Preop. Postop.evaluation

7/29/2019 Preop. Postop.evaluation

1/20

PRE. & POSTOP.

EVALUATION

Dr Hamdi Al-ShenawiMB Ch. B, FRCSI

Consultant G. Surgeon

Assistant Professor of surgery , Medical college, AGU


2/20

ASA Classification

ASA IA norm ally healthy individ ual: no organic, physiological,biochemical or psychiatric disturbance.

ASA IIA pat ient wi th mi ld -moderate systemic d isturbance: thismay or may not be related to the disorder requiring surgicaltreatment, eg diabetes mellitus, hypertension

ASA IIIA patient with in capacitat ing sy stemic d iseasewhich isnot incapacitating eg heart disease with limited exercise tolerance,uncontrolled hypertension or diabetes

ASA IVA patient w ith incapacitat ing sys temic dis ease that is aconst ant threat to l i fewith or without surgery, eg congestivecardiac failure, severe angina.

ASA VA moribund patient who is not expected to live and wheresurgery is performed as a last resort e.g. ruptured aortic aneurysm


3/20

PROBLEM I

65-YEAR-OLD MALE

DIAGNOSIS: CANCER SIGMOID COLON

FOR: SIGMOID COLECTOMY

K / C :

H.T.N

I.H.D

D.M

ON ASPIRIN

B Blockers

ORAL HYPOGLYCEMIC


4/20

Aspirin ?when to withhold before op,?

Bl . Investigations?(CBC, U&E, Bl sugar,

coagulation profile, cross mach)

C XR, ECG, Echo.

Cardiac consultation/Control DM

Bowel preparation?D/C oral hypoglyceamicsc insulin(sliding

scale)

B blockers??IHD & OP, when?


5/20

PROBLEM 2

24-YEAR-OLD BAHRAINI FEMALE

K/ C: SICKLE CELL DISEASE

SYMPTOMATIC GALL STONES

FOR: LAP. CHOLECYSTECTOMY


6/20

Bl investigations?

CBC, LFTs , U&E, HB Electrophoresis, coagulation profile, G& cross

mach.

SCD problems? How to avoid it?

Exchange transfusion,

Hydration ,

Oxygenation ,

Warming,

Antibiotics.

Consent :


7/20

PROBLEM 3

50 YEAR-OLD FEMALE

K/C OF RHEUMATOID ARTHRITIS

ON STEROIDS FOR MANY YEARS

DIAGNOSIS :LARGE P.U.HERNIA

FOR OPERATION


8/20

On co rt icostero ids ? Imuno-compromised

Suprarenal suppression

Shift to IV - - - gradual

Anesthesia problem?


9/20

PROBLEM 4

46-YEAR OLD FEMALE

K/C DYSFUNCTIONAL UTERINE BLEEDING

(FIBROIDS)

FOR: ABDOMINAL HYSTERECTOMY

BODY WEIGHT 150KG

PAST HISTORY OF DVT (LAST DELIVERY)


10/20

DVT high r isk factors?

Virchow

How to p revent?

pre. , during, postop


11/20

PROBLEM 5

70-YEAR-OLD MALE

K / C: CANCER HEAD OF

PANCREAS

OBSTRUCTIVE JAUNDICE FOR: LAPAROTOMY

TRIPLE BY-PASS

(WIPPLES OP)


12/20

Infect ion

Bleeding

Hepato-renal

shutdown --- renal

fai lure


13/20

PROBLEM 6

40-YEAR-OLD MALE

K / C: CHRONIC OBSTRUCTIVE AIRWAY

DIS./ASTHATIC

LEFT INGUINO HERNIA

FOR: REPAIR


14/20

7

BOY 2 YEARS OLD

RIGHT INGUINO HERNIA

FOR HERNIOTOMY


15/20

8

3-YEAR OLD MALE

RIGHT INGUINO HERNIA (RECURRENT)

FOR: OP (REPAIR - MESH)

H/O ALLERGY TO PENICILLIN


16/20

PROBLEM 8

35 years old lady

Diagnosis : symptomatic thyrotxicosis

For subtotal thyrodectomy On medications for two years


17/20

POSTOP. COMPLICATIONS


18/20

A 36-year-old male has been

recovering from an appendectomy.On the seventh post-operative day he

develops crampy abdominal pain,

vomiting, abdominal distention andobstipation. X-rays show air fluid

levels in the small intestine.


19/20


20/20

Documents

Preop. Postop.evaluation