1. Pre and Postoperative Care Dept of Surgery Yong Loo Lin School of Medicine National University of Singapore

2. Preoperative Care “The most important decision a surgeon can make is to operate on a patient” The decision is a Risk-Benefit Analysis

3. Goals(Why) Recognize and Optimize the risk factors for surgery

4. How to do it History Examination Investigations

5. History Taking Past medical & surgical history  Cardiac, respiratory, renal, nutrition Drug hx Social Hx  Functional status

6. ASA Classification

7. Investigations Basics (for all age>50)  FBC, urea/electrolyte  CXR, ECG Specific (when indicated)  LFT; PT/PTT  ABG; Pulmonary function test  others

8. Special Preparation Management of Diabetes DVT Prophylaxis Bowel preparation Prophylactic antibiotics selectively

9. Postoperative Care Recognize postop complications Pain management Postop fevers

10. Postop Complications General  Examples: AMI, CVA, pneumonia/atelectasis, renal failure Specific  Examples: anastomotic leakage, abscess formation, wound infection, ileus, bleeding

11. Postop Complications General  Important examples: AMI pneumonia/atelectasis renal failure DVT/Pulmonary embolism CVA

12. Postop Complications Specific  Examples: anastomotic leakage abscess formation wound infection ileus bleeding

13. Scenario

14. Pain Management Essential part of postop management Pain can increase risk of complications Pain relief- Multimodal  E.g. PCA, IM pethidine, oral analgesics

15. Postop Fevers An important sign of postop complications Many possible DDX Time of onset may guide the management

16. Postop Fevers First 48hrs  Atelectasis  Transfusion rxn  Pre-existing infection 3-7 days: infections  UTI, wound infection, pneumonia, anastomotic leakage

17. Postop Fevers About 7 days onwards  Infections  Abscess formation  DVT/PE

18. Postop Fevers History Examination Investigations (to confirm the diagnosis)

19. Summary 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!

20. Questions