Peri-Operative Care and Post-Operative Complications Flashcards
Why should patients be assessed for fitness to operation and anaesthesia
Every surgery and anesthesia poses it’s own risk and has inherent dangers
What is the object of pre-operative anesthetic assessments
Direct and If possible correct conditions and abnormalities which will increase the risk of anesthesia and surgery
What are the possible conditions which increase risk of surgery and anesthesia
Pulmonary disease
CCF
Anemia
Hypertension
Diabetes
Electrolyte imbalance
Hypovolemia
What happens in the case where gross diseases are found
The surgery must be postponed unless immediate operation is needed to save the patient. Even then, attempts should be made to bring the patient to an optimum condition
What points are to be looked for in a patient’s history before carrying out an operation
Previous illness
Previous operations and anesthesia experience
Concurrent disease
Drug therapy
Social habits like alcohol and tobacco
Effect of long-term steroid therapy in surgery
Depresses adrenocortical function and makes the glucocorticoid response to surgery more inadequate
Depresses lymphocyte and B-cell function and makes patient prone to infection
Women in oral contraceptives are at moderate risk for
Deep vein thrombosis
Should not be taken for about 6 weeks before elective surgery
What covers for patients who have cytotoxic and radiation therapies and could have infections from surgery (although the signs and symptoms may be absent)
Broad-spectrum antibiotics
What substance is a a direct bone marrow toxin?
Alcohol
What are the effects of alcohol
Bone marrow toxin
Impair liver function
Decreased immune competence
Prolonged bleeding time due to suppression of thrombopoeisis
Exaggerated stress response upon to exposure to surgical trauma
Alcohol withdrawal symptoms occur post-operatively until alcohol is given
What are the effects of tobacco
Forms carboxyhaemoglobin (sends dissociation curve to the left)
Disrupts function of alveolar macrophages and cilia
Impaired wound healing due to hypoxia
Sputum must be minimal before surgery, especially in patients with
Bronchiectasis
Which procedures are carried out to help achieve optimum respiratory conditions
Appropriate antibiotics
Postural damage
Chest physiotherapy
FEV1 is measured by a
Spirometer
What disease are FEV1 measurements useful for the diagnosis of
Obstructive airway disease
Adequate substitute for FEV1 measurement for diagnosis of obstructive airway disease
Snider’s match test
Simple bedside respiratory measurements measured by Wright’s respirometer
Tidal volume
Vital capacity
Minute volume
Maximum breathing capacity
Anesthesia reduces cardiac output by about
20%
Aches and pains, especially during the rainy season is characteristic of what disease
Sickle cell
Weight of alcohol abused by alcohol abusers
> 60 kg of ethanol
5 drinks a day for many months or years
What are some post-operative complications faced by alcohol abusers
Wound infections
Pneumonia
UTI
Bacteremia
Dilated cardiomyopathy
Dysrhythmia
Hemostatic imbalance
Why do a pre-op assessment
It allows surgeons to carefully assess the medical condition
Evaluate the patient’s overall health status
Determine risk factors against the procedure
Educate the patient and discuss the procedure in detail
The patient also realises the possible complication during the periop period
The additional time invested yields an improved patient-physician relationship and reduces surgical complications
It considers the patient’s medical condition, the requirements of the surgical procedure and the patient’s preferences
It ensures the patient’s chronic diseases are under appropriate medical therapy prior to an elective procedure
It establishes a rapport and confidence with the patient to allay feats and answer any questions
Patient’s history for general health assessment should include
Past medical history
Surgical history
Social history (use of tobacco, alcohol and illicit drugs)
Any allergies
Use of medications (prescribed, over-the-counter, vitamins and herbal preparations)
Questions about previous anaesthetic problems by patients and/or blood relatives
