16 Questions
What physiological change can occur due to the stress of major surgery?
Increased endocrine responses
What is the purpose of careful preoperative planning?
To minimize the unwanted effects of physiological changes
What should the preoperative clinic assessment include?
Systematic history taking, examination, and investigation
Which team members should ideally be involved in the preoperative planning?
Multidisciplinary team including primary care physician, specialist nurses, physiotherapist, dietician, and perioperative physician
Where can useful baseline information be obtained for preoperative planning?
Hospital notes and primary care physician records
What does the stress of major surgery lead to in terms of oxygen demand?
Up to 40% increase in oxygen demand
What is the primary goal of preoperative planning?
To gather and record all relevant patient information
Why is it important to discuss anesthesia and the effects of comorbid conditions with the patient?
To anticipate and plan for adverse events
What should be done before the start of each surgery list, according to the National Patient Safety Agency’s adaptation of the World Health Organization’s checklist?
Conduct a 'team brief' to share information with the theatre team
Why should recreational drug use and alcohol consumption be noted during patient assessment?
To anticipate and plan for adverse events
What should be documented as part of a patient's history during preoperative planning?
Thorough past medical history, surgical history, systemic enquiry, and important negatives
Why is it important for patients to receive adequate hydration, nutrition, and exercise advice?
To anticipate and plan for adverse events
What is the purpose of a 'team brief' before the start of each surgical list?
To anticipate and plan for adverse events
Why should the surgeon and anaesthetist plan the safest anaesthetic technique and operation for the patient?
To anticipate and plan for adverse events
What should be done for patients with severe comorbidities or undergoing high-risk surgery?
Refer them to specialists to quantify and reduce perioperative risks
Why is it important to have key personnel involved in planning the surgical list order?
To enable the list to run smoothly on the day
Study Notes
Physiological Changes Due to Major Surgery
- The stress of major surgery can lead to increased oxygen demand, which can be detrimental to patients with pre-existing conditions.
Importance of Preoperative Planning
- The primary goal of preoperative planning is to minimize risks and optimize patient outcomes.
Key Components of Preoperative Clinic Assessment
- The preoperative clinic assessment should include a thorough review of the patient's medical history, including comorbid conditions, medications, and allergies.
Multidisciplinary Involvement in Preoperative Planning
- Ideally, the preoperative planning team should include the surgeon, anaesthetist, and other relevant healthcare professionals.
Sources of Baseline Information
- Useful baseline information for preoperative planning can be obtained from the patient's medical history, previous test results, and consultations with other healthcare professionals.
Importance of Patient Education
- It is essential to discuss anesthesia and the effects of comorbid conditions with the patient to ensure they are informed and prepared.
- Patients should receive adequate hydration, nutrition, and exercise advice to optimize their recovery.
Preoperative Checklist
- Before the start of each surgery list, the National Patient Safety Agency's adaptation of the World Health Organization's checklist should be completed to ensure all necessary steps have been taken.
Patient History and Assessment
- The patient's history should be thoroughly documented, including recreational drug use and alcohol consumption, to identify potential risks and complications.
Team Briefing and Planning
- A 'team brief' should be conducted before the start of each surgical list to ensure all team members are aware of the patient's history, medical conditions, and any specific requirements.
- The surgeon and anaesthetist should plan the safest anaesthetic technique and operation for the patient.
- For patients with severe comorbidities or undergoing high-risk surgery, additional planning and precautions should be taken.
- Key personnel should be involved in planning the surgical list order to ensure efficient and safe use of resources.
Test your knowledge of preoperative care, including the high-risk surgical patient, as outlined in Chapter 21 of Bailey & Love. This quiz covers topics such as preoperative preparation for surgery, surgical, medical and anaesthetic assessment, and optimizing patients' condition.
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