Pre and post operative care Flashcards
What is the risk of performing surgery after a recent MI?
Mortality of 30% if emergency surgery is carried out following a recent MI, surgery should be delayed for 6months if possible.
What is the purpose of pre op evaluation?
To identify the problems that may increase the risk of the operation and predispose to post op complications.
What is the cut off for blood pressure pre operatively?
BP must be controlled at or below 160/95. Patients with newly diagnosed hypertension should be deferred and investigated if the surgery is elective.
Potassium levels must be checked if patients are on diuretics
If a patient had respiratory disease how would you optimise them perioperatively?
STOP SMOKING 4 weeks before surgery
Organise pre op chest physio and breathing exercises
Ensure adequet medications are prescribed (bronchodilators, antibiotics etc)
Try to use a local or spinal anaesthetic
Ensure pain is well controlled
Post op phsysio
Early mobilisation
How are patients on dialysis managed peri operatively?
They should have their dialysis 24hrs before the surgery to allow the heparin to wear off.
U&Es, creatinine and HCO3 need to be checked post surgery and a CXR to exclude pulmonary oedema.
GA may cause hyperkalaemia - monitor
Delay dialysis for 24hrs post op if possible to avoid bleeding risk
What is the Child - Pugh score?
It measures hepatic reserve - the higher the score the greater the operative risk.
Uses bilirubin, albumin, INR, presence of ascites and encephalopathy.
What are the main post op problems in patients with liver disease/ obstructive jaundice?
bleeding, infection and poor wound healing
How is haemophilia managed peri operatively?
Cryoprecipitate is used pre and post op until bleeding risk is over
How is Von Willebrands managed peri operatively?
FFP or cryoprecipitate is used
How is a patient on warfarin managed peri operatively?
Discontinue the warfarin 3-4 days preop and start heparin S/C and then IV if needed through the operation.
Vitamin K can be given to reduce INR (takes 4 hrs) or a prothrombin complex can be given, Beriplex (takes 30 min)
What is the ASA classification?
American Society of Anesthesiologists Classification of Physical status.
I. Healthy patient with no systemic disease
II. A patient with mild to moderate systemic disease process caused by either the condition to be treated surgically or by another pathological process which does not limit the patients activity
III. A patient with a severe systemic disturbance from any cause and which imposes a definite functional limitation on the patient
IV. A patient with severe systemic disease which is constant threat to life
V. A moribund patient who is unlikely to survive 24hrs with or without surgery
What criteria need to be satisfied for consent to be valid?
- given before the procedure - can be given at any time, earlier the better so the patient can have time to think and ask questions
- the patient understands the proposed procedure, the risks and benefits and the complications
- it is given voluntarily
- the patient has capacity
What is the purpose of prophylactic antibiotics? and give examples of surgery that needs them
To reduce the risk of wound infection. occurs in 20% of elective GI surgery and 60% in emergency GI surgery.
Should be given 15- 60mins prior to the surgery so that skin concentration is maximal.
examples:
Biliary surgery, appendectomy, colorectal surgery, vascular
