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Surgery - DONE > PERI-OP > Flashcards

PERI-OP Flashcards

1
Q

What is the pre op assessment for?

A

Identify co-morbidity is that may lead to patient complications (2-4 weeks before surgery)

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2
Q

Give examples of questions from the pre-op assessment?

A
  • Any previous operations
  • Anaesthesia before?
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3
Q

What are the 2 elements of a pre op examination?

A
  • General examination (identify any undiagnosed pathology)
  • Airway examination for intubation
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4
Q

What does an ASA score test tell you?

A

Risk of post-op complications and mortality (1 = normal patient to 5 = not expected to survive)

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5
Q

What blood tests will be done pre-operatively and why?

A

FBC (anaemia or thrombocytopenia)

U&Es to assess baseline renal function (for IV fluid management)

LFTs (dictate medication and dose)

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6
Q

What is the difference between a group and save and cross match?

A

G&S = determines patients blood group and RhD status, screening for atypical antibodies

Cross match = after G&S mix patients blood with donor and assess for reaction

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7
Q

What imaging should be done pre-operatively?

A

ECG (for cardiac pathology)

CXR (if necessary): Respiratory illness, Cardiovascular symptoms, recent travel from areas endemic with TB

Pregnancy test - get consent

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8
Q

What is looked at in the pre-op airway assessment?

A
  • Receding mandible?
  • Degree of mouth opening
  • Loose teeth?
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9
Q

What classification is used to asses the potential difficulty of a patient’s airway for intubation?

A

Mallampati

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10
Q

What fasting advice should be given before surgery?

A
  • Stop eating (6 hours before)
  • Stop dairy products (incl. tea and coffee - 6 hrs before)
  • Stop clear fluids (2 hours before)
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11
Q

Why are patients asked to fast before surgery?

A

Reduce risk of pulmonary aspiration

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12
Q

Which drugs should be stopped pre-operatively?

A

CHOW

Clopidogrel ( 7 days prior - aspirin as alternative)

Hypoglycaemics

Oral contraceptive pill / HRT ( 4 weeks before for DVT)

Warfarin (5 days before due to bleeding risk - therapeutic low molecular weight heparin instead)

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13
Q

Which drugs should be altered pre-operatively?

A
  • Subcut insulin to IV variable rate infusion
  • Long term steroids (Prednisolone to hydrocortisone)
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14
Q

What decides the dose of Low Molecular Weight Heparin?

A

After VTE Risk Assessment and prescribe appropriately

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15
Q

Who doesn’t receive prophylactic heparin?

A

Neck / endocrine surgery patients

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16
Q

What should be given peri-operatively prophylactically?

A
  • LMWH
  • TED stockings (except vascular patients, or eczema)
  • Antibiotic prophylaxis (orthapaedic, vascular or GI surgery)
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17
Q

What admission and treatment changes are there for type 1 diabetic patients?

A
  • Reduce insulin night before surgery, omit morning insulin
  • Commence IV variable rate insulin infusion pump (normally actrapid)
  • Whilst patient is nil by mouth give 5% dextrose and check capillary blood glucose every 2 hours
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18
Q

Which patients need bowel preparation?

A

Colorectal surgery patients

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19
Q

What surgery usually indicates the need for bowel preparation? What is given?

A

Left hemi-colectomy / sigmoid colectomy/ abdominal perineal resection / anterior resection

  • Phosphate enema morning of surgery
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20
Q

What are malnourished patients at increased risk of?

A
  • Reduced wound healing
  • Increased infection rates
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21
Q

What screening for malnutrition tool is used by all patients admitted?

A

MUST score

22
Q

What is the desired order for paraenteral nutrition?

A
  • Nasogastric tube feeding
  • Gastroscope feeding (PEG)
  • Jejunal feeding
  • Parenteral nutrition (if intestinal failure)
23
Q

What does a low serum albumin indicate?

A
  • Chronic inflammation
  • Proteinuria
  • Hepatic dysfunction

DOES NOT REFLECT MALNUTRITION

24
Q

Name some commonly used crystalloids?

A

Dextrose, Normal Saline and Hartmann’s

25
Q

When is Dextrose used?

A
  • Fluid volume maintenance
  • Dextrose is taken up into cells readily, remaining is free water equilibrating across compartments
  • Advantage as no extra electrolytes given
26
Q

When is normal saline given?

A

Resuscitation and maintenance regimes

27
Q

What do Colloids contain?

A

Proteins with large molecular weights

28
Q

Name a colloid used in surgery?

A

High albumin solution

Blood products

29
Q

How to assess fluid status in a dehydrated patient?

A
  • Mucous membranes and skin turgor
  • Urine output
  • Orthostatic hypotension
30
Q

How to assess fluid overload in a patient?

A
  • Raised JVP
  • Peripheral / sacral oedema
  • Pulmonary oedema
31
Q

What are the requirements for electrolytes in an adult?

A

Water = 25 ml/kg/day

Na+ = 1 mmol/kg/day

K+ = 1 mmol/kg/day

Glucose = 50g/day

32
Q

What are 3rd space losses?

A

Losses into spaces that aren’t visible

  • Bowel lumen (bowel obstruction)
  • Retroperitoneum (pancreatitis)
33
Q

Name some elements of the Enhanced Recovery After Surgery programme?

A
  • Smoking and alcohol cessation
  • Optimal pre op fasting (12.5% carb beverage within 2 hrs of surgery)

Reduces post-surgical complications, length of stay, and costs

34
Q

What are the advantages of day case surgery?

A
  • Lower infection rates
  • Cheaper
35
Q

What is the criteria for day case?

A

Minimal blood loss expected

< 1 hr operating time

No specialist care after

36
Q

Give 2 examples of complications of packed red cell transfusions?

A
  • Clotting impairment (give FFP and Platelets concurrently)
  • Hypocalcaemia
  • Hyperkalaemia (due to partial haemolysis)
  • Hypothermia
37
Q

What acute transfusion complication can occur post transfusion?

A
  • ABO incompatibility (urticaria, hypotension, fever) - inform blood bank
  • Fluid overload (heart failure)
38
Q

Give 2 examples of delayed transfusion complications?

A
  • Infection (e.g. Hep B, C, HIV…)
  • Iron overload (after repeated transfusions)
39
Q

What is the difference between RhD+ and RhD-?

A
  • Presence / absence of rhesus D surface antigens on RBC
  • Causes potential problems in pregnancy (haemolytic disease of the newborn)
40
Q

When are only packed red cells given?

A

Acute blood loss

Chronic anaemia

41
Q

When are platelets given?

A

Haemorrhagic shock

42
Q

When is FFP given?

A

DIC

Haemorrhage secondary to liver disease

43
Q

What ABP group is the universal recipient?

A

AB +ve

44
Q

What is wound dehiscence?

A

Wound fails to heal

45
Q

What is the most common cause of wound dehicence?

A

Infection

Increasing age

Male

Emergency surgery

Poor surgical technique

46
Q

What is the management for superficial dehiscence?

A

Wash out and allow to heal by secondary intention

47
Q

What can speed up the healing in secondary intension?

A

Vacuum-assisted closure

48
Q

What is the managment of full dehiscence?

A
  • Analgesia
  • Broad spectrum abx
  • Arrange surgery
49
Q

What is the stress response in surgery?

A

Activation of HPA increasing endogenous corticosteroids release (patients with long term steroids should be given a stress dose as their steroids will suppress the HPA axis)

50
Q

In the WHO surgical checklist, when is the sign in, time out and sign out completed?

A

Sign in = before anaesthsia

Time out = before 1st incision

Sign out = Prior to key members of operating teacm leaving

Surgery - DONE (9 decks)

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