Lecture notes for medical students

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7. See notes for bibliography.

2. Preoperative preparation

3. Preoperative preparation
• outpatient office visit to hospital inpatient
consultation to the emergency department
evaluation of a patient.
• depending on the nature of the complaint
and proposed surgical intervention,

4. ROUTINE PREOPERATIVE
PREPARATION FOR SURGERY

5. ROUTINE PREOPERATIVE
PREPARATION FOR SURGERY
• History
• Physical examination
• Special investigation
• Optimization
• Informed consent
• Marking the site/side of operation
• Antibiotic prophylaxis
• Shaving
• Bowel preparation

6. PREOPERATIVE EVALUATION
•

7. PREOPERATIVE EVALUATION
• Aim : not to screen broadly for
undiagnosed disease but rather to identify
and quantify comorbidity that may impact
operative outcome.

8. •
PAST Hx
H/O DM, TB, HTN Bronchial Asthma, MI HIV
Any previous operation.or bleeding tendency
Any previous reaction to anaesthetic agent
DRUGS Hx
Interaction with anesthesia
Drugs for HTN ,IHD to be cont.over preoperative period
Anticoagulant drugs (aspirin, warfarin)

9. •Personal history
Smoking
Alcohol
Occupation
Diet
Family History
HTN, DM , TB, ALLERGIC DISORDER , CA , etc

10. PHYSICAL EXAMINATION

11. PHYSICAL EXAMINATION
• PALLOR PULSE
• ICTERUS B.P.
• CYANOSIS BMI
• JVP
• CLUBBING
• P.EDEMA

12. SYSTEMIC EXAMINATION

13. SYSTEMIC EXAMINATION
Cardiovascular
■ Pulse, blood pressure, heart sounds, bruits, peripheral
pulses, peripheral oedema
Respiratory
■ Respiratory rate and effort, chest expansion and
percussion note, breath sounds, oxygen saturation
Gastrointestinal
■ Abdominal masses, ascites, bowel sounds, bruits, herniae,
genitalia
Neurological
■ Conscious level, any pre-existing cognitive impairment or
confusion, deafness, neurological status of limbs

14. INVESTIGATIONS

15. INVESTIGATIONS
• CBC Grouping,
• S.Creatinine,S.Electrolyte
• RBS/HbA1c
• HbsAg
• HIV
• Urinalysis.
• Xray Chest
• ECG Echo TMT Angiography
• LFT,Clotting screen
• TSH

16. Optimization

17. Optimization
Control
• Hypertension
• Diabetes mellitus
• Thyroid function
• Ascites , coagulation abnormalities
• Renal function Hemodialysis
• Angioplasty
• Adrenal insufficiency
• Respiratory exercises

18. Optimization
Pheochromocytoma
• controlled by a combination of a-
adrenergic and ß-adrenergic blockade

19. Preop. Instructions

20. Preop. Instructions
• NPO
• Enema
• Shaving -NO
• Start DVT prophylaxis
• Bath
• Arrange blood for transfusion
• Predeposit

21. Patient on Medications
Continue-
• Antithyroid,
• Eltroxin,
• Antihypertensives,
• Digoxin,
• Beta blocker
• Antipsychotic

22. Patient on Medications
Stop
• Omit morning dose of antidiabetic
• Warfarin

23. Patient on Medications
Clopidogrel+ Aspirin ?
• Stop if intracranial or post. chamber of eye
operation

24. Informed consent

25. Antibiotic prophylaxis
• Clean surgery –Single shot at the time of
induction repeat if more than 3hours.

26. Marking the site/side of operation

27. PREOPERATIVE CHECKLIST

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