Week 4 - Perioperative evaluation, patient prep, and post-operative care Flashcards
PRE-OPERATIVE ASSESSMENT
• Consider it as ___-___ planning
• Provides a solid _____ for the surgical procedure
• Gives _______ physiologic data for the patient
• Facilities assessment of ______ and the ________ to the surgery
pre-surgical, foundation, baseline, disease, relevance
PRE-OPERATIVE EVALUATION OF
THE PATIENT
• _____ communication and owner _____
• WITH _______!
• Thorough _____ [including medications/supplements]
• Physical ______
• ______ restriction [whenever possible]
• _______ data
• Determination of surgical ___ [____ status]
• Patient _______
• Pre-surgical ______
Client, consent, SIGNATURES, history, examination, Dietary, Laboratory, risk, ASA, Stabilization, medications
CLIENT COMMUNICATION
• Extremely important
• Prior to surgery owner should be informed about?
• Diagnosis
• Prognosis
• Surgical options
• Non-surgical options
• Potential complications *
• Post-operative care
• Cost = low and high end of the bill
HISTORY
• Regardless of the procedure, make sure you’re aware of previous _______ _____.
• Usually obtained from the _____ or _____.
• In an emergency, a _____ history is usually given [eventually a ______ history is obtained]
• ______ history vs. _____ history
• Should always include – ?
medical history, owner, caregiver, brief, thorough, General, Specific, signalment, diet, exercise, past medical problems/surgery, any recent treatment
PRE-OPERATIVE EXAM [PE]
• Determines if the patient is ______ enough to safely undergo _______ and _____
• _______ evaluation of all body systems
• Evaluation of ___-______ physical status
• Patients general body _______ should be noted
• _____ condition, ______, and ______ status
• Ensure thorough _______ evaluation and ____ function assessment
• Rule out a heart _____ or abnormal ______
• +/- Full ____ and _____ examination
• Remember to check ____
• Looking for ______ or ______.
healthy, anesthesia, surgery, Systematic, pre-anesthetic, condition, Body, attitude, mental, cardiac, lung, murmur, arrythmia, neuro, ortho, kennel, diarrhea, vomiting
DIETARY RESTRICTIONS
• _____
• Withhold food for ___-____ hours ____ to surgery [pending patient status]
• Continue to offer ____
• _______ Animals [ie: dogs, cats, swine]
• Fast ___-____ hours prior
• ______ [ie: cattle, sheep, goats]
• Fast ~___-___ hours prior
• _____ and _____ [includes mice, rats, guinea pigs, hamsters]
• High ______ rate
• ____ fasting prior
• ______ Animals [<8 weeks of age; <1 lb]
• _______ concerns –> leads to ?
• Do not ______ water
• Withhold food ___-___ hours prior to anesthetic event
NPO, 6 – 12, prior, water, Monogastric, 6-12, Ruminants, 12 – 24, Rodents, Rabbits, metabolic, No, Underage, Hypoglycemia, seizures, withhold, 1 – 2
PRE-OPERATIVE BLOODWORK
• Depends on the animal’s physical status and the procedure being performed
• Elective or routine procedure
• Emergency
• Reduces risk and increases safety
• Provides a baseline for the patient
• Takes into account patient’s behavior
• Normal bloodwork è Proceed with surgery
• Abnormal bloodworkè Workup and/or treat prior to anesthesia vs. emergency surgery
PRE-OPERATIVE BLOODWORK
• Ideally routine bloodwork completed before any procedure
• Patients undergoing elective procedure [~6 months – 4 years]
• Hematocrit [PCV]
• Total Protein [TP]
• +/- Limited biochemical and urine screening [BUN, Creatinine, USG]
• Mature adults [5 – 7 years]
• Complete blood count [CBC]
• Comprehensive serum biochemistry profile [Chemistry Panel]
• Urinalysis
• 8+ years
• Complete blood count [CBC]
• Comprehensive serum biochemistry profile [Chemistry Panel]
• Urinalysis
• Thyroid Panel [minimum T4]
• Additional Testing
• Coagulation function test, especially for patients with liver disease, maldigestion disorders,
NSAID usage, and breed predisposition
BLOODWORK FOR
LARGE ANIMAL
• Indicated for horses based on age and systemic
status
• Horses younger than 4 years old and healthy
• Packed cell volume [PCV]
• Total Protein
• Horses greater than 4 years old and systemically ill
• Complete blood count [CBC]
• Chemistry Panel
• Electrolyte measurement for right-sided abomasal
disease of the dairy cow
• Urinalysis in the dairy cow to evaluate the presence
of ketosis
• Measurement of BUN [blood urea nitrogen] and
Creatinine, if urinary problems are suspected
• Analysis of peritoneal fluid prior to laparotomy for
horses with colic
Important b/c we want to classify the patient prior to surgery so we know the likelihood of a patient having a cardiac emergency. We number it from 1-5.
If 5, make sure anesthesiologist is with you.
Higher the number, greater risk of anesthetic or surgical complications.
PATIENT STABILIZATION
• Patients should be ______ as thoroughly as possible before surgery
• Correct fluid ____
• Stable dehydrated open ____ patient (make sure patient does not have skin infection)
• Correct ____-____ and ____ abnormalities
• Treat underlying ______
stabilized, deficits, pyometra, acid-base, electrolyte, infection
PRE-OPERATIVE MEDICATIONS
• Maropitant [Cerenia] – 1mg/kg ___ minutes – ____ hour before pre-medications
• Reduces ______, especially if using _____
• May have __-_____ properties
• Potential ______ recovery from gas anesthesia and hasten
return to eating
• Pre-medication – Many different variations and combinations
• Dexmedetomidine/Butorphanol
• Midazolam
• Diazepam
• Hydromorphone = notorious for causing nausea and vomiting,
so make sure you have antiemetic prior to administering.
• Methadone
• Ketamine
• Pre-emptive analgesia
• NSAID [Carprofen, Meloxicam]
• Local Anesthetic [Lidocaine, Bupivacaine]
• Opioids
• +/- Antibiotics [ie: Cefazolin]
45, 1, vomiting, Hydromorphone, anti-inflammatory, smoother
EXCRETIONS
• Allow patient to urinate and defecate prior to induction
• Abdominal Surgery
• Empty bladder
• Colonic Surgery
• +/- Enema
• Bladder Distention
• Could lead to a rough recovery
REASONS TO DELAY SURGERY
• High Fever
• Rule out _____
• Recent _______ Signs [24 – 48 hours]
• Pyoderma = ?
• Infection
• Urinary Tract Infection [URI]
• CIRDC = ?
• Sick
• Uncontrolled ______
• Uncontrolled ______
• In heat = ?
stress, Gastrointestinal, skin infection, canine infectious respiratory disease complex aka kennel cough, Diabetic, Hyperthyroid, always try to reschedule it b/c there is an increased chance of complications b/c tissues are swollen and more friable.
*****HALSTED’S SURGICAL PRINCIPALS
• Strict _____
• ________
• Preservation of _____ supply [accurate anatomical _______]
• _____ tissue handling and manipulation
• Avoid excess _____ on tissue during wound ____
• Accurate tissue _______ in wound closure
• Elimination of _____ space
asepsis, Hemostasis, blood, dissection, Gentle, tension, closure, apposition, dead
Tips to reduce risk of surgical site infection
WOUND/SURGICAL CLASSIFICATION
• Clean
• Clean-Contaminated
• Contaminated
• Dirty
CLEAN WOUND/SURGERY
• Involving non-_______, non-_______, and non-______ surgical site
• _______, ____, and _______ tract not entered
• Examples ?
contaminated, traumatic, inflamed, Gastrointestinal, urinary, respiratory,
• Neuter/Ovariohysterectomy
• Arthrotomy for removal of a chip fracture of a carpal bone
• Elective orthopedic surgery
• Total hip replacement
• PDA
CLEAN-CONTAMINATED WOUND/SURGERY
• Operative wounds/surgery in which the _______, _____, and _______ tract is entered, under ______ conditions without ____ contamination
• Examples ?
gastrointestinal, urinary, respiratory, controlled, unusual
• Abomasopexy [displaced abomasum in dairy cows]
• Enterotomy [foreign body removal] **not every foreign body surgery is clean contaminated
• Small Intestinal Resection
• Bronchoscopy
Disinfectants and Antiseptic
Post-operative care at home
