Preoperative Patient Evaluation
A patient for elective surgery needs thorough evaluation not only for suitability for general anesthesia but also for possible complications related to or arising from the operations(e.g,. A toxic goitre, chronic cough in a hernia patient). Surgical services should be carried out only on level 4 facilities and above. The staff needs to appreciate the abilities of the facility so that high risk procedures are referred to facilities with ICU available unless they are urgent.
A thorough history must be taken. This should include a history of chronic illnesses, a drug history, and a history of previous surgical encounters.
Conduct a thorough physical examination and in particular check for:
- Level of hydration
- Lymph node enlargement
- Respiratory and cardiac function
Assess psychological preparedness for surgery.
Take and record vital signs. For any major operation an observation chart needs to be kept for at least 24 hours before surgery. Specific charts are available for certain disease, conditions, e.g diabetes,hypertension, asthma, etc.
These should include the following:
- Full haemogram
- Urea and electrolytes.
- Blood sugar level
- A chest radiograph is useful
Additional relevant investigations relevant to the diseased system:
- Urine for culture and sensitivity.
- An intravenous urography in most urological operations
- Liver function tests and prothrombin time index (PTI) in hepatobiliary disease.
- Creatinine clearance in renal patients.
- Electrocardiogram (ECG) in hypertensive and known heart patients.
- A thyroid profile may be necessary before thyroid surgery.
TREATMENT-SUPPORTIVE BEFORE SURGERY
These include the following:
- Correction of conditions that are identified in the preoperative evaluation as necessary.
- Correction of volumes and electrolyte imbalance
- Control of blood pressure
- Control of thyrotoxicosis.
- Control of diabetes mellitus(and any other metabolic disease)
- Correction of anaemia and malnutrition
- Prophylactic Antibiotics where indicated (see appropriate section for details).
- Preoperative physiotherapy.
- Counseling the patient and family.
These are prescribed to surgical patients in order to achieve the following objectives:
- Relieve anxiety (oral/parenteral benzodiazepines .
- Antiemetics like metoclopramide (plasil 5-10mg).
- Reduction of secretions(anticholinergics like atropine 0.6 mg,hyoscine 10-20mg).
- Preoperative analgesia(pethidine 1 mg/kg).
- Amnesia (benzodiazepines).
- Reduce gastric fluid pH and volume-Ranitidine 50 mg IV