No

1. Pre and Post-
operative assessment
by family physician
Ahmed Nassr
Assistant lecturer in general surgery
department
Faculty of medicine , Minia
University

2. Preoperative
Evaluation
Patient
Age , comorbidities, general
performance
Surgical Procedure
Elective , emergency, minor or major
operations, type of anasthesia

3. Preoperative
Evaluation
Regular preop fitness
 Young patients
 Elder patients with no comorbities
 Regular Labs +/- ECG

4. Preoperative
Evaluation
(Cardiac patient)
 A preoperative cardiac risk assessment
should address three major
components:
1. The patients risk of a major cardiac
complication
2. The patients current functional status
.
3. The cardiac risk associated with the
planned procedure

7. Preoperative Evaluation
(Cardiac patient)
 PERIOPERATIVE β-BLOCKERS
1. Patients who are already taking (3-
blockers for angina, arrhythmia,
and/or hypertension.
2. Patients undergoing vascular
surgery who have cardiac ischemia
on preoperative evaluation.
3. Intraoperatively and
postoperatively to maintain a heart
rate of 60 to 65 bpm

8. Preoperative
Evaluation
(Cardiac patient)
 PERIOPERATIVE MANAGEMENT OF
ANTICOAGULATION
 Aspirin : it should be stopped 7 days before surgery.
Resume approximately 24 hours after surgery.
 Warfarin should be stopped 4 to 5 days before surgery
and replaced with heparin or LMWH.
 Unfractionated heparin is stopped 5 hours before
surgery, and low-molecularweight heparin (LMWH) is
stopped 12 to 24 hours before surgery. Unfractionated
heparin or LMWH with warfarin therapy may be restarted
postoperatively once hemostasis has been achieved.
 Clopidogrel should be stopped 7 to 10 days before
surgery.

10. Preoperative
Evaluation
(Diabetic patient)
 KEY FACT
 Poor glycemic control in both the chronic and
acute setting is associated with a higher
incidence of infection and delayed wound
healing.

11. Preoperative Evaluation
(Diabetic patient)

12. Preoperative Evaluation
(other comorbidities)

13. Preoperative Evaluation
(Perioperative Prophylaxis)

14. Postoperative
Care
IMMEDIATE POSTOPERATIVE
PERIOD
Monitor postoperative patients until
cardiopulmonary and neurologic function has
returned to baseline
INTERMEDIATE POSTOPERATIVE
PERIOD
from complete recovery from anesthesia until
discharge from the hospital
CONVALESCENT PERIOD

15. Postoperative
Care
MNEMONIC
Remember postoperative orders: FLAVOR
Fluids
Laboratories
Activity
Vital signs
Oral allowances
Rx (medications)

16. Postoperative
Care
(Intermediate
Postoperative
Period)

17. Postoperative
Fever

18. Pain
Management
Complications of uncontrolled post
operative pain
 Splinting of the diaphragm, which can
lead to reluctance to breathe and can
result in atelectasis and pneumonia.
 Limited mobility, which can lead to
venous stasis and cause DVT.
 Release of catecholamines, leading to
vasospasm and hypertension, causing
stroke, MI, and bleeding.

19. Pain
Management

20. CONVALESCENT
PERIOD
The final postoperative phase
begins when a patient is
discharged from the hospital.
 Visiting/home nursing agencies.
 Physical/occupational therapy.
 Rehabilitation services.
 Wound care specialists.

21. Wound
Management
 WOUND PREPARATION
 Debridement.
 Foreign body removal: Retained foreign bodies
are at risk for developing infection.
 Wound exploration ± radiography or ultrasound
(for radiolucent foreign bodies) is necessary.
 Irrigation: Copious irrigation is important to
adequately clean wound.
 Disinfection: Povidone-iodine may be wound-
toxic and should not be used in an open wound

22. Wound
Management
 WOUND CLOSURE
 Sutures: In healthy patients, the ideal
closure for small superficial wounds (eg,
skin lacerations). Sutures are also used
during surgery to close layers and1tension.
 Staples: A quick and strong closure,
cosmetically acceptable, used for scalp,
torso, and extremities.
 Skin adhesive (eg, Dermabond): Works
like glue. Minimal pain, used for low-
tension wounds.

23. WOUND CARE
 Antibiotic prophylaxis: Consider antibiotics only in high-
risk wounds such as heavily contaminated wounds, animal
and human bites, or immunocompromised patients.
 Tetanus prophylaxis: Give tetanus vaccine to patients
who have not had a three-dose 1° tetanus vaccine series or
whose last tetanus vaccination was >10 years (>5 years if
tetanus-prone wounds).
 Suture removal:
1. Face: 3 to 5 days.
2. Scalp: 5 to 7 days.
3. Trunk/arm/hand: 7 to 10 days.
4. Leg/foot: 10 to 14 days.

24. CAUSES OF
WOUND
DEHISCENC
E

25. Thank you