PERI-OP Flashcards
What is the pre op assessment for?
Identify co-morbidity is that may lead to patient complications (2-4 weeks before surgery)
Give examples of questions from the pre-op assessment?
- Any previous operations
- Anaesthesia before?
What are the 2 elements of a pre op examination?
- General examination (identify any undiagnosed pathology)
- Airway examination for intubation
What does an ASA score test tell you?
Risk of post-op complications and mortality (1 = normal patient to 5 = not expected to survive)
What blood tests will be done pre-operatively and why?
FBC (anaemia or thrombocytopenia)
U&Es to assess baseline renal function (for IV fluid management)
LFTs (dictate medication and dose)
What is the difference between a group and save and cross match?
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
What imaging should be done pre-operatively?
ECG (for cardiac pathology)
CXR (if necessary): Respiratory illness, Cardiovascular symptoms, recent travel from areas endemic with TB
Pregnancy test - get consent
What is looked at in the pre-op airway assessment?
- Receding mandible?
- Degree of mouth opening
- Loose teeth?
What classification is used to asses the potential difficulty of a patient’s airway for intubation?
Mallampati
What fasting advice should be given before surgery?
- Stop eating (6 hours before)
- Stop dairy products (incl. tea and coffee - 6 hrs before)
- Stop clear fluids (2 hours before)
Why are patients asked to fast before surgery?
Reduce risk of pulmonary aspiration
Which drugs should be stopped pre-operatively?
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)
Which drugs should be altered pre-operatively?
- Subcut insulin to IV variable rate infusion
- Long term steroids (Prednisolone to hydrocortisone)
What decides the dose of Low Molecular Weight Heparin?
After VTE Risk Assessment and prescribe appropriately
Who doesn’t receive prophylactic heparin?
Neck / endocrine surgery patients
What should be given peri-operatively prophylactically?
- LMWH
- TED stockings (except vascular patients, or eczema)
- Antibiotic prophylaxis (orthapaedic, vascular or GI surgery)
What admission and treatment changes are there for type 1 diabetic patients?
- 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
Which patients need bowel preparation?
Colorectal surgery patients
What surgery usually indicates the need for bowel preparation? What is given?
Left hemi-colectomy / sigmoid colectomy/ abdominal perineal resection / anterior resection
- Phosphate enema morning of surgery
What are malnourished patients at increased risk of?
- Reduced wound healing
- Increased infection rates
What screening for malnutrition tool is used by all patients admitted?
MUST score
What is the desired order for paraenteral nutrition?
- Nasogastric tube feeding
- Gastroscope feeding (PEG)
- Jejunal feeding
- Parenteral nutrition (if intestinal failure)
What does a low serum albumin indicate?
- Chronic inflammation
- Proteinuria
- Hepatic dysfunction
DOES NOT REFLECT MALNUTRITION
Name some commonly used crystalloids?
Dextrose, Normal Saline and Hartmann’s
