Pre-operative Assessment and

Preparation

By
Mr. Richard Wismayer
Lecturer, Habib Medical School, Uganda
Year 3
Pre-operative Assessment and Preparation

 Why ?
 How ?
 When ?
 What ?
 Pre-operative Assessment and Preparation
WHY ?

 Elective operation should be performed under

optimal condition with full physical and
psychological preparation of a fully informed
patient.
 Emergency operation may have to be done in
less than ideal circumstances .
 Pre-operative Assessment and Preparation
HOW ?

 History
 Physical exam
 Investigation
 Pre-operative Assessment and Preparation
WHEN ?

 Out patient visit

 Pre-operative ward round
 ER
 Pre-operative Assessment and Preparation
WHAT TO DO ?

 Six tasks
 To explain to the patient / relative the nature of the illness ,
implications of surgery and prognosis
 Identification of potential operative mortality and
postoperative morbidity
 To assess the fitness for operation
 Identification of the risks of potential postoperative
complications and prophylactic measures .
 Planning of operation and consent
.
 Task one

To explain to the patient / relative

 Nature of surgery
 Implication of surgery
 Alleviate fear/anxiety of the patient
 Prognosis
 Task two

Identification of potential operative

mortality and morbidity

 Look for the risk factors?

Risk factors of mortality and morbidity

 Myocardial infarction  Avoid op.whenever possible for at

least 6 months
 Pregnancy  Elective op. is avoided.Risk of
miscarriage & teratogenicity
 Thrombogenic drugs  Steroids & pills
 Smoking
 Previous anesthetics  Suxamthonium/halothane
 Allergies  Penicillin/Iodine-containing drugs
 Task three

To assess the fitness for operation

 Assessment of general condition
 Assessment of metabolic state
 Assessment of cardiovascular system
 Assessment of respiratory system
 Assessment of renal system
Assessment of general condition
 Careful clinical exam.  Full blood count
 Pulse rate  Serum urea & electrolytes
 B.P.  Blood group & save serum
 X-match blood if needed
Assessment of metabolic state
 Height  Problems associated
 Weight with obesity :
 Venepuncture
 Anatomical landmarks
 Respiratory problems
 Thromboembolism
 Wound infection
 Wound dehiscence
Assessment of cardiovascular
system
 Clinical exam of heart  ECG
and vessels  Echocardiogram
Cardiovascular conditions

 Increase risk of CVA/MI

 Hypertension
 Myocardial ischaemia  Avoid techniques /drugs which
increase heart rate/diastolic
B.P/perfusion gradient
 Cardiac arrhythmias
 Discuss with cardiologist pre-op
 Valve disease/septal
 Cover with antibiotics
defect
 Hypovolemia
 Restore blood volume pre-op
Assessment of respiratory system
 Clinical exam of chest  CXR
 Sputum for bacteriological
exam
 Blood gases
 Pulmonary function tests:
FEV1 FVC
 Respiratory conditions
 Chronic bronchitis  Suffer HYPOXEMIA.DO blood gases High
risk patients-consider only for urgent op
.
 Asthma  At risk of post-op respiratory failure.Give
bronchodilator. Best index: FEV1/FVC X100
 Brochiectasis
 Physiotherapy + Antibiotics (use local
 Common cold blocks instead of general anaesthesia)
 Cancel op. in acute phase
Assessment of renal system
 Clinical examination  Urinanalysis & microscopy
 Urine for microbiological
examination
 Serum urea
 Serum creatinine
Renal disorders
 Chronic retention
 Task four
Identification of risks of potential post
operative complications and prophylaxis
 Pulmonary collapse and Pre-op breathing exercises
infection
 Cardiac complications  Avoid excessive fluid post-op in
all patients with cardiac
ischemia or valvular disease
 Major causes are hypovolemia,
 Acute renal failure
characterized by: sepsis, jaundice and
(oliguria, dilute urine , & mismatched blood
urea conc.<300 mmol/l)
 Task four (continue)
Identification of risks of potential postoperative
complications and prophylaxis (continue)
 Venous Thrombosis  Avoid compression of legs
during and after op.
 If necessary,use graded
compression stocking / low
dose heparin 5000 I.u Q.12
hrs OR a single dose of LMW
heparin

 Wound infection  Prophylactic antibiotics

(Bactericidal best guess for
offending organism,high
doses,three doses..when?
 Task five
Planning of the operation
 The operation should be properly named after
full explanation to the patient and the side of
operation is marked in case of bilateral parts.
 He/she should consent for it.
 The duration of hospital stay,convalescense
and time off work should be indicated.
 CONSENT

 Explain to the patient in simple non medical

language what is going to be done.
 Alleviate his/her fears.
 Do not deceive the patient.
 Reassure the patient
 Task six
Pre-operative orders
 Keep NPO (Nil per Oral) from ??:00 hrs
 Medications
 Essential
 Prophylaxis
 Prepare area for surgery
 Cleaning
 Shave
 Enema
 Etc