Perioperative management

Question 1

3 leading causes of death following non-cardiac surgery

Answer 1

myocardial injury
haemorrhage
sepsis

Question 2

What can be used to stratify risk pre-operatively?

Answer 2

ASA
performance status
POSSUM
APACHE

Question 3

What tests should be done pre-operatively?

Answer 3

FBC
U&Es
coagulation screen
group and save
ECG
lung function/ABG

Question 4

List some minor surgery examples

Answer 4

excising skin lesion
draining breast abscess

Question 5

List some intermediate surgery examples

Answer 5

primary repair of inguinal hernia
excising varicose veins in leg
tonsillectomy/adenotonsillectomy
knee arthroscopy

Question 6

List some major surgery examples

Answer 6

total abdominal hysterectomy
endoscopic resection of prostate
lumbar discectomy
thyroidectomy
total joint replacement
lung operations
colonic resection
radical neck dissection

Question 7

Pre op risk factors

Answer 7

obesity
cardiac disease
respiratory disease
renal disease
diabetes
anaemia
bleeding tendency

Question 8

How should patients with respiratory conditions be optimised pre-operatively?

Answer 8

smoking cessation
preoperative physiotherapy
optimising medical therapy

Question 9

How long should warfarin be withheld prior to surgery?

Answer 9

5 days to allow INR to drop <1.5

Question 10

Indications for bridging therapy when stopping warfarin for surgery

Answer 10

metal valves
cardiac stents
stroke
uncontrolled AF

Question 11

How long should clopidogrel be withheld prior to surgery?

Answer 11

7-10 days

Question 12

Problems that can arise post-operatively

Answer 12

pain
respiratory
cardiac
neurological - confusion
GI - ileus, nausea, vomiting
kidney - low urine output
haemorrhage
sepsis/pyrexia
VTE
pressure sore

Question 13

What respiratory problems can occur post-operatively?

Answer 13

hypoxaemia
hypercapnia
aspiration
atelectasis - chest infection later
pulmonary embolism
pulmonary oedema

Question 14

Respiratory management post-operatively to reduce to reduce risk of complications

Answer 14

effective analgesia
chest physiotherapy
nutrition
fluid balance (avoid over hydration as increases risk of pulmonary oedema)

Question 15

What can cause post op confusion?

Answer 15

neurological causes eg. stroke
alcohol withdrawal
drugs
electrolytes
infection - wound, urine, chest
urinary retention
heart arrhythmias, MI
endocrine eg. thyroid, addison’s

Question 16

What can cause post-op pyrexia?

Answer 16

wound
intra-abdominal collection
chest
leak
urine, catheter
lines
VTE

Question 17

Factors that increase risk of pressure sores

Answer 17

poor nutritional status
dehydration
lack of mobility

Question 18

Pressure sore prophylaxis

Answer 18

early mobilisation
patients should be turned every 30 min
air mattresses for high risk patients