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Pre Op Assessment of the Surgical Patient PowerPoint PPT Presentation


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Pre Op Assessment of the Surgical Patient. Who goes to PAC?. 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. Why have Pre op assessment?. - PowerPoint PPT Presentation

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Pre Op Assessment of the Surgical Patient

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Pre op assessment of the surgical patient l.jpg

Pre Op Assessment of the Surgical Patient


Who goes to pac l.jpg

Who goes to PAC?

  • 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


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Why have Pre op assessment?

  • Chance to be assessed by all teams involved in the care of the surgical patient

    • Surgical resident/intern

    • Anaesthetics

    • Nursing staff


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What is included in the Pre Op assessment?

  • History

  • Examination

  • Blood tests

  • Radiology

  • Consent

  • Tissue bank (if required)


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Important Questions to ask

  • What surgery they are having

  • Natural history of the disease process, and any worsening since last seen in clinic

    • E.g., further obstruction in a patient having a thyroidectomy


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Important Questions to ask

  • Medical history

    • Diabetes (T1DM vs T2DM)

    • HTN

    • Asthma/COPD/OSA  are they on CPAP usually?

    • Heart disease

      • Recent AMI/valvular disease/CABGs/AF

    • Strokes

    • Thyroid disease

    • Steroid dependent/Immunosuppressed

    • etc.


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Important Questions to ask

  • Medications

    • Anticoagulation

      • Clopidogrel vs warfarin vs aspirin

    • Diabetic meds

      • Insulin vs metformin

    • Immunosuppressants/steroids

    • Thyroxine

    • Parkinsons medications

    • etc


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Examination

  • Usually heart, lungs depending on history

  • Then specific examination for particular system being operated on


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Bloods and radiology

  • FBC, UEC, coags

  • LFT/CMP if you are concerned.

  • Extended G+H if surgery is more than 3 days away

  • CXR

    • Only if indicated

  • Limb/pelvis for orthopedic patients


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Consent/tissue bank

  • If unsure call registrar

  • Often done when request for admission is done in clinic, need to check it is properly signed.

  • Often will just need to answer any further questions

  • Tissue bank consent for any tumours


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Case studies


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Orthopedics

  • 70 F for right total knee replacement

  • Hx

    • On aspirin for TIAs

    • HTN, COPD, OSA on CPAP

  • Radiology is over 1 year old

  • What do we need to think about for this patient?


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Orthopedics

  • 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 respiratory R/V / recent RFTs

  • Radiology

    • need recent films. If knee replacement, needs long leg views as well as AP, lat and skyline.


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Colorectal surgery

  • 25 F for colonoscopy

  • Hx

    • Type 1 DM

    • Nil other medical history

  • What do we have to think about for this patient?


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Colorectal surgery

  • 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


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Plastics

  • 80 M LLC NH resident for excision 3 x lower leg SCCs

  • Hx

    • St Judes MVR on warfarin

    • CAD, no recent AMIs

    • HTN, CRF Creat 120

    • What do we need to think about for this patient?


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Plastics

  • Warfarin

    • Will need to be stopped as bleeding is high risk

    • At LLC NH

    • Will need to continue theraputic clexane due to metal heart valve

      • Made easier as at NH, usually call nursing staff at NH to help organise

    • Need a clear plan on stopping and restarting warfarin.


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Neurosurgery

  • 52 M ASAP PAC for symptomatic meningioma

  • Otherwise healthy

  • What do we need to think about for this patient?


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Neurosurgery

  • Usually special set of rules for neurosurg

  • Bloods including coags, G+H

  • Usually you do consent in emergency PAC situations

  • Will need CT/MRI with fiducials if using brainlab technology  will need to organise

  • Tissue bank very important


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Summary

  • Pre operative assessment extremely important

  • Any problems ALWAYS call your senior

    • Always better to look a bit silly in front on them than in front of the surgeon once patient is in theatre

    • Remember you have an anaesthetics registrar around if you need help