Pre-op 101 & Procedures Flashcards
When can a patient eat prior
to major surgery?
Patient should be NPO after midnight
the night before or for at least 8 hours
before surgery
What risks should be discussed
with all patients and
documented on the consent
form for a surgical procedure?
Bleeding, infection, anesthesia, scar;
other risks are specific to the individual
procedure (also MI, CVA, and death if
cardiovascular disease is present)
If a patient is on antihypertensive
medications, should
the patient take them on the
day of the procedure?
Yes, (remember clonidine “rebound”)
If a patient is on an oral
hypoglycemic agent (OHA),
should the patient take the
OHA on the day of surgery?
Not if the patient is to be NPO on the
day of surgery
If a patient is taking insulin,
should the patient take it on
the day of surgery?
No, only half of a long-acting insulin
(e.g., lente) and start D5 NS IV; check
glucose levels often preoperatively,
operatively, and postoperatively
Should a patient who
smokes cigarettes stop
before an operation?
Yes, improvement is seen in just 2 to
4 weeks after smoking cessation
What laboratory test must
all women of childbearing
age have before entering
the O.R.?
-HCG and CBC because of the possibility
of pregnancy and anemia from menses
What is a preop colon
surgery “bowel prep”?
Bowel prep with colon cathartic (e.g.,
GoLYTELY), oral antibiotics (neomycin
and erythromycin base), and IV antibiotic
before incision
Has a preop bowel prep
been shown conclusively to
decrease postop infections
in colon surgery?
No, there is no data to support its use
What preoperative
medication can decrease
postoperative cardiac events
and death?
-blockers!
What must you always order
preoperatively for your
patient undergoing a major
operation?
- NPO/IVF
- Preoperative antibiotics
- Type and SCREEN blood (PRBCs)
What electrolyte must you
check preoperatively if a
patient is on hemodialysis?
Potassium
Who gets a preoperative
ECG?
Patients older than 40 years of age
Roux-en-Y limb
Jejunojejunostomy forming a Y-shaped
figure of small bowel; the free end can
then be anastomosed to a second hollow
structure (e.g., esophagojejunostomy)
Brooke ileostomy
Standard ileostomy that is folded on
itself to protrude from the abdomen
2 cm to allow easy appliance placement
and collection of succus
CEA
Carotid EndArterectomy; removal of atherosclerotic
plaque from a carotid artery
Bassini herniorrhaphy
Repair of inguinal hernia by approximating
transversus abdominis aponeurosis
and the conjoint tendon to the reflection
of Poupart’s (inguinal) ligament
McVay herniorrhaphy
Repair of inguinal hernia by approximating the transversus abdominis aponeurosis and the conjoint tendon to Cooper’s ligament (which is basically the superior pubic bone periosteum)
Lichtenstein
herniorrhaphy
“Tension-free” inguinal hernia repair using
mesh (synthetic graft material)
Shouldice herniorrhaphy
Repair of inguinal hernia by imbrication of the transversalis fascia, transversus abdominis aponeurosis, and the conjoint tendon and approximation of the transversus abdominis aponeurosis and the conjoint tendon to the inguinal ligament
Plug and patch hernia
repair
Prosthetic plug pushes hernia sac in and
then is covered with a prosthetic patch to
repair inguinal hernias
APR
AbdominoPerineal Resection; removal of the rectum and sigmoid colon through abdominal and perineal incisions (patient is left with a colostomy); used for low rectal cancers 8 cm from the anal verge
LAR
Low Anterior Resection; resection of
low rectal tumors through an anterior
abdominal incision
Hartmann’s procedure
- Proximal colostomy
- Distal stapled-off colon or rectum that
is left in peritoneal cavity
Mucous fistula
Distal end of the colon is brought to the
abdominal skin as a stoma (proximal end
is brought up to skin as an end colostomy)
Kocher (“koh-ker”)
maneuver
Dissection of the duodenum from the
right-sided peritoneal attachment to
allow mobilization and visualization of
the back of the duodenum/pancreas
Highly selective
vagotomy
Transection of vagal fibers to the body of the stomach without interruption of fibers to the pylorus (does not need pyloroplasty or other drainage procedure because the pylorus should still function)
Enterolysis
Lysis of peritoneal adhesions
LOA
Lysis Of Adhesions (enterolysis)
Appendectomy
Removal of the appendix
Lap appy
Laparoscopic removal of the appendix
Cholecystectomy
Removal of the gallbladder
Lap chole
Laparoscopic removal of the gallbladder
Nissen
Nissen fundoplication; 360 wrap of the
stomach by the fundus of the stomach
around the distal esophagus to prevent
reflux
Lap Nissen
Nissen fundoplication with laparoscopy
Simple mastectomy
Removal of breast and nipple without
removal of nodes
Choledochojejunostomy
Anastomosis of the common bile duct to the jejunum (end to side)
Graham patch
Placement of omentum with stitches over
a gastric or duodenal perforation (i.e.,
omentum is used to plug the hole)
Heineke-Mikulicz
pyloroplasty
Longitudinal incision through all layers of
the pylorus, sewing closed in a transverse
direction to make the pylorus nonfunctional
(used after truncal vagotomy)
Pringle maneuver
Temporary occlusion of the porta hepatis
(for temporary control of liver blood flow
when liver parenchyma is actively bleeding)
Modified radical
mastectomy
Removal of the breast, nipple, and axillary lymph nodes (no muscle is removed)
Lumpectomy and
radiation
Removal of breast mass and axillary
lymph nodes; normal surrounding breast
tissue is spared; patient then undergoes
postoperative radiation treatments
I & D
Incision and Drainage of pus; the wound
is then packed open
Exploratory laparotomy
Laparotomy to explore the peritoneal cavity
looking for the cause of pain, peritoneal
signs, obstruction, hemorrhage, etc.
TURP
TransUrethral Resection of the Prostate;
removal of obstructing prostatic tissue via
scope in the urethral lumen
Fem pop bypass
FEMoral artery to POPliteal artery
bypass using synthetic graft or saphenous
vein; used to bypass blockage in the
femoral artery
Ax Fem
Long prosthetic graft tunneled under the
skin placed from the AXillary artery to
the FEMoral artery
Triple A repair
Repair of an AAA (Abdominal Aortic
Aneurysm): Open aneurysm and place
prosthetic graft; then close old aneurysm
sac around graft
CABG
Coronary Artery Bypass Grafting; via saphenous vein graft or internal mammary artery bypass grafts to coronary arteries from aorta (cardiac revascularization)
Hartmann’s pouch
Oversewing of a rectal stump (or distal
colonic stump) after resection of a
colonic segment; patient is left with a
proximal colostomy
PEG
Percutaneous Endoscopic Gastrostomy: Endoscope is placed in the stomach, which is then inflated with air; a needle is passed into the stomach percutaneously, wire is passed through the needle traversing the abdominal wall, and the gastrostomy is then placed by using the Seldinger technique over the wire
Ileoanal pull-through
Anastomosis of the ileum to the anus
after total proctocolectomy
Hemicolectomy
Removal of a colonic segment
i.e., partial colectomy
Truncal vagotomy
Transection of the vagus nerve trunks; must provide drainage procedure to stomach (e.g., gastrojejunostomy or pyloroplasty) because after truncal vagotomy, the pylorus does not relax
Antrectomy
Removal of stomach antrum
Whipple procedure
Pancreaticoduodenectomy: Cholecystectomy Truncal vagotomy Pancreaticoduodenectomy—removal of the head of the pancreas and duodenum Choledochojejunostomy Pancreaticojejunostomy (anastomosis of distal pancreas remnant to the jejunum) Gastrojejunostomy (anastomosis of stomach to jejunum)
Excisional biopsy
Biopsy with complete excision of all suspect tissue (mass)
Incisional biopsy
Biopsy with incomplete removal of suspect tissue (incises tissue from mass)
Tracheostomy
Placement of airway tube into trachea
surgically or percutaneously
