pre op eval
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PREOP EVALUATION
GOAL: -
Reduce morbidity of surgery.
Increase quantity but decrease cost of preop
care.
Return patient to desirable functioning as
quickly as possible.
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PREOP EVALUATION
PURPOSE OF MEETING BETWEEN PATIENT &
ANAESTHETIST: -
Obtain pertinent information about patients
medical history, physical conditions, thus
determine which tests & consultations needed.
Obtain informed consent.
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Educate patient about anaesthesia preop care
& pain treatments to allay anxiety & facilitate
recovery.
Guided by patient choice & risk factors careplans to be followed.
Make preop care more efficient & less
expensive.
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PREOP EVALUATION
SUMMARY: -
Optimize patient health before surgery.
Plan most appropriate perioperative
management. Reduce rate of cancellation.
Increase patient satisfaction.
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PREOP EVALUATION
Preop evaluation gives
practitioners confidence that
they will not be surprised by
unexpected patient conditions& gives patients confidence
that health care system is
responding to their individualconditions.
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PREOP EVALUATION
A study at the University of Florida inGainesville formed that preop evaluationprovides information leading to changes incare plans for more than 15% of all healthypatient & 20% of all patient in general.
Example of conditioner care: -
- Gastric reflux.
- IDDM & NIDDM- Asthma
- Suspected different int.
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PREOP EVALUATION
HISTORY: -
In the beginning preop assessment relied
only on accurate history taking & physical
examination. In 1960s multiphasescreening lab tests were added to the
procedure
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PREOP EVALUATION:CHANGING
NATURE !!!
Is patient in optimalhealth
Can or should the patientphysical or mental
condition be improved
before surgery.
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PREOP EVALUATION
Does patient have any health problem or useany medication that could unexpectedlyinfluence perioperative events.
Job of anaesthesiologist is not simply to putpatient to sleep & wake him earlier aftersurgery, but to maintain.
Pain therapy.
Haemostatis
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PREOP EVALUATION
Anaesthesiologist must interfere
with stress response induced by
pain & manage the patients
medical problems.
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HISTORYFIRST AREA OF CONCERN
Last anaesthesia.
Any problem (Also in family members)
Allergies.
Blood tests in last 6 months
CXR in last 2 months.
ECG in last 2 months
Medications.Artificial aids (hearing, eyes, denture etc)
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CVS: - Congestive heart failure (CHF) highest risk
Cardiomyopathy
IHD
Valvular HD
HTN
Cardiac rhythm
Carditis
Arteritis.
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RESP & AIRWAY PROBLEMS: -
Evidence of airway obstructions Restricted jaw movements.
Smoking.
Occupational hazard.
Chr bronchitis
Emphysema
Chr infection
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HEPATIC OR GI DISORDERS: -
Hiatus hernia
Hepatitis, Liver ds, Malaria etc. Gall bladder ds
Bloody or tarry stools.
? Frequent, nausea with vomiting
Rx history
BLEEDING PROBLEMS: -
Bleeding Tendency.Anemia.
BT history
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RENAL DS: -
- Kidney problem.
- RF problem.
- Dialysis.
- Infections.- Calculi.
(Voluntary avoidance of food having a high
proteins content is s/o Renal Disease)
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ENDOCRINE DISTURBANCES: -
- End organ effects of DM,
- Thyroid,- parathyroid,
- pituitary,
- adrenal &- carcinoid disease
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QUESTIONS: -
- Frequency of micturition
-diurnal variations
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NEUROLOGICAL DS: -
- QUES
- seizure
- stroke- migraine
- tremors
- nv injury
- numbness,tingling
- antidepressants
- sedatives
- .MUSCULOSKELETAL DS: -
- Arthritis
- LBA
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SENSITIVE AREA OF CONCERY: -
- Pregnancy.
- Illicit drug use.
- AIDS etc
PHYSICAL EXAMINATION: -
- G/E
- S/E
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THANK YOU
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