Pre- and Post-operative care

Question 1

A 65 year old man has been transferred from the ward to the operative theatres for an elective right knee replacement. Outline his pre-operative management and post-operative recovery room care.

Answer 1

Introductory
Break into pre-op assessment, pre-op management, then post-operative care.

Pre-operatively;

• gain informed consent
• identify whether fit for surgery; assess medications and pre-operative condition, consider physio + pre-habilitation
• then relevant pre-op management and post-operative recovery room care.

Question 2

Pre-operative assessment

Answer 2

Pre-operative assessment
1) Fitness for surgery
o History: PMHx, PSHx, medications, anaesthetic history
o Examination: general systems review, anaesthetic assessment (Jaw ROM, head and neck ROM, teeth/dentures, malampatti score
o Investigations: ECG, CXR, UEC, LFT, FBC, G+H

2 - Medications
o anticoagulants: Warfarin cease 5 days pre-op, NOACs cease day before
o anti platelet: cease clopidogrel 7 days before
o anti-hypertensives: keep ß-blockers
o diabetic meds: Metformin cease stop morning of, SGLT2 cease 3 days prior, insulin don’t take morning dose, consider I-G infusion once in anaesthetic bay

Question 3

Pre-operative management

Answer 3

Pre-operative management

• Fast from midnight
• Check in to OT with consent
• pre-operative marking
• taken to anaesthetic bay for review, IVC, induction agents
• safety huddle + time-out
• closed-loop communication
• procedure
• handover to recovery

Question 4

Post-operative management

Answer 4

Post-operative management (recovery room)

• 15 minute obs for 1 hour then every 30 if not btf
• NP oxygen as recovering to maintain sats
• appropriate analgesia (procedure specific, ?PCA)
• anaesthetic review if any deterioration