Perioperative

1. Principles of Pre
and Post Operative
Care in Surgical
Patients
Dr. OM Williams

2. “Surgery is an “indivisible,
indispensable part of healthcare.”
Dr. Jim Yong Kim

3. Access to surgical and anaesthesia care,
which is available, affordable, timely, and
safe to ensure good coverage, uptake, and
outcomes.

4. Global Burden of Disease
• Global burden of surgical disease and unmet
surgical needs
• Indicators: timely access, workforce, surgical
volume, POMR, protection from catastrophic
and impoverishing expenditure
• Targets – POMR30

5. Introduction
• The aim of perioperative care is to ensure the
best outcome for surgical patients.
• Preoperative assessment of the surgical disease
and health status of the patient
• Proper planning of care and requirements to
ensure safety
• Patient education

6. Introduction
• Perioperative care periods
• Surgical patients and mode of
presentation
• Risk factors

7. Risk factors
• Age – extremes of age, chronic disorder
• Cardiovascular disease – MI, hypertension
• Respiratory disease – COPD, Smoking, asthma
• Gastrointestinal and hepatobiliary disease
• Renal disease – acute or chronic
• Haematological disorders

8. Risk factors
• Obesity / underweight
• Risk factors for DVT
• Diabetes Mellitus
• Allergies – drugs, food substances etc
• Medications including alternative medicines
• The surgeon
• Type of procedure

9. Guiding principles
• Establish diagnosis and need for surgery
• Identify risk factors and assess fitness for surgery
• Identify and correct deficiencies / comorbidity
• Assess surgical risk factors
• Assess the capacity and limitation of the system
• Plan and prepare for the appropriate surgery

10. Preoperative Evaluation
• History and Physical examination
• Past medical history
• Investigations:
• Confirm / establish diagnosis
• Assess physiological status
• Assess risk for surgery

11. Existing and past medical
conditions
• DM
• Hypertension
• Cardiovascular disease
• Hepatitis, HIV
• Bleeding diathesis
• Smoking, asthma, COPD

12. Existing and past medical
conditions
• Pregnancy
• Nutritional disorder
• Seizure disorder
• Allergies
• Wound complications – eg keloids
• Previous surgery and anaesthesia - complications

13. Investigations
• Full blood count
• Electrolytes, urea and creatinine
• Urinalysis
• Chest X-ray
• Electrocardiogram
• Viral Screening

14. Preoperative Evaluation
• Evaluate the primary disease and determine the best
mode of treatment
• Identify risk factors and comorbidities and optimize the
outcome of surgery
• Identify surgical requirements including intraoperative
and postoperative care
• Prophylactic measures against common postoperative
complications

15. Preoperative Care
• Nutritional assessment – weight gain, weight loss,
nutrient replacement
• Stop smoking and alcohol intake
• Medications and drug interaction
• Preoperative fasting
• Informed consent for surgery

16. Preoperative Care
• General preparation of the patient for surgery e.g.
shaving
• Estimation of the amount of blood required to cover
the operation
• Assessment of the postoperative course and need for
HDC or intensive care

17. System factors
• Plan, study, rehearse the surgical
procedure
• Ensure the availability of theatre space
• Multidisciplinary team requirements
• System capacity for perioperative care

18. Preoperative Assessment
• American Society of Anesthesiologist
grading (ASA)
• Injury scoring
• Cardiac risk index
• ACS surgical risk calculator
• Clinical risk assessment

19. Intraoperative Care
• WHO surgical safety checklist
• Communication with the anaesthetist
• Adequate surgical access
• Minimize blood loss
• Careful estimation and replacement of fluid and blood
• Good lighting and careful tissue handling
• Be quick but precise

21. Principles of Post operative care
• Fluid management and homeostasis
• Pain relief and early mobilisation
• Antibiotics therapy
• Nutritional management
• DVT prophylaxis

22. Principles of Post operative care
• Prevention and early detection of
complications
• Wound care
• Rehabilitation and return to normal function
• Follow up care and further treatment

23. Post Operative Care
• Recovery room
• Post operative disposition
• Intensive care unit
• HDCU
• Ward
• Discharge home
• Documentation

24. Immediate recovery phase
• Positioning
• Airway
• Oxygen
• Monitoring – GCS, ECG, SaO2, fluid, BP,
CVP
• Pain control

25. Ward Management
• Nutritional management
• Fluid and electrolyte balance
• Adequate pain relief
• Antibiotics
• DVT prophylaxis

26. Ward Management
• Wound care
• Early detection of complications
• Early ambulation
• Further treatment
• Rehabilitation
• Follow up

27. Peri operative Mortality
• Up to 30 days post operation
• Re-operation rate
• Wound complications rate
• Pulmonary complications
• Surgical outcomes