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13 Cards in this Set
- Front
- Back
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Preoperative evaluation is aimed at providing a _________ and assessing the possibility of total repair, partial repair or salvage of a given problem.
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Diagnosis
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What PreOp steps do you take in the days leading up to the Surgical Operation?
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1. History and PE
2. Extra tests (Blood, Rads, etc. as needed) 3. Dx - is Surg needed? Prognosis with or without operating? Risks? 4. Client Comms and Estimate Given 5. FAST (12hrs for monogastric, 24hr for Ruminants) Do NOT withhold water! |
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What PreOp steps do you take the day of the Surgical Operation?
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1. Set a sterile field
2. Consider Antibiotic Therapy IMMEDIATE PreOp Considerations: 1. IV Fluids 2. Intubation 3. Monitors (EKG, Doppler, etc..) 4. Temp (Heating Pad, etc..) |
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In all surgical procedures, adherence to the following FIVE surgical principles will promote wound healing and increase the success of the procedure:
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1. Asepsis
2. Gentle Tissue Handling 3. Accurate Hemostasis 4. Elimination of Dead Space 5. Accurate Apposition of Layers |
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Surgical Concerns associated with:
AGE |
Geriatric - need more complete screening of Kidney and Liver function
may need thoracic Rads or UA Is Surgery worth 2 more natural years? Puppies/Kittens under 8 weeks: Not physically mature = Significant Anesthetic Risk |
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Surgical Concerns associated with:
HEART MURMUR |
Is it clinically significant?
Low grade mitral regurg - Not Really. Murmur alone - not too bad... but does it Impact the Cardiovascular Performance??? Cough, Exercise Intolerance, Lethargy --> Need Complete Cardiac Exam Puppies - may indicate a serious congenital defect |
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Surgical Concerns associated with:
ANEMIA |
Safe = Minimum PCV 25-30 and TS above 4.0 g/dL
Main Concern - O2 carrying capacity of blood. Blood Count monitored during and after Surgery If PCV is borderline low - should have a PreOp crossmatch to live or stored whole blood. |
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Surgical Concerns associated with:
TRAUMA |
Covered by Dr. Otto
but common concerns are Shock, Hypovolemia, Cardiac Arrhythmias, Ventilation Issues |
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Surgical Concerns associated with:
ONCOLOGIC PATIENTS |
Determine Regional/Distant Metastases
Palpate - Aspirate - Rads Suspicion of Paraneoplastic Syndrome? Many Oncologic patients are Anemic and/or Thrombocytopenic. Coag Screen. DIC? FeLV - pancytopenic, poor candidate for surgery PostOp Nutrition for Cachexic patients |
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Surgical Concerns associated with:
UREMIA |
Best to Lower Creatinine and stabilize Electrolytes before Surgery.
Done so by Fluid Diuresis (chronic), or Diuresis and abdominal drainage (acute uroperitonieum) Anesthesia - swap drugs to maintain renal perfusion. Keep an eye on Urine Output |
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PreOp concerns in patients with:
ORTHOPEDIC INJURY |
Injured limb should be evaluated for Nerve Function (esp Radial, Sciatic)
Soft Tissue Injury? Blunt Trauma - Pulmonary Contusion, Pneumothorax, Myocarditis? Pelvic Fracture - Bladder Rupture, Urethral Tear? |
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PreOp concerns in patients with:
LIVER DISEASE |
Abnormal Blood Clotting
Coag Profile Many require Blood Component Therapy - restore normal levels and clotting capability - Have Blood Ready! Anesthesia - Don't use drugs requiring Hepatic Metabolism |
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PreOp concerns in patients with:
DIABETES |
Higher Incidence of PostOp wound due to suppression of Phagocytic Activity in Leukocytes.
Insulin May be Crucial for Tissue Metabolism May be reqd for Fibroblast Proliferation Stress may destabilize --> Ketoacidosis and Renal Failure Should be Well-Controlled. Admitted 1 day before procedure. Monitor feeding, Blood Glucose, Creatinine. Morning of - no food, 1/2 insulin. Surg Fluid - Dextrose Post - Monitor Blood Glucose - keep over 70mg/dL Should keep overnight after surgery too - Monitor urine and glucose. If not eating - keep on fluid therapy. |
