Principles of Surgery ppt

Surgery Classification

• Elective Surgery: Scheduled at least 24 hours in advance, non-emergent.
• Emergent Surgery: Required for life-threatening conditions, must occur within hours; time frame can vary.

Emergency Surgery Pre-op Questions: AMPLE

• AMPLE History: Quick essential history for urgent situations.
  • Allergies: Document known allergies, particularly to medications.
  • Medications: List current medications with dosages and frequency.
  • Past Medical History: Note any significant prior medical conditions and surgeries.
  • Last Meal: Record timing and content of the last meal for anesthesia safety.
  • Events/Environment: Describe context leading to injury or illness.

Enhanced Recovery After Surgery (ERAS)

• A new approach to optimize surgical care across pre, intra, and postoperative phases.
• Key outcomes:
  • Faster recovery and less physiological stress.
  • Decreased hospital stay duration and fewer complications.

Surgical Stress Response

• Defined as the body's adaptive response to surgery:
  • Increased secretion of pituitary hormones.
  • Activation of sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS).
  • Effects include salt and water retention, and increased energy mobilization through catabolism.

Preoperative Management

• Importance of maintaining an empty stomach (NPO):

  • Decreases aspiration risk during anesthesia.
  • Clear liquids: 2 hours, light meal: 6 hours, heavy meal: 8 hours before surgery.

• Carbohydrate Loading:

  • Adequate intake of carbohydrates up to 2 hours prior to surgery can prevent fasting-related complications and improve recovery.

ERAS Key Components

• Pre-operative:

  • Patient education and emphasizing their role in recovery.
  • Advising on smoking and alcohol cessation.

• Intra-operative:

  • Infection prevention through skin preparation and use of antibiotics.
  • Minimizing surgery length and invasive procedures.

• Post-operative:

  • Emphasis on multimodal analgesia to manage pain while minimizing opioid use.
  • Importance of early enteral feeding and mobilization to prevent complications.

Fluid and Electrolyte Management

• Monitor fluid status meticulously; urine output is a primary indicator of renal perfusion.

• Total Body Water (TBW) averages 60% of weight in adults; divided into intracellular and extracellular compartments.

• Calculate maintenance fluid needs:

  • 100 ml/kg/day for first 10 kg.
  • 50 ml/kg/day for next 10 kg.
  • 20 ml/kg/day for weight above 20 kg.

• Use isotonic fluids (e.g., Normal Saline, Lactated Ringer's) for rapid volume restoration.

Acute Volume Deficit and Overload

• Volume Deficit Signs: Low blood pressure, high heart rate, decreased urine output.
• Volume Overload Signs: Weight gain, elevated jugular venous pressure, peripheral edema, rales.

Surgical Team Structure

• Attending Surgeon: Senior physician with overall patient responsibility.
• Fellows and Residents: Surgeons in various stages of training.
• Operating Room Team: Includes anesthesia providers (MD anesthesiologists & CRNAs), scrub nurses, and circulating nurses/techs.

Types of Surgical Procedures

• Open Surgery: Traditional technique allowing large access (e.g., laparotomy).
• Endoscopic Surgery: Minimally invasive methods (e.g., laparoscopic).
• Robotic Surgery: Surgeons operate remotely using robotic technology.