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Pre Op Assessment of the Surgical Patient
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?.
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Pre Op Assessment of the Surgical Patient
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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? Chance to be assessed by all teams involved in the care of the surgical patient Surgical resident/intern Anaesthetics Nursing staff What is included in the Pre Op assessment? History Examination Blood tests Radiology Consent Tissue bank (if required) 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 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. Important Questions to ask Medications Anticoagulation Clopidogrel vs warfarin vs aspirin Diabetic meds Immunosuppressants/steroids Thyroxine Parkinsons medications etc Examination Usually heart, lungs depending on history Then specific examination for particular system being operated on Bloods and radiology FBC, UEC, coags LFT/CMP if you are concerned. Extended G+H if surgery is more than 3 days away CXR Limb/pelvis for orthopedic patients 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 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? 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. Colorectal surgery 25 F for colonoscopy Hx Type 1 DM Nil other medical history What do we have to think about for this patient? 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 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? 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. Neurosurgery 52 M ASAP PAC for symptomatic meningioma Otherwise healthy What do we need to think about for this patient? 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 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