The document discusses the preoperative management of surgical patients. It outlines the goals of the preoperative period which include obtaining a medical history, optimizing the patient's condition, choosing an appropriate surgery, planning for potential adverse events, and informing all relevant parties. The preoperative workup varies between procedures and patients but aims to identify those at risk of morbidity and mortality to allow for further evaluation and informed consent discussions. Special preparations may be needed depending on the surgery, such as scans or medical treatments. Factors like diabetes, age, thrombosis risk, infection risk, and nutrition are evaluated and managed to optimize the surgical outcome.

1. preoperative management of surgical patient
Presented by :
Aya El-Gendy
assistant lecturer surgical oncology

2. • Preoperative period :
Def
Types
Aim = Plan
1 – History : record information
2 - Optimize patient condition
3 - Choose surgery
4 - plan for adverse events
5- Inform everyone concerned

3. • There is no “standard” preoperative workup that fits all
patients.
• Each procedure and each patient have their own unique
needs with regard to preoperative preparation
• Identify patients with the risk of morbidity and mortality
for further evaluation and discussions re
garding informed consent.

5. Special preparation :
• Thyroid surgery; : IL .
• Parathyroid surgery : sestamibi scan
• Sentinel node biopsy : radioactive marker/
patent blue dye.
• Pheochromocytoma surgery; will need alpha
and beta blockade
• Colorectal cases; bowel preparation

6. ●. Preoperative Concern :
Diabetes :
Diabetic patients have greater risk of complications.
Poorly controlled diabetes carries high risk of wound infections.
Diabetic cases should be operated on first.
Elderly Patients :
Comprehensive geriatric assessment
Frailty : Lack of physiologic reserve

7. •

8. Deep venous thrombosis:
• Pulmonary embolism
Mechanical thromboprophylaxis:
• • Early ambulation after surgery is cheap and is effective
• • Compression stockings (contra -indicated in peripheral
arterial disease)
• • Intermittent pneumatic compression devices
• • Foot impulse devices
Therapeutic agents
Unfractionated heparin and LMWH

11. Prophylactic systemic antibiotics
• prophylactic antibiotics be given 30-60 minutes prior
to the time of incision.
Not indicated for elective, clean cases due to the low
risk of infection.
For clean-contaminated cases, where organs such
as those of the genitourinary or gastrointestinal
tracts may be entered, or in emergency cases.

12. PERIOPERATIVE NUTRITIONAL MANAGEMENT
• Malnutrition is a common issue in cancer patients
wound healing and development of post-operative infections
and increases length of stay.
Patients identified as being malnourished
• • BMI < 18.5 kg/m2
• • unintentional weight loss of > 10% over 3-6/12
• • BMI < 20 kg/m2 and unintentional weight loss of > 5% over 3-
6/12
AT RISK of malnutrition
• • Eaten nothing or little > 5 days, who are likely to eat little for a
further 5 days
• • Poor absorptive capacity
• • High nutrient losses

13. • Enteral nutrition is generally considered the preferred
route for nutritional support in patients with functioning
GI tracts.
Patients with low or intermediate levels of malnutrition
can be considered for preoperative nutritional
supplements.
Preoperative full nutritional support remains controversial
and is generally only considered in patients with severe
malnutrition. These patients should receive 7 or more days
of enteral or parenteral nutrition prior to surgery.