Pre-Operative Assessment and Planning

Question 1

What are the aims of pre-operative assessment and planning?

Answer 1

Gain informed consent
Assess risk vs benefits
Optimise fitness of patient
Check anaesthesia/analgesia type that will be suitable

Question 2

What pre-op checks should be made?

Answer 2

OP CHECS - 
Operation fitness
Pills (medication)
Conset 
History 
Ease of intubation
Clexane
Site

Question 3

What should be assessed in operation fitness?

Answer 3

Cardiorespiratory co-morbidities

Question 4

What history is important in pre-op checks?

Answer 4

MI
Asthma
HTN
Jaundice
DVT
Previous anaphylaxis

Question 5

What is it important to know to assess ease of intubation?

Answer 5

Neck arthritis
Dentures
Loose teeth

Question 6

What is the purpose of clexane?

Answer 6

DVT prophylaxis

Question 7

What needs to be done to the surgical site in pre-op checks?

Answer 7

Ensure is correct site, and mark it

Question 8

What changes should be made to anti-coagulants pre-operatively?

Answer 8

Depends - you should balance risk of haemorrhage vs. risk of thrombosis

Question 9

What should be avoided if the patient is on anti-coagulants?

Answer 9

Epidural, spinal, and regional blocks

Question 10

What changes should be made to anti-epileptic drugs pre-operatively?

Answer 10

They should be given as normal

Question 11

How should anti-epileptic drugs be given post-operatively?

Answer 11

If unable to tolerate orally, should give IV or via NGT

Question 12

What changes should be made to OCP/HRT pre-operatively?

Answer 12

Stop 4 weeks before major or leg surgery

Question 13

When should OCP/HRT be restarted if they are stopped for surgery?

Answer 13

2 weeks post-op, if mobile

Question 14

What changes should be made to ß-blockers pre-operatively?

Answer 14

Continue as normal

Question 15

What pre-operative investigations should be performed?

Answer 15

Bloods
Cardiopulmonary function
MRSA swabs

Question 16

What routine bloods should be done pre-operatively?

Answer 16

FBC
U&Es
G&S
Clotting 
Glucose

Question 17

When should LFTs be done pre-operatively?

Answer 17

Liver disease
EtOH
Jaundice

Question 18

When should TFTs be done pre-operatively?

Answer 18

Thyroid disease

Question 19

How much blood should be cross matched for a gastrectomy?

Answer 19

4 units

Question 20

How much blood should be cross matched for an AAA?

Answer 20

6 units

Question 21

What may be assessed when investigating cardiopulmonary function pre-operatively?

Answer 21

CXR
Echo
ECG
Cardiopulmonary exercise testing
PFT

Question 22

When is a CXR required pre-operatively?

Answer 22

Cardiorespiratory disease/symptoms

>65 years

Question 23

When is an echo required pre-operatively?

Answer 23

Poor LV function

Murmurs

Question 24

When is an ECG required pre-operatively?

Answer 24

HTN
Hx of cardiac disease
>55 years

Question 25

When are PFTs required pre-operatively?

Answer 25

Known pulmonary disease | Obesity

Question 26

When might a lateral C-spine in flexion and extension views be done pre-operatively?

Answer 26

Rheumatoid arthritis | Ankylosing spondylitis

Question 27

How long should a patient be NBM before surgery?

Answer 27

2 hours for clear fluids | 6 hours for solids

Question 28

When might bowel prep be needed pre-operatively?

Answer 28

For left sided operations

Question 29

Is bowel prep needed in right-sided procedures?

Answer 29

Not usually

Question 30

What can be used for bowel prep?

Answer 30

Picolax | Klean-Prep

Question 31

What is picolax?

Answer 31

Picosulfate and Mg citrate

Question 32

What is Klean-Prep?

Answer 32

Macrogol

Question 33

What are the disadvantages of bowel prep?

Answer 33

Liquid bowel content may spill during surgery Electrolyte disturbance Dehydration Increased rate of post-op anastomotic leak

Question 34

When are prophylactic antibiotics used in surgery?

Answer 34

GI surgery | Joint replacement

Question 35

What is the infection rate of elective GI surgery?

Answer 35

20%

Question 36

When should pre-operatively antibiotics be given?

Answer 36

15-20 minutes before surgery

Question 37

What antibiotic prophylaxis should be given in biliary surgery?

Answer 37

Cef 1.5mg and met 500mg IV

Question 38

What antibiotic prophylaxis should be given in colorectal surgery or appendicetomy?

Answer 38

Cef and met TDS

Question 39

What antibiotic prophylaxis should be given in vascular surgery?

Answer 39

Co-amoxiclav 1.2g IV TDS

Question 40

What antibiotic prophylaxis should be given in MRSA +ve patients?

Answer 40

Vancomycin

Question 41

How are DVTs prevented in low risk patients?

Answer 41

Early mobilisation

Question 42

How are DVTs prevented in medium risk patients?

Answer 42

Early mobilisation TEDS 20mg enoxaparin

Question 43

How are DVTs prevented in high risk patients?

Answer 43

Early mobilisation TEDS 40mg enoxaparin Intermittent compression boots peri-operatively

Question 44

How long can medical DVT prophylaxis be continued at home?

Answer 44

Up to 1 month

Question 45

What is ASA grade 1?

Answer 45

Normally healthy

Question 46

What is ASA grade 2?

Answer 46

Mild systemic disease

Question 47

What is ASA grade 3?

Answer 47

Severe systemic disease that limits activity

Question 48

What is ASA grade 4?

Answer 48

Systemic disease which is a constant threat to life

Question 49

What is ASA grade 5?

Answer 49

Not expected to survive 24 hours without operation