1. The document discusses perioperative care and postoperative complications. It covers topics like preoperative evaluation and management of common medical conditions, intraoperative care, and postoperative care and complications.
2. Preoperative evaluation involves assessing the patient's history and risk factors, performing examinations, and optimizing any medical conditions to reduce surgical risk. Intraoperative care focuses on monitoring the patient, maintaining homeostasis, and using sterile techniques.
3. Common postoperative complications discussed include bleeding, deep vein thrombosis, pulmonary embolism, wound infections, and respiratory issues like pneumonia. The goal of postoperative care is to provide a safe and comfortable recovery for the patient.
General Preoperative &Postoperative Care of Surgical PatientsOmarAlaidaroos3
1. Preoperative evaluation and preparation of surgical patients involves a thorough history, physical exam, appropriate diagnostic testing, counseling and informed consent obtaining, optimization of medical conditions, and NPO status prior to surgery.
2. Intraoperative care focuses on anesthetic management and monitoring while postoperative care aims to monitor for complications, manage pain and encourage early mobilization through actions like incentive spirometry.
3. Common complications assessed and managed in the postoperative period include respiratory issues like atelectasis and pneumonia, infections, thromboembolic events, and other surgery-specific complications.
The document discusses different aspects of pre-operative patient care including:
1. The pre-operative period involves evaluating and preparing the patient prior to surgery through obtaining medical history, conducting examinations, reviewing lab results, assessing physical and psychological needs, obtaining informed consent, and providing patient education.
2. Key parts of pre-operative evaluation and preparation include developing a pre-operative plan, taking a thorough medical history, conducting a focused physical exam, ordering relevant tests and labs, addressing any comorbidities, and discussing the planned surgery and post-operative expectations with the patient to obtain informed consent.
3. The goals are to optimize the patient's condition for surgery, identify any issues that could impact the procedure,
The document discusses preoperative, intraoperative, and postoperative care for a patient undergoing surgery. In the preoperative stage, patients undergo assessments of their medical history and comorbidities, labs and tests are ordered to optimize the patient's health status, and the surgical plan is arranged. Intraoperatively, strict infection control protocols are followed and checklists are used to ensure safety. Postoperatively, patients are monitored, complications are prevented, and care is documented before discharge. The overall goal is to safely prepare the patient for surgery, perform the procedure, and provide care during recovery.
Preoperative preparation involves optimizing a patient's condition before surgery through assessment, investigation, and management of medical conditions. It is a multidisciplinary process involving surgeons, anesthesiologists, nurses, and other staff. Through history, examination, investigations, and treatment, the goals are to evaluate fitness for surgery, minimize risks, plan logistics, and obtain consent. Special considerations include managing medications, timing of fasting, and arranging the operating schedule. With thorough preparation, surgical risks and recovery times can be reduced.
The document establishes guidelines for proper documentation in medical records to ensure effective communication between healthcare professionals and compliance with legal responsibilities, noting that orders must be clear, concise, organized, legible, and evaluated regularly for changes in patient condition. It outlines the roles and responsibilities of various professionals who can accept and document patient care orders, and provides standards for ensuring orders are appropriate, reasonable, and promptly questioned if issues arise.
preoperative preparation and postoperative care Sabrina AD
The document discusses preoperative preparation and postoperative care. It covers patient assessment, risk assessment and consent, arranging the theatre list, preoperative problems and referrals, and management of specific medical conditions like cardiovascular disease, respiratory disease, gastrointestinal disease, genitourinary disease, endocrine disorders, and more. The goal is to optimize patients medically, identify and address risks, and ensure safe surgery.
This document outlines preoperative care for gynecologic patients. It discusses preoperative evaluation including obtaining a comprehensive medical history, physical examination, anesthesiology examination, and necessary investigations. Preoperative preparation is also covered, such as correcting anemia, smoking cessation, medical consultation, bowel preparation, use of antibiotics and thromboprophylaxis. The goal of preoperative care is to avoid or minimize both intra- and postoperative complications and enable a successful surgical outcome.
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
General Preoperative &Postoperative Care of Surgical PatientsOmarAlaidaroos3
1. Preoperative evaluation and preparation of surgical patients involves a thorough history, physical exam, appropriate diagnostic testing, counseling and informed consent obtaining, optimization of medical conditions, and NPO status prior to surgery.
2. Intraoperative care focuses on anesthetic management and monitoring while postoperative care aims to monitor for complications, manage pain and encourage early mobilization through actions like incentive spirometry.
3. Common complications assessed and managed in the postoperative period include respiratory issues like atelectasis and pneumonia, infections, thromboembolic events, and other surgery-specific complications.
The document discusses different aspects of pre-operative patient care including:
1. The pre-operative period involves evaluating and preparing the patient prior to surgery through obtaining medical history, conducting examinations, reviewing lab results, assessing physical and psychological needs, obtaining informed consent, and providing patient education.
2. Key parts of pre-operative evaluation and preparation include developing a pre-operative plan, taking a thorough medical history, conducting a focused physical exam, ordering relevant tests and labs, addressing any comorbidities, and discussing the planned surgery and post-operative expectations with the patient to obtain informed consent.
3. The goals are to optimize the patient's condition for surgery, identify any issues that could impact the procedure,
The document discusses preoperative, intraoperative, and postoperative care for a patient undergoing surgery. In the preoperative stage, patients undergo assessments of their medical history and comorbidities, labs and tests are ordered to optimize the patient's health status, and the surgical plan is arranged. Intraoperatively, strict infection control protocols are followed and checklists are used to ensure safety. Postoperatively, patients are monitored, complications are prevented, and care is documented before discharge. The overall goal is to safely prepare the patient for surgery, perform the procedure, and provide care during recovery.
Preoperative preparation involves optimizing a patient's condition before surgery through assessment, investigation, and management of medical conditions. It is a multidisciplinary process involving surgeons, anesthesiologists, nurses, and other staff. Through history, examination, investigations, and treatment, the goals are to evaluate fitness for surgery, minimize risks, plan logistics, and obtain consent. Special considerations include managing medications, timing of fasting, and arranging the operating schedule. With thorough preparation, surgical risks and recovery times can be reduced.
The document establishes guidelines for proper documentation in medical records to ensure effective communication between healthcare professionals and compliance with legal responsibilities, noting that orders must be clear, concise, organized, legible, and evaluated regularly for changes in patient condition. It outlines the roles and responsibilities of various professionals who can accept and document patient care orders, and provides standards for ensuring orders are appropriate, reasonable, and promptly questioned if issues arise.
preoperative preparation and postoperative care Sabrina AD
The document discusses preoperative preparation and postoperative care. It covers patient assessment, risk assessment and consent, arranging the theatre list, preoperative problems and referrals, and management of specific medical conditions like cardiovascular disease, respiratory disease, gastrointestinal disease, genitourinary disease, endocrine disorders, and more. The goal is to optimize patients medically, identify and address risks, and ensure safe surgery.
This document outlines preoperative care for gynecologic patients. It discusses preoperative evaluation including obtaining a comprehensive medical history, physical examination, anesthesiology examination, and necessary investigations. Preoperative preparation is also covered, such as correcting anemia, smoking cessation, medical consultation, bowel preparation, use of antibiotics and thromboprophylaxis. The goal of preoperative care is to avoid or minimize both intra- and postoperative complications and enable a successful surgical outcome.
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
The document discusses the Surgical Intensive Care Unit (SICU), describing it as a tertiary care facility that provides critical care to unstable, severely ill surgical patients requiring constant monitoring and emergency interventions. Anesthesiologists and surgeons play major roles in the SICU by managing airways, ventilation, resuscitation, and monitoring patients with critical illnesses or injuries. The document outlines patient admission criteria and monitoring, discharge criteria, and the roles and communication between intensivists and surgeons in managing and caring for patients in the SICU.
1) Pre-operative evaluation and preparation is important to assess patient risk and optimize their health status prior to surgery. It involves diagnostic testing, assessing any medical conditions, and preparing the patient with things like diet, medication adjustments and consent.
2) Post-operative care begins during surgery and involves close monitoring in the recovery room and ICU if needed to watch for complications like bleeding, infection and instability in vital functions. Patients are monitored and treated according to individualized post-op orders tailored to their procedure and needs.
3) Careful pre-operative and post-operative management can help avoid unnecessary risks and complications for patients undergoing even elective surgical procedures.
Post operative-care,gynecology and obstetriczaid rasheed
Pre and postoperative care involves careful preparation and management of patients before and after surgery. Preoperative care includes patient education, assessments, preparation through managing medications and comorbidities, and thromboprophylaxis. Immediate postoperative care focuses on monitoring in PACU until stable for discharge. Intermediate care involves continued monitoring on the ward. Post-cesarean and post-gynecological operation care follow specific guidelines around monitoring, wound care, and managing potential complications. Care aims to enable safe and fast recovery.
The document contains 24 multiple choice questions about medical surgical nursing. The questions cover topics like appropriate nursing interventions, nursing diagnoses, physiological responses to surgery, medication administration, diet recommendations, and quality improvement processes. The questions test understanding of concepts important for medical surgical nursing practice.
PERIOPERATIVE MANAGEMENT OF COVID 19 SUSPECT/ CONFIRMED PATIENTBhagwatiPrasad18
These recommendations are based on recent guidelines and protocols followed in major hospitals in India and also from recent articles published online. This cannot be taken as final. Guidelines will be updated from time to time.
Watch this presentation in laptop/ pc as slideshow for beautiful animations.
This document provides guidance on perioperative assessment for a patient undergoing hernia repair surgery who has diabetes and is on warfarin. It outlines steps to evaluate the patient, including taking a history and physical, performing diagnostic testing, and considering specific medical factors like diabetes, anticoagulation, and cardiovascular status. Evaluation ensures the patient's medical status is optimized and surgery is appropriate. It also provides recommendations for managing the patient's diabetes and anticoagulation in the perioperative period.
Management Of Patient Undergoing Surgerykalyan kumar
The document discusses the management of patients undergoing surgery. It covers the three main phases of surgical management: pre-operative, intra-operative, and post-operative management. For pre-operative management, the document outlines the physical, psychosocial, physiological preparations and assessments a patient undergoes before surgery including examinations, investigations, pre-medications. It then briefly describes the roles of the surgical team during intra-operative management. Finally, it discusses the immediate post-operative recovery phase in PACU and management of common post-operative complications.
This document provides guidance on preoperative preparation for general surgery patients. It discusses defining the preoperative period, objectives of preoperative assessment, types of patients, principles of history taking and medical examination, common investigations, optimizing medical conditions, obtaining consent, and organizing the operating theatre list. The key aspects of preoperative preparation covered include gathering relevant patient information, assessing and optimizing the patient's medical status, anticipating and planning for risks, and informing all parties involved in the patient's care.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
1. Preoperative preparation aims to optimize the patient's condition for surgery and postoperative recovery through relevant medical assessments, investigations, and risk optimization within available time windows prior to surgery.
2. The preoperative evaluation involves a thorough patient history, clinical examination, risk assessment, and appropriate investigations to address any medical optimization needs and inform patient consent for surgery.
3. Effective preoperative preparation requires coordination between the surgical team, nursing staff, anesthesiology team, and other specialists to arrange the operating list, ensure necessary equipment and staffing, and prepare high-risk patients such as those with obstructive jaundice or bleeding disorders.
Two years before surgery, the surgeon must prepare themselves through skills training, observing other surgeons, and ensuring the operating room (OR) and team are ready. One week before, the surgeon confirms the indication for surgery, reviews contraindications and counsels the patient. The day before, the patient receives instructions and the surgeon ensures the OR and team are prepared. On the day of surgery, the surgeon obtains consent, checks equipment and the anesthetized patient is brought to the OR. Special considerations are discussed for obese, pregnant and high risk patients.
Treatment aspects : Pre/Post Operative Care & Pharmacological AspectsKHyati CHaudhari
This document discusses various aspects of pre-operative care for patients undergoing surgery. It covers obtaining informed consent, assessing patient health factors like nutrition and medications, and providing pre-operative education. Key areas of focus include getting consent, evaluating respiratory, cardiac, and immune function, reviewing medications, and addressing psychosocial concerns. The goal is to optimize patient health and prepare them physically and emotionally for surgery.
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.
The document discusses blood transfusion, blood products, and safety protocols. It covers the components of blood including red cells, plasma, and platelets. It outlines the shelf life of different blood products and storage considerations. The document details eligibility requirements for blood donors and transfusion rules. It explains blood typing, matching blood to patients, and monitoring patients during transfusions. Key safety protocols for administering blood components and managing potential transfusion reactions are also summarized.
Preoperative preparations by Dr.Syed Alam ZebSyed Alam Zeb
The document discusses the role of the surgeon in preoperative patient preparation. It outlines the steps involved which include taking a history, performing examinations and required investigations, providing preoperative treatments, ensuring proper communication, and obtaining informed consent. Various types of examinations, common investigations, preoperative treatments for different medical conditions, and elements of the informed consent process are described in detail.
This study aims to compare postoperative mortality rates between diabetic and non-diabetic patients undergoing emergency laparotomy. 60 patients undergoing emergency laparotomy were divided into two groups - Group A consisted of 30 diabetic patients and Group B consisted of 30 non-diabetic patients. Various preoperative, intraoperative and postoperative factors were studied. Postoperative mortality, complications and their management were compared between the two groups.
The document discusses the Surgical Intensive Care Unit (SICU), describing it as a tertiary care facility that provides critical care to unstable, severely ill surgical patients requiring constant monitoring and emergency interventions. Anesthesiologists and surgeons play major roles in the SICU by managing airways, ventilation, resuscitation, and monitoring patients with critical illnesses or injuries. The document outlines patient admission criteria and monitoring, discharge criteria, and the roles and communication between intensivists and surgeons in managing and caring for patients in the SICU.
1) Pre-operative evaluation and preparation is important to assess patient risk and optimize their health status prior to surgery. It involves diagnostic testing, assessing any medical conditions, and preparing the patient with things like diet, medication adjustments and consent.
2) Post-operative care begins during surgery and involves close monitoring in the recovery room and ICU if needed to watch for complications like bleeding, infection and instability in vital functions. Patients are monitored and treated according to individualized post-op orders tailored to their procedure and needs.
3) Careful pre-operative and post-operative management can help avoid unnecessary risks and complications for patients undergoing even elective surgical procedures.
Post operative-care,gynecology and obstetriczaid rasheed
Pre and postoperative care involves careful preparation and management of patients before and after surgery. Preoperative care includes patient education, assessments, preparation through managing medications and comorbidities, and thromboprophylaxis. Immediate postoperative care focuses on monitoring in PACU until stable for discharge. Intermediate care involves continued monitoring on the ward. Post-cesarean and post-gynecological operation care follow specific guidelines around monitoring, wound care, and managing potential complications. Care aims to enable safe and fast recovery.
The document contains 24 multiple choice questions about medical surgical nursing. The questions cover topics like appropriate nursing interventions, nursing diagnoses, physiological responses to surgery, medication administration, diet recommendations, and quality improvement processes. The questions test understanding of concepts important for medical surgical nursing practice.
PERIOPERATIVE MANAGEMENT OF COVID 19 SUSPECT/ CONFIRMED PATIENTBhagwatiPrasad18
These recommendations are based on recent guidelines and protocols followed in major hospitals in India and also from recent articles published online. This cannot be taken as final. Guidelines will be updated from time to time.
Watch this presentation in laptop/ pc as slideshow for beautiful animations.
This document provides guidance on perioperative assessment for a patient undergoing hernia repair surgery who has diabetes and is on warfarin. It outlines steps to evaluate the patient, including taking a history and physical, performing diagnostic testing, and considering specific medical factors like diabetes, anticoagulation, and cardiovascular status. Evaluation ensures the patient's medical status is optimized and surgery is appropriate. It also provides recommendations for managing the patient's diabetes and anticoagulation in the perioperative period.
Management Of Patient Undergoing Surgerykalyan kumar
The document discusses the management of patients undergoing surgery. It covers the three main phases of surgical management: pre-operative, intra-operative, and post-operative management. For pre-operative management, the document outlines the physical, psychosocial, physiological preparations and assessments a patient undergoes before surgery including examinations, investigations, pre-medications. It then briefly describes the roles of the surgical team during intra-operative management. Finally, it discusses the immediate post-operative recovery phase in PACU and management of common post-operative complications.
This document provides guidance on preoperative preparation for general surgery patients. It discusses defining the preoperative period, objectives of preoperative assessment, types of patients, principles of history taking and medical examination, common investigations, optimizing medical conditions, obtaining consent, and organizing the operating theatre list. The key aspects of preoperative preparation covered include gathering relevant patient information, assessing and optimizing the patient's medical status, anticipating and planning for risks, and informing all parties involved in the patient's care.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
1. Preoperative preparation aims to optimize the patient's condition for surgery and postoperative recovery through relevant medical assessments, investigations, and risk optimization within available time windows prior to surgery.
2. The preoperative evaluation involves a thorough patient history, clinical examination, risk assessment, and appropriate investigations to address any medical optimization needs and inform patient consent for surgery.
3. Effective preoperative preparation requires coordination between the surgical team, nursing staff, anesthesiology team, and other specialists to arrange the operating list, ensure necessary equipment and staffing, and prepare high-risk patients such as those with obstructive jaundice or bleeding disorders.
Two years before surgery, the surgeon must prepare themselves through skills training, observing other surgeons, and ensuring the operating room (OR) and team are ready. One week before, the surgeon confirms the indication for surgery, reviews contraindications and counsels the patient. The day before, the patient receives instructions and the surgeon ensures the OR and team are prepared. On the day of surgery, the surgeon obtains consent, checks equipment and the anesthetized patient is brought to the OR. Special considerations are discussed for obese, pregnant and high risk patients.
Treatment aspects : Pre/Post Operative Care & Pharmacological AspectsKHyati CHaudhari
This document discusses various aspects of pre-operative care for patients undergoing surgery. It covers obtaining informed consent, assessing patient health factors like nutrition and medications, and providing pre-operative education. Key areas of focus include getting consent, evaluating respiratory, cardiac, and immune function, reviewing medications, and addressing psychosocial concerns. The goal is to optimize patient health and prepare them physically and emotionally for surgery.
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.
The document discusses blood transfusion, blood products, and safety protocols. It covers the components of blood including red cells, plasma, and platelets. It outlines the shelf life of different blood products and storage considerations. The document details eligibility requirements for blood donors and transfusion rules. It explains blood typing, matching blood to patients, and monitoring patients during transfusions. Key safety protocols for administering blood components and managing potential transfusion reactions are also summarized.
Preoperative preparations by Dr.Syed Alam ZebSyed Alam Zeb
The document discusses the role of the surgeon in preoperative patient preparation. It outlines the steps involved which include taking a history, performing examinations and required investigations, providing preoperative treatments, ensuring proper communication, and obtaining informed consent. Various types of examinations, common investigations, preoperative treatments for different medical conditions, and elements of the informed consent process are described in detail.
This study aims to compare postoperative mortality rates between diabetic and non-diabetic patients undergoing emergency laparotomy. 60 patients undergoing emergency laparotomy were divided into two groups - Group A consisted of 30 diabetic patients and Group B consisted of 30 non-diabetic patients. Various preoperative, intraoperative and postoperative factors were studied. Postoperative mortality, complications and their management were compared between the two groups.
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Perioperative & post operative Care
1. 1
DEBRE BIRHAN UNIVERSITY
COLLEGE OF MEDICINE
Perioperative care & postoperative complicaton
By Zelalem Mekonnen (C-II)
Shegaw Merkebu (C-II)
Modulator: Dr.Addis (G. Surgeon)
September 2015 E.C
2. Outline
2
Patient evaluation/assessment: Hx + P/E+ Ix + Dx
Specific preoperative problems and their management
Fitness assessment
Obtaining consent
Wrong person, site, procedure prevention
Psychological preparation
Documentation.
How to recognise and treat common postoperative complications
3. Introduction
3
Perioperative care: is the process of making sure that a
surgical patient will be safe during the perioperative period by
understanding the patient's risk & optimizing the outcome.
Perioperative care: Preoperative + Intraoperative +
Postoperative cares.
Any problems should be treated if possible
4. 4
Preoperative care can be conducted during:
Outpatient office visit
Hospital inpatient consultation
Emergency department evaluation of a patient
5. 5
Approaches to preoperative care
Elective patients all possible medical problems should be
identified & optimized before surgery.
Critically ill/ Emergency patients only continuous resuscitation on
the way to theatre may be the only possible care .
6. 6
Goals of preoperative care:
Gather & record concisely all relevant information.
Comorbidity management plan (to minimize the risk & maximize the
benefit for the patient)
Consider possible complications (to reduce perioperative morbidity &
mortality).
Communicate the surgical plan & ensure that everyone (including the
patient) understands it
7. Preoperative evaluation
7
The aim is not to screen for undiagnosed disease.
Focus on comorbidity that affects operative outcome
The detail of the evaluation is determined by:
The planned procedure (low, medium, or high risk)
The planned anesthetic technique
8. 8
History taking
Do not assume that the history has already been adequately
covered previously.
Look for overlooked or new onset symptoms and signs.
Ask for
Medical conditions & risk factors.
Surgical conditions & risk factors.
Personal or family history of anesthesia-related
complications.
9. 9
Physical Examination:
A general PE should be performed.
Possible DDxs should be excluded.
Weight for managing the postoperative fluid balance.
10. 10
Investigations
Most hospitals use Protocols for all elective or emergency cases.
In general:
Chemistries & Hgb/ Hct ≤ 1 month are acceptable ( in the stable
situation).
Coagulation studies ≤ 1 week are acceptable.
ECG & CXR ≤ 6 months need not be repeated (unless there is
change in status).
ECG is routinely obtained, especially all patients older than 50 yrs.
11. Standard preoperative considerations
11
Medical mgt of comorbidities.
Blood loss preparation.
Smoking cessation.
Surgical site infection prevention.
Anesthesia fitness
assessment.
Informed consent.
Scheduling for OR
Wrong person, site,
procedure prevention.
Psychological preparation.
12. SPECIFIC PREOPERATIVE PROBLEMS
12
Hypertension:
If SBP ≥160 mmHg & DBP ≥ 95 mmHg defer elective surgery until
BP is controlled.
Emergency surgery the BP needs to be controlled rapidly with Iv
medication.
Cause of elevated BP might be Stress & anxiety.
Managed by Anxiolytics or sedation & adequate pain control.
13. 13
Ischaemic heart disease
Recent MI strong contraindication to elective anesthesia
Within 3 months of MI mortality rate from anaesthesia is high.
Elective surgery delay until at least 6 months.
If urgent surgery is required,
Aggressive medical therapy, and
Meticulous optimisation of oxygenation & fluid balance in ICU.
14. 14
Dysrhythmia
Atrial fibrillation must be controlled before surgery by
medication or pacemakers.
If digoxin is being used, regular measurement of serum
potassium
If a pacemaker is already fitted cardiology consultation
should be obtained.
15. 15
Cardiac failure:
Needs careful work-up & medical specialist evaluation.
To avoid cardiovascular depressant effects of anesthetic.
Decompensated heart failure defer elective procedures &
optimize cardiac performance.
If emergency procedure need invasive monitoring (e.g., intra-
arterial line, pulmonary artery catheter, & transesophageal
echocardiography).
20. 20
Anemia & blood transfusion
Preoperative transfusion should be considered if Preoperative
Hgb < 8 g/dl or Patient is symptomatic & actively losing blood.
In stable patients transfuse a day or so before the surgery
For major surgeries cross-match preoperatively.
If patients refuse blood transfusion (e.g. Jehovah’s Witnesses).
They should sign an extra consent accepting the consequences.
21. 21
Respiratory disease
Significantly ↑ postoperative morbidity.
↑ risk should be made clear to the patient & mentioned in the
consent.
If the patient smokes stop for at least 4wks.
Lower respiratory tract infections should be treated before surgery
except when the surgery is life-saving.
It is reasonable to delay elective surgery in the presence of a viral
URI.
22. 22
Chronic obstructive pulmonary disease:
Treat aggressively to achieve their best possible baseline level
of function.
Regional anaesthetic techniques need to be considered if
possible.
Appropriate postoperative care ( ICU bed) need to be arranged
25. 25
Surgical site infection prevention:
Meticulous operative technique + Prophylactic antibiotics.
skin antisepsis, hair removal, drapes, surgical hand hygiene.
Prophylactic antibiotic are useful if infection is an unavoidable
risk.
26. 26
Malnutrition:
Elective surgery (nutritional support for a minimum of 2 wks)
Emergency cases incorporate the risks into the consent form
Obesity ( BMI of more than 30):
Elective cases better to delay surgery until they have lost weight.
Emergency cases incorporate the risks into the consent form.
27. 27
Regurgitation risk:
Prevention methods : Keeping patient NPO, H2-receptor
blockade, Nasogastric tube.
For adults: NPO time For pediatric: NPO time
Clear liquids up to 2 - 4 hours, and
Solid food for a minimum of 6
hours,
Oral preoperative medications up
to 1-2 hours before anesthesia
with sips of water.
Clear liquids up to 2 hours,
Breast milk up to 4 hours, and
Solid foods, including nonhuman milk
& formula, up to 6 hours.
28. 28
Renal failure:
Treat the cause (if possible) + Nephrology consultation needed.
Already on dialysis need the dialysis 24 hours before surgery
to:
Ensure optimal fluid balance & electrolyte correction
Further dialysis should be delayed for 24 hours after surgery if
possible.
29. Diabetes
29
Minor surgery in Type 2 diabetic can be managed by:
Omitting their morning dose of medication,
Listing them for early surgery, and
Restarting treatment when they start eating
postoperatively.
For major surgery & in Type 1 diabetic:
Insulin infusion will be required.
Started infusion when the patient first omits a meal &
continued until they have recovered from the surgery.
30. 30
Patients taking drugs that interfere with the clotting cascades:
Warfarin is the commonest drug in this category.
INR should be ≤ 1.5 before elective surgery.
For low risk patients (simple atrial fibrillation) stop warfarin 3–4 days restarted
at the normal dosage level on the evening after surgery.
For intermediate risk patients replace with low molecular weight heparin
subcutaneous.
For high risk patients (mechanical heart valve) replace with an infusion of
heparin, which is stopped 2 hours before surgery restarted immediately
afterwards.
31. 31
Acquired coagulopathy:
Disorders such as DIC Hematologist consultation is needed.
Hypothermic patients warm actively because they bleed more
than normal.
Prolonged procedures kept warm all patients intraoperatively.
32. 32
Neurological & psychiatric disorders
Peripheral neuropathies & myopathies patients prolonged
ventilation postoperatively may be needed.
Anticonvulsants continued perioperatively & changed to IV if
NPO time is prolonged.
Psychiatric patients GA than Regional anaesthesia may be
required.
33. Fitness assessment
33
The anesthesiologist should take Hx & review the surgical diagnosis,
organ systems.
Classifies anesthetic risk of the patient & formulates an anesthetic
care plan.
Widely used Anesthetic risk prediction method is the ASA
classification.
37. CONSENT
37
Informed consent is more than a signature on a piece of paper.
It is a process of discussion & a dialogue between the surgeon and patient.
Competence
To give informed consent adults ( ≥17 years).
Competent: can comprehend & retain the information discussed
Children ≤ 16 years of age can only give consent if they truly understand the
nature, purpose and hazards of the treatment options.
38. Scheduling OR
38
If any special equipment is required inform theatre scrub staff.
If any consultants are anticipated to be needed arrange prior to
the day of operation.
39. Wrong person, site, procedure prevention
39
WHO surgical safety checklist.
Timeout
Marking
If the patient is to proceed to surgery it is good to mark the
relevant side/limb.
40. Psychological preparation
40
Psychological preparation is as important as pharmacologic
preparation for anesthesia & surgery.
The hospitalized patient may be separated from his or her
The surgeon’s reassurance & confident manner.
41. DOCUMENTATION
41
Ixs & Mx plan should be clearly listed for action.
A drug chart should be completed
Fluid charts.
Blood & blood products preparation confirmation paper.
Imaging results should be checked
Informed consent should be signed & documented.
42. Intraoperative care
42
Intraoperative care is all working as a team.
Intraoperative care include
Monitoring the patient's vital signs ,blood oxygenation levels
Fluid therapy,
Medication transfusion, anesthesia
43. 43
Purpose
To maintain patient safety and comfort during surgical procedures.
Maintaining homeostasis during the procedure
Maintaining strict sterile techniques to decrease the chance of cross-
infection
Ensuring that the patient is secure on the operating table
Taking measures to prevent hematomas from safety strips or from
positioning
44. Precautions
44
oxygenation should be monitored by continuous pulse oximetry
Continuous ECG should be in place
HR & BP should be monitored at least every five minutes.
In case of an emergency backup personnel who are experts in
airway management , emergency intubation
Advanced cardiac life support (ACLS) must be availables
ACLS should be checked daily to ensure proper function
45. Cont..
45
Areas of the operating table that come into contact with the
patient's bony prominences must be padded to prevent skin trauma
and hematomas.
The nurses should an accurately count of all sponges, instruments,
and sharps that may become foreign bodies upon incision closure.
46. Cont..
46
The temperature in the intraoperative room should be maintained at 20–
23°C
Relative humidity should be 30%–60%.
Health care personnel must not be permitted to work if they have open
lesions on the hands or arms, eye infections, diarrhoea , or respiratory
infections.
Scrub attire must be worn by all personnel entering the operating room.
Head and facial hair must be completely contained in a lint-free cap or
hood
47. Postoperative care & complications
47
In order to provide the patient with as quick, painless & safe a
recovery from surgery as possible
patient’s vital signs ,level of consciousness, pain and
hydration status are monitored in the recovery room.
48. 48
The patient can be discharged from PACU when they
fulfil the following criteria:
Patient is fully conscious.
Respiration and oxygenation are satisfactory.
Patient is normothermic.
Cardiovascular parameters are stable.
There are no concerns related to the surgical procedure
49. Classification of postoperative
complications
49
Classification of postoperative complications of surgery:
1. Linked to time after surgery:
Immediate (within 6 h of procedure)
Early (6–72 h)
Late (>72 h).
2. Generic & surgery specific
50. General postoperative complications
50
Bleeding
Most common in the immediate postoperative period.
Caused by an arterial or venous leak, or a coagulopathy
The treatment of haemorrhage is both to stop the bleeding and
supportive.
Supportive treatment includes oxygen and fluid resuscitation.
It may require correction of coagulopathy.
51. 51
Deep vein thrombosis
well-known and, when complicated by pulmonary embolus,
potentially fatal complication of surgery
prevention are guided by the risk score
Doppler ultrasound and venography to assess flow and the
presence of a thrombosis
Treatment with parenteral anticoagulation, followed by longer-
term warfarin
52. Pulmonary embolus
52
Mostly in the early postoperative period
Signs and symptoms depend on the size of the embolus
May range from dyspnoea, cough, and pleuritic chest pain to
sudden cardiovascular collapse
Treatment resuscitation, anticoagulation, followed by long-term
oral anticoagulation
53. Post operative Pyrexia
53
Common causes of pyrexia
Cut (Wound Infection)
Collection (Pelvic or Subphrenic Abscess)
Chest (Infection or PE )
Cannula (Infection
Catheter (UTI)
Calves (DVT)
54. Wound dehiscence
54
Disruption of any or all of the layers in a wound.
Dehiscence may occur in up to 3% of abdominal wounds and
is very distressing to the patient
commonly occurs after 15th postoperative day when the
strength of the wound is at its weakest
Usually presents with a serosanguinous discharge.
patient felt a popping sensation during straining or coughing
55. Risk factors in wound dehiscence
General factor Local factor
55
Diabetes
Obesity
Malnourishment
Sepsis
Cancer
Treatment with steroids
Inadequate or poor closure of
wound
Poor local wound healing, e.g.
because of infection
Increased intra-abdominal
pressure
56. CONT…….
56
Treatment
it may be appropriate to leave the wound open and treat with
dressings
Most patients will need to return to the operating theatre for
resuturing
manage underlying comorbidity
Nutrition therapy
57. Respiratory system
57
Immediate respiratory complications
Can be due to laryngospasm, soft tissue
oedema,haematoma, vocal cord dysfunction or foreign body.
Most interventions are simple & involve manual support of the
jaw or insertion of an oral or nasal airway
58. Early and late respiratory complications
58
Early and late postoperative pulmonary complications are a
significant cause of postoperative morbidity and mortality
between 5% and 70%.
Bronchospasm
Atelectasis
pneumonia
Pleural effusion
Pneumothorax
60. 60
Hypotension
may be due to hypovolaemia, myocardial impairment or
vasodilatation from subarachnoid & epidural anaesthesia.
surgical bleeding, sepsis,tension pneumothorax, pulmonary
embolism, pericardial tamponade & anaphylaxis
Treatment should be aimed at the cause
61. 61
Hypertension
May be due to pain, agitation,anxiety, bladder spasm
secondary to urinary catheterisation
May be due to pre-existing poorly-controlled hypertension
63. 63
References
1. Bailey & Love Bailey short practice of surgery 27th edition
2. Sabiston text book of surgery 19th edtition
3. AGS best practice guidelines geriatric perioperative
assesment 2012
4. Uptodate 2018