Pre Operative 2 Flashcards
What u should do before deciding if patient can go or not to surgery?
After history, physical examination, investigation
What is the criteria of patient that ready for surgery?
1- he fits anaesthesia 2- optimized physical condition 3-almost possible correction 4-high emergent 5- pt gives legal consent
When u till the patient to postpone the surgery?
1-not fit the anaesthesia 2-ont optimized physical condition 3-not not almost possible correction 4-not emergent 5- have no legal consent
How many classes in ASA??
6
رتب 1-sever systemic disease ( sDM, COPD) 2-healthy mormally patient 3-mild systemic disease 4- declared brain dead 5-incapacitating systemic disease 6-moribund patients not expected to survive 24hrs
CLASS lll Class I Class II CLASS E CLASS IV CLASS V
In general, what is pre operative optimization?
- Any fluid or electrolyte imbalance should be corrected
- Extent ot existing comorbidities should understood, condtions should be optimized prior to surgery
- Medications need adjustment
Enumerate steps of pre operative optimization of medications?
Pre operative medications to
1. Conseder
Stop
Adjust
Enumerate preoperative medications to stop?
- ORAL ANTIHYPERGLYCEMIC DRUGS
- ACEIS AND ARB
- WARFARIN AND HEPARIN
- NSAIS AND ASPIRIN
- HERBAL SUPPLEMENTS
Enumerate pre operative medications to consider?
Prophylaxis :
- GE REFLUX : RANITIDINE, METOCLOPRAMIDE, NA CITRATE
- ANTIBIOTICS : INFECTIVE ENDOCARDITIS
- STEROIDS FOR ADRENAL INSUFFICIENT
- ANXIETY :BENZODIAZEPINES
- BRONCHODILATOR: COPD AND ASTHMA
- NITROGLYCRIN and B BLOCKERS FOR CAD
To adjust??
BRONCHODILATOR
PREDNSONE
Insulin ( insulin)/dextrose infusion or holding dose
Which diseases complications continue to account for major morbidity and
mortality in patients undergoing noncardiac surgery?
Cardiovascular and pumonary complications
Which blood pressure not independently risk factor for perioperative cardiovascular complications?
Systole less than 180
Diadtole < 110
Clarify pre operative optimization of CAD???
➢At least 60 day should elapse after a MI before a noncardiac surgery in the absence of a
coronary intervention
• This period carries an increased risk of re-infarction/death
➢Mortality with perioperative MI is 20-50%
What are the advantages and disadvantages s of b blocker in CAD patient!
Dicrease the risk of cardiac events and mortality rate.
Increase peri operative strokes
Continue -blocker if patient is…….
routinely taking it prior to surgery
Consider initiation of -blocker in????
1.CAD and other ondications
2 intermediate and high risk surgerys as vascular surgery
Enumerate high Risk factor assessment of Noncardiac Surgical Procedurs?
- high emergent with elderly 🧓
- prolonged surgery with high fluid shift/blood loss
- aortic and other non carotid vascular surgery ( endovascular and non endo…)
Enumerate lower Risk factor assessment of Noncardiac Surgical Procedurs?
Eye 👁🗨
Skin
Superficial surgery
Endoscopic procedures
Enumerate intermediate Risk factor assessment of Noncardiac Surgical Procedurs?
- head and neck 🧣
- Carotid endartrectomy
- Thoracic
- abdominal
- Orthopedic 🍖
- Prostate
Enumerate adverse effects of smoking?
🚬
- Alter mucous secretion
- Dicrease small airway calibre
- Alter o2 carrying capacitiy
- Increase airway respond
- Alter immune response
When the patient abstain smoking before surgery!
8 weeks
At least, 24 hrs enough to increase o2 availability in tissue
What asthmatic patients need before surgery??
- Short course of ( corticosteriods+ B2 AGONIST INHALATION)
- Avoiding NON SELECTIVE B BLOCKER
- CAN TAKE CARDIOSELECTIVE B BLOCKER
Enumerate 2 of CARDIOSELECTIVE b blocker?
Metoprolol
Atenolol
When asthmatic patients should delay surgery???
1** Poorly controlled asthma
(COGH, HIGH SPUTUM PRODUCTION, ACTIVE WEEZING)
2** URTI
Asthmatic patients with URTI should delay surgery for………..
6 weeks
Enumerate condtions exacerbate COPD patients??
Then the their effects???
Anaesthesia Upper abdominal surgery Pain .......... Atelctasis Bronchospasm Pneumonia Prolonged mech ventillation Respiratory faliure
Investigación should COPD patients do pre operative??? And why!!
ABG, to knlw baseline respiratory acidosis, plan the post operation management
Which types of COPD need ABG?
II
III
When COPD patients should cancel or delay the surgery??
Acute exacerbation
Enumerate factors increase risk of aspiration!?
- ⬆️ Intra abdominal pressure
- ⬇️ Gastric emptying
- Spheincter incompetence
- ⬇️ Level of consciousness
- Unprotected airway
How to manage aspiration??
- Manage risk factors if possible
- ⬇️ Gastric volume and acidity
- Protect airway(endotracheal tube)
- Delay inhibiting air way reflexes with MS relaxants
- Empoly rapid sequence induction
Enumerate fasting guidlines prior to surgery!
- 8 h after a meal that includes meat, fried or fatty foods
- 6 h after a light meal (such as toast or crackers) or after ingestion of infant formula or nonhuman milk
- 4 h after ingestion of breast milk
- 2 h after clear fluids (water, black coffee, tea, carbonated beverages, juice without pulp)
Put examples on :
⬇️ Level of consciousness??
CNS PATHOLOGY
HEAD TRUAMA
Shock/truama
DRUGS/ALCOHOL
Put examples on :
⬆️ Abdominal pressure??
PREGNANCY 🤰
OBESITY
BOWEL OBSTRUCTION
ACUTE ABDOMEN
Put examples on :
Delayed gastric empty??
DM
NARCOTICS
Non FASTED WITHIN 8 HRS
Put examples on :
⬇️ Sphincter competance
GERD Hiatus hernia Nasogadtric tube Pregnancy 🤰 OBESITY
In hematological disorders evaluate………..
Hb
Hematocrite
Coagulation proles
In case of Anemia, preoperative treatment is……?? And by……???
⬆️ Hemoglobin
PO, IV iron supplements
Erythropoiten
Pre admission blood collection
In coagulapathies, pre operative treatment is to stop……….. And may need to take……….
Anticoagulants( warfarin, Aspirin, apixaban, clopidogrel, dabigatran) Reversal dugs( VIT. K, recombenant factor VII, prothrombin complex concentrats)
In case of DM, be aware of end organ damage to……………?
CVS ♥
Renal
preiphral, central and autonomic nervous sys🧠
Enumerate pre operative guidlines for DM!!?
- Verify target bl. Glucose
( ⬇️180 in critical cases,, ⬇️ 140 in stable cases) - Insulin therapy
- Stop oral hypoglycemic drugs
- Cancel non emergent procedures if glucose > 400, HHS, DKA
Treatment of hyñerthyroidism pre operative??
B blocker
Prophylactic ⚕
Both obesity and………….. Independently ⬆️ risk of…………,………,………
OSA
- difficult ventillation, intubation
- post operative resp. Complications
Hyper thyroidism can experience……… If not……….. Pre operative.
Thyroid storm
Treated or well controlled
Thank you
⚕️⚕️⚕️⚕️
