Pre-operative Preparation

Introduction
• Definition
Surgery has been defined as a legalised
and controlled assault on a human being
with a therapeutic intent, and with consent
obtained under duress imposed by pain,
suffering or fear of death

Classification
• Classified as:
• - Elective
• - Emergency

Elective surgery
Surgical intervention that is planned for a
given date and time to suit both patient
and surgeon following a work-up and
preparation

Pre-operative care
• Involves
- Operative risk assessment
- Informed consent
- Correction of Nutrition, blood volume,
electrolyte and fluid deficiencies
- Prophylaxis against possible infection
- assessment of likely immediate and long
term complications

Risk assessment
• Defined as “reduction of harm to the
organisation”
• Improves quality and reduces harm to the
patient
• Also referred to as Clinical risk reduction
• This is an approach designed to improve the
quality of care and which places special
emphasis on the occasions on which patients
are harmed or disturbed by their treatment.

Risk assessment
• Prophylactic measures
- Prevention against infective endocarditis
- Chemoprophylaxis against surgical
infection
- Prophylaxis against deep vein thrombosis
- Prevention of renal failure

Prevention against endocarditis
• At risk patients include
- Diabetics
- Alcoholics
- Immune compromised
- Cardiac abnormalities
* streptococci, staphylococci, and enteric
bacteria are common pathogens

Prevention against endocarditis
• Procedures include:
- Dental surgery
- Gastro-intestinal surgery
- Genito-Urinary surgery
- Fracture management
- Liver biopsy
- Endoscopic surgery

Prevention against endocarditis
• Antimicrobial therapy includes
- Intravenous amoxycillin
- Vancomycin
- Teicoplanin
- Clindamycin
- Amoxycillin and gentamicin in those who
had previous endocarditis or prosthetic
valves

Prevention against Surgical
infection
• Clinical conditions include
- Orthopedic operations
- Neurosurgical operation
- Breast surgery
- Biliary surgery
- Colorectal surgery
- Vascular surgery

Prevention against surgical
infections
When and how
- Single dose administered 2hours before
surgery or at the time of induction, im/iv is
sufficient
- Antibiotic prophylaxis should not be used
in clean operations

Prophylaxis against deep vein
thrombosis
• Prophylaxis against DVT/PE should be
given according to the degree of risk , at
least until discharge from hospital.

Risk rate percentage
Risk level DVT PE Patient group
low <10 0.01 -Minor surgery, no risk other than age
-Major surgery, age<40
-Minor trauma, medical illness
Moderate 10-40 0.1-1 -Major surgery, urological,
gynaecological, age>40
-major medical illness, Heart, lung
disease, cancer, -major trauma or burns
-minor surgery with previous DVT, PE
High 40-80 1-10 Major pelvic, abdominal surgery for
cancer
Major trauma with h/o DVT/PE

Prophylaxis against deep vein
thrombosis
• Low risk
- Graduated compression stockings, early
mobilisation
• Moderate risk
- GCS, Early mobilsation, Mechanical
prophylaxis, Low molecular weight heparin
• High risk
- As for moderate risk

Chemoprophylaxis
- LMWH must be administered together with
mechanical methods in all patients with
moderate and severe risk of thrombo-
embolism
- Heparin prophylaxis is not used in
neurosurgery because of risks of
intracranial post operative bleeding

Chemoprophylaxis
• Dextran 70
as effective as low dose heparin in
prevention of fatal PE
Dextran is contra indicated in pregancy

Chemoprophylaxis
• Other agents
Aspirin ( anti platelet0
Hydroxycholoroquine

Mechanical methods
• Graduated compressions stockings
• Intermittent pneumatic compression
• Foot impulse technology

Prevention of Renal failure
• Causes
- Persistent hypovolaemia
- Myoglobinuria
- Jaundice

Correction of other defects
• Nutrition
• Electrolyte
• Blood pressure
• Hypovolaemia

Conclusion
• The aim of history, examination is to
assess risks that the patient may have
• Informed consent presents the same risks
back to the patient making him/her aware
of the challenges that may be present and
giving options available and taking the
best available option
• Investigations weighs the severity of the
risks

Conclusion
• With the history taken, examination done
and the investigations results available, a
plan is laid done on the best surgical,
medical management of the patient
• Do not operate on a patient without
adequate pre operative care.
• It increases morbidity and mortality

The end!