Pre-Op Assessment and Post-Op Complications Flashcards
Important cause of perioperative bleeding and hematoma formation
Hypertension
History taking for the general health assessment of a patient awaiting surgery should include
- Past medical and surgical history
- Social history (use of tobacco,alcohol or other illicit drugs)
- Any known allergies
- Drug history (prescribed, herbal, vitamins, over-the-counter)
- Anesthesia problems experienced by patient and/or blood relatives
What medications are described as over-the-counter?
They are medicines one can buy without a prescription. They also known nonprescription medicines.
Eg. pain relievers like ibuprofen
Give 5 pre op risk factors for pulmonary complications
- If it involves a thoracic and upper abdominal surgery
- Preop history of COPD (chronic obstructive pulmonary disease)
- Preop purulent or productive cough
- If anesthesia time is greater than 3hours
- Hx of cigarette smoking
- If patient is beyond 60years of age
- Poor preop nutritional state
- Symptoms of respiratory disease
- Abnormal findings on P/E, where P/E could be physical examination
- Abnormal findings on CXR (Chest X-Ray)
What can be done to prevent/ minimize post op complications in a patient with COPD?
- Cessation of smoking
- Use of bronchodilators
- Chest physical therapy
- Use of antibiotics (if sputum is purulent)
Useful predictors of life threatening complications of cardiac origin after non cardiac operations
Diabetes mellitus Hypertension Stable angina pectoris Cardiomegaly Smoking
Increased risk factors of DVT
Cancer Obesity Smoking Myocardial dysfunction Prior hx of thrombosis IBD Inherited thrombophilia syndromes Age over 45 years
What to do for patients with severe liver disease in preop assessment
- may require preop Fresh frozen plasma or clotting factors
- antibiotics and anesthetics that are metabolized in liver should be avoided or used with reduced dosages.
What to do for patient with history of ischaemic heart disease
May need sublingual nitroglycerin
What to do for a patient with valvular heart disease or prosthetic valves
May need prophylaxis to prevent risk of developing endocarditis
Why is there adverse wound healing and increased risk of Infections in patients with poorly controlled DM
Because of defects in chemotaxis, opsonization and phagocytosis
Why is it necessary for a doctor to ask about the history of seizures during preop assessment
To help avoid large doses of anesthetic because precipitating convulsion is possible
Why is a history or previous stroke important in preop assessment
- May be a clue to underlying coronary heart disease
- also an indication that the patient is most likely on an antiplatelet agent. E. G aspirin, warfarin
ASA classification
I - Normal healthy patient
II - patient with mild systemic disease
III - patient with severe systemic disease that limits activity but is not incapacitating
IV- Moribund patient not expected to survive 24 hours with or without operation
< or equal to 48 hours post op fever
Consider atelectasis
