive blood loss & HCT < 28 will increase MI risk
→ might want to transfuse
What surgeries carry higher risk of infection?
- Oral,
- Trauma,
- Bowel,
- Vaginal
How to prevent infection during surgery?
o Abx admin prior to surgery
o Prophylactic abx used if risk is >2%
What RFs do pts w/ DM present Post-Op?
o ↑Risk for:
• Stroke, MI, Inf, DKA, Wound dehiscence
