Pre-Operative Care Flashcards
why do cardiovascular conditions need to be disclosed in a pre-op assessment and why?
there is an increased risk of an acute cardiac event when a patient is under anaesthesia
why do respiratory conditions need to be disclosed in a pre-op assessment and why?
patient needs adequate oxygenation to prevent ischaemic complications during surgery
what complications of renal disease can increase the risk of surgical complications?
anaemia, coagulopathy, biochemical disturbances
when should extra care be taken when operating on a patient with severe renal dysfunction?
when giving IV contrast or during blood loss in theatre as can cause further damage to the kidneys
what endocrine diseases need to be considered when operating on a patient and why?
diabetes and thyroid disease
the medications used to treat these conditions may have to be changed peri-operatively
what is post operative nausea and vomiting (PONV)?
nausea and vomiting that occurs within the first 48 hours post-op often caused by opioid anaesthesia
what is the eating regimen pre-op?
stop eating and drinking 6 hours prior
stop clear fluids 2 hours prior
why should a patient not eat or drink prior to surgery?
an empty stomach reduces the risk of pulmonary aspiration, which can lead to aspiration pneumonia
what is the pneumonic for commonly discontinued medications pre-operatively?
CHOW: Clopidogrel Hypoglycaemics Oral contraception or HRT Warfarin
what is the protocol for clopidogrel prescriptions pre-op?
should be stopped 7 days pre-op to reduce bleeding risk
true or false: aspirin should be stopped pre-op
false.
aspirin has a minimal effect on surgical bleeding and can be continued
what is the protocol for type I diabetic patients pre-op?
- patient should be taken into theatre in the early morning as will be NBM from night time
- patients should miss morning insulin and be started on an IV sliding scale
- patient should also be given IV dextrose while NBM and BM should be monitored
what is the protocol for type II diabetic patients pre-op?
- metformin should be stopped the morning of surgery
- other diabetic drugs should be stopped 24 hours pre-op
- patient should be placed on IV sliding scale and dextrose the same as type I diabetics
what is the protocol for pre-op patients on OCP or HRT?
should be stopped 4 weeks before surgery due to DVT risk
what is the protocol for pre-op patients on warfarin?
stopped 5 days before surgery to reduce bleeding risk
- therapeutic LMWH given instead
- INR <1.5 needed for surgery to go ahead, PO vitamin K may be given to help lower INR
what is the protocol for pre-op patients on long-term steroids?
these should be continued, as the risk of an Addisonian Crisis increases if stopped
what three things should be prescribed to a patient pre-operatively?
- low molecular weight heparin (LMHW)
- TED stockings
- antibiotic prophylaxis
why is a pre-op patient given LMWH?
this is done to reduce the risk of VTE
when would you not prescribe TED stockings?
if a patient is undergoing vascular surgery or has peripheral vascular or neuropathic conditions
why is a pre-op patient given prophylactic antibiotics?
in order to reduce the risk of infection peri and post-operatively
what specific surgeries would a patient need ‘bowel preparation’ for?
if the patient is having one of the following colorectal surgeries:
- left hemi colectomy
- sigmoid colectomy
- abdo-peroneal resection
- anterior resection
what is ‘bowel preparation’ and what specific drugs are given?
giving a patient laxatives or enemas to clear out their bowels prior to surgery.
phosphate enemas most commonly given
how is the difficulty of intubation assessed?
by giving the patient a Mallampati grade
what is assessed in Mallampati grading?
- facial deformities
- degree of mouth opening
- presence of teeth and dentition
- oropharynx and visibility of their uvula
- range of movement of the neck
what investigations are normally conducted pre-operatively?
- blood test
- imaging
- urine dip
- pregnancy testing
what specific blood tests are done and why?
- FBC to assess for any undiagnosed anaemia or thrombocytopenia (these can increase risk of CVS events)
- U&Es to assess baseline renal function and inform on IV fluid management intra-operatively
- LFTs to assess liver metabolism as it can inform of drugs prescribed
- Clotting screen to assess risk of bleeding or risk of clots
- X-match and G&S in the event of a transfusion needed
what specific imaging is done and why?
- ECG preformed for patients with a history of CVD or if they are undergoing major surgery, done to provide a baseline of cardiac activity
- CXR if the patient is a smoker or has had a cardiorespiratory illness
