Surgical Care 101: Preoperative Evaluation

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@FinestCarolingianArt

Study Notes

Obtain a history and physical (H&P) within 30 days prior to surgery
ASA classification is used to determine the degree of perioperative risk, ranging from ASA I (healthy) to ASA VI (brain dead)
RCRI (Revised Cardiac Risk Index) is used to assess the risk of developing post-cardiac complications, and cardiac consult is only necessary if the result will change care
VTE (Venous Thromboembolism) risk is assessed using the Caprini risk assessment tool

Surgical site infection (SSI) is predicted by post-op hyperglycemia >140 mg/dL, emphasizing the need to tightly control diabetes
Hypoalbuminemia carries a 5x risk for SSI post-op

Give prophylactic antibiotics 1 hour before incision
Consider holding antibiotics until after culture with concern for abscess, septic joint, etc.

Anesthesia options range from local to general, with monitored anesthesia care (MAC) and conscious sedation being intermediate options
Monitored Anesthesia Care (MAC) involves IV sedation (propofol), allowing patients to breathe on their own
Conscious sedation involves IV sedation and analgesic (fentanyl and versed), allowing patients to breathe and be conscious

The layers of the lateral abdominal wall, from superficial to deep, are: skin, subq, superficial fascia, deep fascia, musculoaponeurotic layers, investing fascia, fascia transversalis, and pre-peritoneal fatty tissue/extraperitoneal fat
The arcuate line marks the lower boundary of the posterior rectus sheath, and C-sections are performed below this line (Pfannenstiel incision)

Hasselbach's triangle is the anatomical region used for laparoscopic inguinal hernia repair, bounded by the lateral border of rectus abdominus, inferior epigastric artery, and inguinal ligament
Calot's triangle is the anatomical region used for laparoscopic cholecystectomy, bounded by the cystic duct, cystic artery, and common hepatic duct
The epigastric arteries and iliohypogastric/ilioinguinal nerves are important structures to avoid during laparoscopic surgery

Toothed forceps/skin hooks are preferred over regular forceps to handle wounds and avoid crushing wound edges

Patients requiring IV treatment or meeting the 2 midnights rule (requiring 2 nights of inpatient care) are candidates for admission
Admit orders should follow the ADC VANDIMALS format, including admit to, diagnosis, condition/code status, vitals, activity, nursing instructions, diet, IV fluids, meds, allergies, labs, and special studies/consults/instructions