Pre and Postoperative Care

1
Pre and Postoperative Care

• Dept of Surgery
• Yong Loo Lin School of Medicine
• National University of Singapore

2
Preoperative Care

• The most important decision a surgeon can make
  is to operate on a patient
• The decision is a Risk-Benefit Analysis

3
Goals(Why)

• Recognize and Optimize the risk factors for
  surgery

4
How to do it

• History
• Examination
• Investigations

5
History Taking

• Past medical surgical history
• Cardiac, respiratory, renal, nutrition
• Drug hx
• Social Hx
• Functional status

6
ASA Classification
7
Investigations

• Basics (for all agegt50)
• FBC, urea/electrolyte
• CXR, ECG
• Specific (when indicated)
• LFT PT/PTT
• ABG Pulmonary function test
• others

8
Special Preparation

• Management of Diabetes
• DVT Prophylaxis
• Bowel preparation
• Prophylactic antibiotics selectively

9
Postoperative Care

• Recognize postop complications
• Pain management
• Postop fevers

10
Postop Complications

• General
• Examples AMI, CVA, pneumonia/atelectasis, renal
  failure
• Specific
• Examples anastomotic leakage, abscess formation,
  wound infection, ileus, bleeding

11
Postop Complications

• General
• Important examples
• AMI
• pneumonia/atelectasis
• renal failure
• DVT/Pulmonary embolism
• CVA

12
Postop Complications

• Specific
• Examples
• anastomotic leakage
• abscess formation
• wound infection
• ileus
• bleeding

13
Scenario
14
Pain Management

• Essential part of postop management
• Pain can increase risk of complications
• Pain relief- Multimodal
• E.g. PCA, IM pethidine, oral analgesics

15
Postop Fevers

• An important sign of postop complications
• Many possible DDX
• Time of onset may guide the management

16
Postop Fevers

• First 48hrs
• Atelectasis
• Transfusion rxn
• Pre-existing infection
• 3-7 days infections
• UTI, wound infection, pneumonia, anastomotic
  leakage

17
Postop Fevers

• About 7 days onwards
• Infections
• Abscess formation
• DVT/PE

18
Postop Fevers

• History
• Examination
• Investigations (to confirm the diagnosis)

19
Summary

• Pre and Postop care are essential parts of
  surgical treatment
• Good History, physical examination and selected
  investigations are the key
• Complications do occur, but many are preventable!

20
Questions