Pre Op Assessement And Planning

Question 1

What are the pre-op checks you need to do?

Answer 1

O- operative fitness - CR comormidities
P- pills
C- consent
H- history - PMH plus Surg Hx and complications of Anaesthesia
E - ease of intubation - neck arthritis and teeth loose/ dentures
C- clexane - DVT prophylaxis
S - site correct and marked

Question 2

When to do neck X-rays before surgery?

Answer 2

Rheumatoid arthritis

Ank spond

Question 3

What’s the guidance of NBM pre surgery?

Answer 3

> 2 hrs clear fluids

> 6 hrs for solids (including milk)

Question 4

When to use and give prophylactic abx in surgery?

Answer 4

GI surgery
Joint replacement

Give 15-60mins before surgery

Question 5

What’s the ASA grading mean?

Answer 5

Predicts surgical mortality

Asa 1: normally healthy

2: mild systemic disease
3: severe systemic disease that limits activity
4: systemic disease which is a constant threat to life
5: moribund: not expected to survive 24hrs without surgery
6: brain dead who’s organs are being removed for donor purposes

Question 6

What’s the advice regarding insulin dependant diabetics and surgery?

Answer 6

Stop long acting insulin jig before
Omit AM insulin if op in morning.
Start sliding scale
Aim for glucose 7-11

Post op
Continue scaling scale until tolerating food
Switch to SC around a meal

Question 7

What’s the advice regard non insulin DM and surgery?

Answer 7

If poor control fasting BG >10 - treat as if insulin dependant

Good control
Omit oral hypoglyemics on AM of surgery,
Resume them when pt is eating around a meal.
If not eating post op start sliding scale

Question 8

Anti-coagulation (warfarin) and surgery?

Answer 8

Fine balance, depends on risk.

Low risk eg AF - stop warfarin 5 days pre-op need INR <1.5

High risk eg recurrent VTE, valves - need bridging LMWH

Emergency - stop warfarin give IV vit K 5mg, request FFP/PCC to cover surgery.

Question 9

Which surgeries are at a definite chance of needing a transfusion?

Answer 9

Total gastrectomy 
Oophorectomy
Oesophagectomy
Elective AAA
Cystectomy
Hepatectomy

Cross match 4-6 units

Question 10

Which surgeries are low risk of bleeding therefore only need a group and save (no cross match)?

Answer 10

Hysterectomy
Appendectomy
Thyriodectmy
Elective c-sec
Lap chole