The document outlines the procedures and considerations for preoperative and postoperative assessments in surgical patients. It emphasizes the necessity of thorough medical evaluations to ensure patient safety and readiness for surgery, detailing various medical histories, medication management, and potential complications. Postoperative care is also covered, focusing on monitoring, pain management, and addressing complications to ensure recovery and discharge readiness.

1. Zaid Azhar
2017-097
PREOPERATIVE AND
POSTOPERATIVE
ASSESSMENT

2. • Pre-op assessment Slides 1-16
• Post-op assessment Slides 21-32
Content

3. When patient is seen at clinic, the
doctor deciding their need for an
operation thinks they need to be
seen in the pre-op setting to ensure
the patient’s readiness for theatre.
Who goes for pre-operative assessment?

4.  Identify patient’s medical problems
 Check if further information is
needed to characterize patient’s
medical status
 Establish if patient’s condition is
medically stable
 Confirm appropriateness of the
planned procedure
 Establish plan to minimize risk to the
patient
Goals of Pre-Op Assessment

5. • History
• Examination
• Investigations
• Consent
What’s included in the Pre Op assessment?

6.  History of Presenting Complaint
 Past medical history
 Past surgical history
 Family history of disease
 Social history/substance abuse
 Medication
 Drug allergy
 Past Anesthetic history
History

7.  Year
 Procedure
 Type of Anesthesia
 Complications e.g DVT, MRSA
wound infection.
Past surgical history

8.  Smoking
 Alcohol
 Substance abuse
 IV abuse - screening for HBV,
HCV, HIV
Social History

9. Drugs that may cause concern:
 Warfarin
 Aspirin - stop at least 10 days pre-
operatively
 OCP
 DVT
 Pulmonary Embolism
 Discontinue 6 weeks before surgery
 Steroids-dependent patients will need
hydrocortisone injection to over come
peri-operative stress.
 Immunosuppression
 Diuretics
 Electrolyte imbalance
Medication

10.  Take history of any
reaction in the past or in
family history
 Consider allergy to:
 Anesthetics
 Antimicrobial Drugs
 Antiseptics e.g iodine
 Wound dressings
Drug Allergy

11. • Difficult intubation
• Aspiration during anesthesia
• Psedocholinesterase deficiency
• Scoline apnea
• Malignant Hyperthermia
Past anesthetic history

12.  BMI
 GPE
 Vitals
 Pulse
 Blood pressure
 Temperature
 Respiratory rate
 CVS, RES, CNS
 Intubation
 Mallampati score
 Dentition
 Neck movement
 TMJ movement
Examinations

13.  Cormack-Lehane grade Mallampati score
Ease of intubation

14. ASA scoring system

15.  Information : patient should
be aware of his surgeon, staff
and procedure
 Teamwork: Operative team
should be on the same page
 Recording information: all
important information should
be recorded clearly in the
patient notes
Communication

16. • Antibiotics
• Transfusion
• Nutrition
• Thromboprophylaxis
Preoperative treatment

17. Cases

18.  Aspirin
• Some surgeons don’t mind
patient being on Aspirin, call
registrar if unsure. If clopidogrel,
MUST stop
• Will need eG+H, often bleed +++
 CPAP
• Will need to bring in her machine
or book a bed in RCU  may
need recent RFTs
 Radiology
• need recent films. If knee
replacement, needs long leg views
as well as AP, lat and skyline.
• 70 F for right total knee
replacement
• Hx
• On aspirin for TIAs
• HTN, COPD, on CPAP
• Radiology is over 1 year old
• What do we need to think about
for this patient?
Case 1

19. • Type 1 diabetic
• On insulin, CANNOT stop it
• Patient will be fasting, not good
for a type 1
• Will need bowel prep.
• Likely will need admission the
night before or morning of
procedure for insulin/dextrose
infusion to control BSLs
• 25 F for colonoscopy
• Hx
• Type 1 DM
• What do we have to think
about for this patient?
Case 2

20. • Warfarin
• Will need to be stopped as
bleeding is high risk
• Will need to continue
theraputic clexane due to metal
heart valve
• Need a clear plan on stopping
and restarting warfarin.
• 80 M for excision lower leg
SCC
• Hx
• On warfarin
• Mitral valve replacement
• What do we need to think
about this patient?
Case 3

21. Post operative assessment

22. • Postoperative care is the management
of a patient after surgery. This includes
care given during the immediate
postoperative period, both in the
operating room and post anesthesia
care unit (PACU), as well as during the
days following surgery.
• The post operative period begins from
the time the patient leaves the
operating room and ends with the
follow up visit by the surgeon.
Post-operative care

23.  Care of the surgical patient who has been
transferred from the Phase I post op unit
 Patient requiring less observation and
less nursing care than Phase I
 This phase is also known as Step down or
progressive care unit
• It is the immediate recovery phase and
requires intensive nursing care to detect
early signs of complication
• Receive a complete patient record from
the operating room which to plan post
operative care
• Designated for care of surgical patient
immediately after surgery and patient
requiring close monitoring
Post Op Period

24. • Clinical assessment and
monitoring
• Respiratory management
• Cardiovascular management
• Renal Management (urine
output)
• Fluid and electrolyte balance
• Control of sepsis
• Nutrition
Post op care instructions

25. Immediate post-operative assessment

26. • Assess the patient’s:
i. Pulse
ii. BP
iii. Temperature
iv. RR
v. Oxygen saturation
vi. Level of
consciousness
Immediate post-operative assessment

28. • Analgesia relieves suffering
• Inadequately controlled pain increases
sympathetic outflow, leading to an increase
HR, vasoconstriction and increased O2
demand, particularly in the myocardium and
may contribute to MI
• Pain (from e.g. abdominal and thoracic
procedures) may impair Respiratory function
leading to atelectasis/Pneumonia
• Good analgesia allows for rehabilitation
Post Op Analgesia

29. Paracetamol
 Should be given regularly, oral,
rectal or IV
NSAIDs
 Used as adjuncts, Increase
efficacy and reduce opioid use
 Can affect haemostasis and
renal function gastric ulceration
Opioids
 Gold standard in severe pain
Post Op Analgesia

30. • Cardiovascular complications
• Postoperative pulmonary dysfunction
• Aspiration
• Postoperative renal complications
• Metabolic complications
• Electrolytes and glucose imbalance
• Miscellaneous complications
Complications

31. • Local complications
• Skin blisters/ bed sores
• Muscle tear and atrophy
• Tendon tear, tendinitis
• Nerve compression and neuritis
• Vascular injury
• Bone malunion
• Contractures
• General complications
• Shock
• DVT
• Tetanus
• Gas gangrene
• Fever
• Fat embolism
• Delerium tremors
Post operative complications

32. When is the patient discharged?