The document discusses the pre-operative preparation of patients for surgery. It describes evaluating patients' medical history and health status, conducting physical examinations and medical tests, assessing surgical risks, providing pre-operative treatments as needed, obtaining informed consent, and explaining the procedure and potential complications to the patient. The goal is to carefully prepare the patient and reduce risks prior to surgery.

2. Pre operative preparations of
patient for surgery.
Prepared by: Elsayed Abdalla Mohamed.
Moderator: DR/ Mohamed Adel.

3. Definition:
Preoperative care is the preparation and
management of a patient prior to surgery. It
includes both physical and psychological
preparation.

4. Aim:
Carefully access the medical condition.
Evaluate the patient’s overall health status.
Determine risk factors against procedures.
Educate the patient.
Discuss procedure in detail.

5. Routine preparation:
History.
Physical examination.
Special investigations.
Assessment Risk of surgery.
Pre operative Treatment.
Informed consent.

6. History
 A complete history and physical should be
obtained at least 1 week before the scheduled
surgery for patients who have significant
medical conditions.1. Presenting
complaint.
2. Systemic
assessment.
3. Past Medical and
Surgical history.

7. 4. Drug and Allergic History.
• Interaction with anesthesia (MAOI).
• Related with sudden withdrawal (Steroids).
• Drugs foe HTN , IHD to be continued over perioperative period.
• Anti coagulant drugs.
• HRT.

8. 5. Family History.
6. Social History.

9. Physical
Examination:
1. General.
2. Systemic.
3. Specific
surgical.
4. Specific
Medical.

10. • Aims to confirm previous
findings , diagnosis.
• To determine severity
and extent.
Specific
Surgical Ex
• Aims to evaluate the presence
and severity of other
problems.
• Diabetic patient need careful
examination for sepsis ,
Specific
Medical Ex

12. Pre operative
Investigations
Medico Legal
considerations
Confirmati
on of
diagnosis
Assessment
of fitness of
surgery
To know
extent of
disease
Exclusion
of alternate
diagnosis
Risk to
Others

13. Pre operative Investigations:

16. Chest X-RAY
1. All elective pre operative cases
over 60 years.
2. All cases of cervical , thoracic ,
abdominal trauma.
3. Acute Respiratory symptoms or
signs.
4. Previous CRD and no recent
chest x-ray.

17. 5. Thoracic surgery.
6. Malignant disease.
7. Viscous perforation.
8. Recent h/o TB .
9. Thyroid Enlargement.

18. Electrocardiogram
Within 12 weeks of surgery for patient with known Cardiac
Disease.
Within 6 months prior to surgery for all patients > 50 years.

19. Other Investigations:
Performed according to requirement.
Ultrasound.
C.T Scan.
MRI.

22. Assessment of Risk of surgery
 There are few patients who have
no risk of surgery.
 It is important to quantify the risks
involved so they will be discussed
with the patient.
 Two main prognostic scoring
systems which are in current use
APACHE System.
ASA System.

23. APACHE System.
Acute Physiology And Chronic Health Evaluation.
Helps to predict the outcome of patients admitted to ICU
and has subsequently been applied to patients
undergoing surgery.

24. APACHE II Classification.
Score is A+B+C
A(Acute Physiology Score)
1. Recent
Temperature
2. MBP
3. HR
4. RR
5. FiO2
6. PH
7. Serum Na
8. Serum K
9. Serum Creatinine
10. WBC
11. Hematocrite %
12. GCS

25. B (Age points)
Graded from <44 to <75

26. C (Chronic Health Problems).
2 points for
elective post-op
admission.
5 points for emergency op, non operative admission,
Immunocompromised patients , CVD , Respiratory or Renal
disease.
APACHE II score = acute physiology score + age points + chronic health points.
Minimum score = 0; maximum score = 71. Increasing score is associated with
increasing risk of hospital death.

27. ASA System.
American Society Of Anesthesiologists
It is very simple and widely accepted.
50% of patients presenting for elective surgery in
ASA Gr I
Operative mortality rate for these patients is less than
1 in10000.

28. ASA Grading and Predictive Mortality.
ASA Grade Definition Mortality%
I Normal Healthy Individual. 0.06
II Mild systemic disease that doesn't
limit the activity.
0.4
III Sever systemic disease that limit the
activity.
4.5
IV Sever systemic disease that is
constant threat to life.
23
V Moribund , not expected to survive 24hrs
with or without surgery
51

30. Pre operative Treatment.
Antibiotics.
Should be at peak level when surgery starts.
Transfusion.
Nutrition.
Thromboembolic prophylaxis.

31. Prophylactic
antibiotics
depend on
The most likely pathogen
encountered
Class of operative
procedure
Class I
Class II
Class III
Class IV

32. Class I
(Clean)
Don’t require antibiotic prophylaxis, except in
cases of indwelling prosthesis placement or
bone incision.
Class II
(Clean Contaminated)
Only single pre operative prophylactic dose.
Class III
(Contaminated)
&
Class IV
(Dirty)
Mechanical preparation plus parenteral
antibiotics with aerobic and anaerobic cover.

33. Prophylactic Antibiotics.
 The commonest infective organism is Staphylococcus aureus .
 Most used Broad Spectrum Antibiotics ,
To cover S. aureus , streptococci and anaerobes.
 Prophylactic Antibiotics best administrated just prior to induction.

35. Anemia & Blood
Transfusion
Pre operative
Transfusion
should be
considered if
major blood loss
is anticipated
during surgery
or if Hb% <8
g/dl.

36. Malnutrition:
Malnourished patient is at high risk of
morbidity and mortality following surgery.
Nutritional support is required for a minimum
of 2 weeks prior to surgery.

37. • Malabsorption overcome by vitamins and enzymes while
obstructive conditions
N/G feeding , IV fluids ,Surgical bypass , Formal
Enterostomy.

38. Thromboembolic prophylaxis
DVT is common in surgical patients.
Can cause PE which carries a high mortality.

40. Pre operative Fasting:
 Due to risk of perioperative pulmonary aspiration of gastric contents that
may result in morbidity or mortality.
 Patients are often told not to eat after midnight.
 The reasons for fasting should be explained to the patient. Not only is
there an increased risk of nausea and vomiting postoperatively, there is
the risk of regurgitation and pulmonary aspiration, which can have very
serious consequences.

41. Informed Consent.
Stages:-
I. Preparation.
II.Explanation.
III.Competence.
IV.Closure.

42. I. Preparation.
A. Introduction
Your name.
Patient name.
Explain what are you doing & by which authority.
B. Background
Check what patient knows.
Explore how much he/she actually want to know.

43. II. Explanation.
A)What is wrong
• Explain the
diagnosis in
simple language.
B)Action
• What is the
proposed action??
• Is it differ from
national or other
guidelines??
• Justify.
C)Outcome
• Describe the likely
short and long
outcome.
D)Choices
• Describe all viable
choices.

44. E)Complications:-
• Explain in clear language all serious complications
& those with risk>1%.
• Describe the actions that will be taken to prevent
them.
• Explain how they will be managed if occur.

45. • Make it clear that the final
decision is the patient’s
alone.
• Give the patient time to think
about the decision.
F) Right
of
Refusal

46. III. Competence.
 Check the ability of patient to take in , retain , consider the
information provided and articulate the decision.
 Can be achieved by recording the patient’s answers to the
questions.
(Tell me what you have understood).

47. IV. Closure.
a) Open Question:
e.g. (Is there
anything else
you would like
to discuss??).
b) Record:
Record & write
everything was
discussed &
what was
agreed.