Peri-Operative Care and Post-Operative Complications

Question 1

Why should patients be assessed for fitness to operation and anaesthesia

Answer 1

Every surgery and anesthesia poses it’s own risk and has inherent dangers

Question 2

What is the object of pre-operative anesthetic assessments

Answer 2

Direct and If possible correct conditions and abnormalities which will increase the risk of anesthesia and surgery

Question 3

What are the possible conditions which increase risk of surgery and anesthesia

Answer 3

Pulmonary disease
CCF
Anemia
Hypertension
Diabetes
Electrolyte imbalance
Hypovolemia

Question 4

What happens in the case where gross diseases are found

Answer 4

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

Question 5

What points are to be looked for in a patient’s history before carrying out an operation

Answer 5

Previous illness
Previous operations and anesthesia experience
Concurrent disease
Drug therapy
Social habits like alcohol and tobacco

Question 6

Effect of long-term steroid therapy in surgery

Answer 6

Depresses adrenocortical function and makes the glucocorticoid response to surgery more inadequate
Depresses lymphocyte and B-cell function and makes patient prone to infection

Question 7

Women in oral contraceptives are at moderate risk for

Answer 7

Deep vein thrombosis

Should not be taken for about 6 weeks before elective surgery

Question 8

What covers for patients who have cytotoxic and radiation therapies and could have infections from surgery (although the signs and symptoms may be absent)

Answer 8

Broad-spectrum antibiotics

Question 9

What substance is a a direct bone marrow toxin?

Answer 9

Alcohol

Question 10

What are the effects of alcohol

Answer 10

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

Question 11

What are the effects of tobacco

Answer 11

Forms carboxyhaemoglobin (sends dissociation curve to the left)
Disrupts function of alveolar macrophages and cilia
Impaired wound healing due to hypoxia

Question 12

Sputum must be minimal before surgery, especially in patients with

Answer 12

Bronchiectasis

Question 13

Which procedures are carried out to help achieve optimum respiratory conditions

Answer 13

Appropriate antibiotics
Postural damage
Chest physiotherapy

Question 14

FEV1 is measured by a

Answer 14

Spirometer

Question 15

What disease are FEV1 measurements useful for the diagnosis of

Answer 15

Obstructive airway disease

Question 16

Adequate substitute for FEV1 measurement for diagnosis of obstructive airway disease

Answer 16

Snider’s match test

Question 17

Simple bedside respiratory measurements measured by Wright’s respirometer

Answer 17

Tidal volume
Vital capacity
Minute volume
Maximum breathing capacity

Question 18

Anesthesia reduces cardiac output by about

Answer 18

20%

Question 19

Aches and pains, especially during the rainy season is characteristic of what disease

Answer 19

Sickle cell

Question 20

Weight of alcohol abused by alcohol abusers

Answer 20

> 60 kg of ethanol
5 drinks a day for many months or years

Question 21

What are some post-operative complications faced by alcohol abusers

Answer 21

Wound infections
Pneumonia
UTI
Bacteremia
Dilated cardiomyopathy
Dysrhythmia
Hemostatic imbalance

Question 22

Why do a pre-op assessment

Answer 22

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

Question 23

Patient’s history for general health assessment should include

Answer 23

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