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Surgery LO's > Pre-Operative Assessment and Planning > Flashcards

Pre-Operative Assessment and Planning Flashcards

1
Q

What are the aims of pre-operative assessment and planning?

A

Gain informed consent
Assess risk vs benefits
Optimise fitness of patient
Check anaesthesia/analgesia type that will be suitable

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2
Q

What pre-op checks should be made?

A 
OP CHECS - 
Operation fitness
Pills (medication)
Conset 
History 
Ease of intubation
Clexane
Site
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3
Q

What should be assessed in operation fitness?

A

Cardiorespiratory co-morbidities

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4
Q

What history is important in pre-op checks?

A 
MI
Asthma
HTN
Jaundice
DVT
Previous anaphylaxis
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5
Q

What is it important to know to assess ease of intubation?

A

Neck arthritis
Dentures
Loose teeth

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6
Q

What is the purpose of clexane?

A

DVT prophylaxis

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7
Q

What needs to be done to the surgical site in pre-op checks?

A

Ensure is correct site, and mark it

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8
Q

What changes should be made to anti-coagulants pre-operatively?

A

Depends - you should balance risk of haemorrhage vs. risk of thrombosis

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9
Q

What should be avoided if the patient is on anti-coagulants?

A

Epidural, spinal, and regional blocks

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10
Q

What changes should be made to anti-epileptic drugs pre-operatively?

A

They should be given as normal

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11
Q

How should anti-epileptic drugs be given post-operatively?

A

If unable to tolerate orally, should give IV or via NGT

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12
Q

What changes should be made to OCP/HRT pre-operatively?

A

Stop 4 weeks before major or leg surgery

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13
Q

When should OCP/HRT be restarted if they are stopped for surgery?

A

2 weeks post-op, if mobile

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14
Q

What changes should be made to ß-blockers pre-operatively?

A

Continue as normal

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15
Q

What pre-operative investigations should be performed?

A

Bloods
Cardiopulmonary function
MRSA swabs

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16
Q

What routine bloods should be done pre-operatively?

A 
FBC
U&Es
G&S
Clotting 
Glucose
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17
Q

When should LFTs be done pre-operatively?

A

Liver disease
EtOH
Jaundice

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18
Q

When should TFTs be done pre-operatively?

A

Thyroid disease

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19
Q

How much blood should be cross matched for a gastrectomy?

A

4 units

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20
Q

How much blood should be cross matched for an AAA?

A

6 units

21
Q

What may be assessed when investigating cardiopulmonary function pre-operatively?

A 
CXR
Echo
ECG
Cardiopulmonary exercise testing
PFT
22
Q

When is a CXR required pre-operatively?

A

Cardiorespiratory disease/symptoms

>65 years

23
Q

When is an echo required pre-operatively?

A

Poor LV function

Murmurs

24
Q

When is an ECG required pre-operatively?

A

HTN
Hx of cardiac disease
>55 years

25
Q

When are PFTs required pre-operatively?

A

Known pulmonary disease

Obesity

26
Q

When might a lateral C-spine in flexion and extension views be done pre-operatively?

A

Rheumatoid arthritis

Ankylosing spondylitis

27
Q

How long should a patient be NBM before surgery?

A

2 hours for clear fluids

6 hours for solids

28
Q

When might bowel prep be needed pre-operatively?

A

For left sided operations

29
Q

Is bowel prep needed in right-sided procedures?

A

Not usually

30
Q

What can be used for bowel prep?

A

Picolax

Klean-Prep

31
Q

What is picolax?

A

Picosulfate and Mg citrate

32
Q

What is Klean-Prep?

A

Macrogol

33
Q

What are the disadvantages of bowel prep?

A

Liquid bowel content may spill during surgery
Electrolyte disturbance
Dehydration
Increased rate of post-op anastomotic leak

34
Q

When are prophylactic antibiotics used in surgery?

A

GI surgery

Joint replacement

35
Q

What is the infection rate of elective GI surgery?

A

20%

36
Q

When should pre-operatively antibiotics be given?

A

15-20 minutes before surgery

37
Q

What antibiotic prophylaxis should be given in biliary surgery?

A

Cef 1.5mg and met 500mg IV

38
Q

What antibiotic prophylaxis should be given in colorectal surgery or appendicetomy?

A

Cef and met TDS

39
Q

What antibiotic prophylaxis should be given in vascular surgery?

A

Co-amoxiclav 1.2g IV TDS

40
Q

What antibiotic prophylaxis should be given in MRSA +ve patients?

A

Vancomycin

41
Q

How are DVTs prevented in low risk patients?

A

Early mobilisation

42
Q

How are DVTs prevented in medium risk patients?

A

Early mobilisation
TEDS
20mg enoxaparin

43
Q

How are DVTs prevented in high risk patients?

A

Early mobilisation
TEDS
40mg enoxaparin
Intermittent compression boots peri-operatively

44
Q

How long can medical DVT prophylaxis be continued at home?

A

Up to 1 month

45
Q

What is ASA grade 1?

A

Normally healthy

46
Q

What is ASA grade 2?

A

Mild systemic disease

47
Q

What is ASA grade 3?

A

Severe systemic disease that limits activity

48
Q

What is ASA grade 4?

A

Systemic disease which is a constant threat to life

49
Q

What is ASA grade 5?

A

Not expected to survive 24 hours without operation

Surgery LO's (10 decks)

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