Transcript Asepsis & antisepsis in surgery

Pre and Postoperative Care
Dept of Surgery
Yong Loo Lin School of Medicine
National University of Singapore
Preoperative Care
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“The most important decision a surgeon can
make is to operate on a patient”
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The decision is a Risk-Benefit Analysis
Goals(Why)
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Recognize and Optimize the risk factors for
surgery
How to do it
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History
Examination
Investigations
History Taking
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Past medical & surgical history
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Cardiac, respiratory, renal, nutrition
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Drug hx
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Social Hx
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Functional status
ASA Classification
Investigations
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Basics (for all age>50)
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FBC, urea/electrolyte
CXR, ECG
Specific (when indicated)
 LFT; PT/PTT
 ABG; Pulmonary function test
 others
Special Preparation
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Management of Diabetes
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DVT Prophylaxis
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Bowel preparation
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Prophylactic antibiotics selectively
Postoperative Care
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Recognize postop complications
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Pain management
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Postop fevers
Postop Complications
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General
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Examples: AMI, CVA, pneumonia/atelectasis,
renal failure
Specific
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Examples: anastomotic leakage, abscess
formation, wound infection, ileus, bleeding
Postop Complications
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General
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Important examples:
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AMI
pneumonia/atelectasis
renal failure
DVT/Pulmonary embolism
CVA
Postop Complications
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Specific
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Examples:
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anastomotic leakage
abscess formation
wound infection
ileus
bleeding
Scenario
Pain Management
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Essential part of postop management
Pain can increase risk of complications
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Pain relief- Multimodal
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E.g. PCA, IM pethidine, oral analgesics
Postop Fevers
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An important sign of postop complications
Many possible DDX
Time of onset may guide the management
Postop Fevers
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First 48hrs
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Atelectasis
Transfusion rxn
Pre-existing infection
3-7 days: infections
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UTI, wound infection, pneumonia, anastomotic
leakage
Postop Fevers
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About 7 days onwards
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Infections
Abscess formation
DVT/PE
Postop Fevers
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History
Examination
Investigations (to confirm the diagnosis)
Summary
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Pre and Postop care are essential parts of
surgical treatment
Good History, physical examination and
selected investigations are the key
Complications do occur, but many are
preventable!
Questions