Peroperative Assesment1 Flashcards
Define preoperative care& enumerate phases of perioperative care??
1-term used to describe entire operative span, what occure before, during, after actuall operation.
2- pre-operative
Intra- operative
Post-operative
Pre operative begin…………….. Until……………….
With the decision to perform surgery
Reaching operative room
Intra operative includes………………. Until the cleint reach…………….
Entire duration of surgical procedure
Recovery area
Postoperative begin with……………. Until…………..
Admession to recovery area
Follow up evaluation at home, rehabilitation unit
Enumerate goals of pre operative assesment?
1-asses fitness for anaesthesia
2- optimizing patient physical condition to surgery and anaesthesia.
3-allay fear and anxiety
4-permedication
5-establish preoperative fasting
6-provide apperopriate information to patient, obtain consent.
7-further investigations, consultaions, treatment of patienrs not yet optimized.
Enumerate phases of preoperative assesment?
1-History
2-physical examination
3-ñeroperative investigation
Clarefy what u know about peroperative history?
1-history of present illness and reason of surgery.
2-medical condition(acute or chronic).
3-allergy
4-substance use: alcohol, street drugs, tobacco
5-drug use
6-past medical history
7-past hospitalization and surgeries
8-past problems with anaesthesia
9-family history ( hereditary diseases& problem with anaesthesia
10- review of system
Clarefy problems can anti-hypertensive drugs do?
1-ACEIS»»»sever hypotention during induction
2-B Blocker»»-ve inotropic additive to anaesthesia
3- Ca Blocker»> - ve AV confuction & excitability
4- Digoxin»_space;»> toxicity during hypokameia (should corrected pre)
5-Diuretics»_space;»> hypokameia & potentiate MS relaxant
Anti-convulsant!
MAOIS»»»with opioids(pethedine) cause coma and convulsions.
Mechanism of Tricyclic A. D to cause arrythmia?
Inhibit cate. Metabolism
Antibiotics ( Aminoglycosides) potentiate what?
NM excitability
Enumerate drugs potentiate action of MS relaxant?
Duretics
Magnesium
Enumerate drugs cause bleeding and its mechanism or effect?
1-NSAI&ASPIRIN»>interfer with platlet function&coagulation mech.
2-anticoagulant»» bleeding in minor trauma & interfere with surgery homeostasis
Why u should take history of smoking?
1-nicontine effect( HPT&TACHYCARDIA)
2-vascular diseases(peripheral, cerebral, coronary)
3-increase co hemoglobin, dscrease o2 delivery to tissue.
4-lung carcinoma,
5-six fold increase risk of post operative respiratory morbidity.
6- stop smoking 6 weeks before surgery ot at least 12 hours before.
Define peroperative physical examination?
Full medical examination should performed primarly by surgeon and documented in patients record
Anasthesiologist should emphasis on CardioVascular, Pulmonary, airway examination and other relative findings.
Enumerate: General examination?
1-Nutritional state
2-fluid balance
3-state of skin & mucous membrane(anemia, perfusion, jaundice)
4-Temp
Enumerate local examinations should performed pre operative?
Cardiovascular Respiratory Air way Nervous Skeletal
Cvs examination??
1- dyspnea, fatigue, chest pain 2-lower limb edema 3-neck vein 4-pulse( Rate, rythm, volume) 5- carotud bruites
Respiratory examination?
Tracheal shift
Cough, tachypnea, cyanosis(peripheral and central)
Ascultation of all lung fields
Airway examination???
Teeth( dentures, loose teeth, protruding upper incisors)
Predict diffults in airway( ventillation of endotracheal intubation)
Nervous examination??
Document
1- level of conscousness
2- peripheral or cranial nerves lesion
Pre operative investigations guided by?
History Clinical examination Type of surgery Age Gender
Enumerate preoperative investigation?
CBC ECG URINE ANALYSIS FBG RENAL FUNCTION TEST LIVER FUNCTION TEST CHEST X RAY COAGULATION PROFILE
PULMONARY&ABG
PREGNANCY
When should patient perform CBC??
1- male>50 years 2- all adult females 3- anemia 4-hemoglobiopathy 5-CVD 6-Major surgeries 7-blood surgery
Major surgeries require…..
Group and screening
Or
Cross and match
What test is routine for all patients before surgery??
Urine analysis
When should perform FBG?
D. M
Steroid therapy
Renal function tests include?
Urea
Creatinine
Electrolytes
Who should performe renal function test?
>65 \+ve urin analysis Renal, liver diseases Malnutrion Dehydration DM Adrenal, pituitary or vascular disease Drugs( steroids, anti-hypertensive, digoxin, diuretics and other drug therapy affect electrolytes)
ECG????
>50 yrs Smoker>45 yrs CVD and DM PULMONARY DISEASE Drugs act on CVS AND DIURETICS
Liver function test?
Alcoholism
Hepatitis
Liver disease
Malnutrion
Coagulation profule includes
INR, APTT
Coagulación profile test performed to…..
History of bleeding disease
Liver disease
Drug abuse
Anticoagulant drugs
Liver disease patients require what investigations?
Renal function test
Liver function test
COAGULATION PROFILE
DM REQUIRE
Renal function test
ECG
Chest X RAY
All>60
CVD
PULMONARY DIS
THYROID ENLARGMENT( thoracic inlet x ray)
Pulmonary function test&ABG??
COPD&asthmatic patients
Elective thoractomy
Pregnancy with HCG?
And women in reoroductive age
