5. Preoperative preparation and examination of the patient.

Pre & Post Operative Periods

Written by Rhiana Devadasan

5) Preoperative assessment of a surgical patient

6) Postoperative period. Postoperative complications - surgical, pulmonary, cardiovascular, gastrointestinal, renal, hepatic, hepatorenal syndrome.

Preoperative Period

Preoperative Period = starts from the time the patient is admitted to the hospital's surgical department to the time the surgery begins.

PREOPERATIVE TASKS / ROUTINE

1. Anamnesis and physical examination – inspection, palpation, percussion, auscultation
2. Work towards a diagnosis
3. Explain to the patient: the nature of their illness, the options; the prognosis, and alleviate any fear or anxiety the patient may have.
4. Decide whether patient is fit for surgery (optimal health that will allow reduction of risks)

Potential RFs for Operative Mortality / Post-Operative Morbidity:

• Myocardial Infarction (avoid operation for at least 6 months after)
• Pregnancy (elective operations should be avoided due to risk of miscarriage or congenital malformations - teratogenicity)
• Thrombogenic drugs (steroids, pills)
• Previous anaesthetics (suxamthonium/halothane)
• Smoking
• Allergies (penicillin/iodine-containing drugs)

5. Perform Preoperative tests

(to clarify/quantify the extent of disease at operative site & to assist in surgical planning)

(to further assess patient's fitness for surgery)

General condition

• Careful clinical exam
• Full blood count
• Pulse rate
• BP
• Blood group
• Serum urea & electrolytes
• Wound infection

Metabolic State

• Height
• Weight
• Obesity?

Respiratory system

• Blood gas analysis (arterial blood gas analysis or venous)
• Pulmonary function tests – vital capacity, peak expiratory flow rate, forced VC, FEV₁
• Chest X-ray – bronchography, CT, MRI
• Sputum for bacteriological examination
• Pulmonary function tests (spirometry)
• E.g. Asthma requires bronchodilator, due to chance of pre-op failure

Bronchiectasis requires physiotherapy and antibiotics & local blocks not general anesthesia

Common cold = cancel operation in acute phase

Cardiovascular system

• Pulse, central venous pressure, blood pressure
• ECG + clinical exam of heart & vessels
• Vascular Doppler (Ultrasound for blood vessels)
• E.g. Hypertension = increased risk of CVA / MI

Myocardial Ischemia = avoid drugs which increase HR, diastolic BP perfusion gradient

Cardiac arrhythmias

Valve/Septal defects = cover with antibiotics

Hypovolemia = restore blood volume in pre-op

Urinary system

• Renal function tests (K, Na, Creatinine & urea levels)
• Urine dipstick (pH, protein, glucose, ketones, blood/hemoglobin)
• Blood – serum creatinine, serum urea
• GFR
• X-ray with or with contrast – urography, cystography, CT and MRI
• Urinalysis & Microbiological examination

Haematological system

• Blood tests – RBC, fasting blood sugar (FBS), dried blood spot (DBS), blood group testing
• Blood Glucose test
• Hemostasis tests (PT, APTT, etc.)
• O₂ and CO₂ content of blood, acid-base status

Endocrine system