Pre-Operative care of surgery

Pre-Operative care
Every year a lot more than 3 million operations are carried out. It is common practice to do routine testing on patients before they're going to theatre. Popular investigations are discussed below.
Examination
General
An over-all systems examination should be done to pick up any abnormalities:
• CVS - heart murmur. Except for emergency surgery, patients ought to be haemodynamically stable and their vital signs normal before beginning anaesthesia.
• RS - abnormal breath sounds
• GI - abdominal masses, previous scars
• Musculoskeletal - skeletal malformations for example kyphoscoliosis
• General - local skin infection
Airway assessment
How easy or difficult it will likely be to intubate a patient depends upon the following points:
• Are they obese?
• Do there is a short neck and small mouth?
• To what extent do they really open their mouth?
• Is there any soft tissue swelling at the rear of the mouth or any limitations in neck flexion or extension?
Investigations
A doctor should ask if the result of the test will alter the patient's management. Ordering unnecessary tests is neither helpful nor economical.
Full blood count (FBC)
This can demonstrate anaemia. This boosts the risk of intra-operative hypoxia or increased cardiac workload. Addititionally there is an increased risk of myocardial infarction (MI) or cerebrovascular event (CVE) and delayed healing. It's also useful as a baseline way of measuring haemoglobin if the proposed operation is anticipated to cause substantial hemorrhaging.
Urea and electrolytes (U&E)
Detects underlying renal deficiency and chance of developing acute renal failure (ARF) after major surgery. This may also influence the choice of drugs given inside the anaesthetic.
Liver function tests (LFT)
Does the individual have any underlying malnutrition? This might affect the patient's capability to heal.
Calcium
It is possible to suggestion of underlying malignancy?
Clotting
Clotting and platelet function is pertinent for the many patients taking aspirin or warfarin. Also patients with known clotting disorders.
Group and save (or hold)
Anticipating there may be a requirement for blood, although not routinely for this procedure, the patient's blood type is identified and held, pending a potential (later) request for units of blood or blood products.
Cross-match
Essential for transfusion needs to be expected to avoid high demand/unavailable resource. Choices makes a prediction (in units of blood) for that procedure. That amount, typed especially for that patient, is locked in blood bank every day and night. The decision about whether or not to cross match serum in order to order group and save ought to be judged on the current haematological status from the patient as well as the estimated hemorrhaging.
Urinalysis
Urine dipstick or analysis is advantageous to detect undiagnosed diabetes or uti.
Chest X-ray (CXR)
Rules out infection and prevents last second delay in anaesthetic. It's also an aid to diagnosis when the patient has a poor reaction to general anaesthetic. It may also help arrange for post-operative physiotherapy.
A CXR should simply be requested by the anaesthetist for assessment, or maybe they felt the patient may require admission to ITU post-operatively. This may be the situation in patients with rheumatoid arthritis symptoms, to assess instability from the cervical spine - almost 90% of patients possess some degree of involvement.3Also patients with ankylosing spondylitis may have a semifused spinal column and the anaesthetist should bear this in your mind when extending the patient's neck during intubation.
The next types of surgery require a CXR if not already performed included in work-up:
• Abdominal, cardiac and thoracic plus some oesophageal surgery
• Thyroidectomy or neck and head surgery
• Neurosurgery - due to prolonged nature of anaesthesia and want for post-op ITU
• Lymph node surgery
Spirometry
Spirometry tests make the perfect measure of pulmonary physiology and therefore are useful in patients with obstructive or restrictive patterns of disease.
Electrocardiogram (ECG)
This can show any silent myocardial ischaemia or infarction. It's also a baseline to compare against possible post-op events. Additionally, it demonstrates arrhythmias.
Sickle cell testing
You should offer testing pre-operatively to recognize risk before the anaesthetic - surgical or dental. This will be significant for ethnic groups who've a family history of homozygous sickle cell anaemia or sickle cell trait, particularly high is no previous surgical history.
Pregnancy testing
The necessity to test depends on the danger to the fetus in the surgery and anaesthetic. These risks ought to be explained to the patient.
The girl should be asked sensitively when there is any possibility of pregnancy. When there is any doubt, a test ought to be done with the woman's consent.
Similar questioning ought to be carried out before a CXR.
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