peri operative care basic understanding for medical student

1. PERIOPERATIVE CARE

2. What is meant by perioperative?
Perioperative is a term used to describe the
entire span of surgery, including what occurs
before, during and after the actual operation.

3. Phases of perioperative care
• Preoperative : begins with decision to perform surgery and continues
until the patient has reached the operating area.
• Intraoperative: incudes the entire duration of surgical procedure, until
transfer of patient to the recovery area.
• Postoperative: begins with admission to recovery area and continues
until the patient receives a follow up evaluation at home, or is
discharged to rehabilitation unit.

4. Classifications of surgery
purpose
• Diagnostic
• Exploratory
• Curative
• Palliative
• cosmetic
Degree of risk
• Major
• Minor
Urgency
• Emergency
• Urgent
• Required
• Elective
• optional

5. Preoperative evaluation and optimisation
Each patient and each procedure require a unique set off investigation
with regards to preoperative preparations. But in general for a surgical
patient we begin with following-
1. Thorough history and physical examination- giving specific attention
to comorbidities that may affect surgical risk and require additional
pre-op workup.
2. Basic laboratory investigation-CBC, liver function test, renal function
test, serum electrolytes, coagulation study, blood grouping, albumin
level, urinalysis, pregnancy testing
3. Chest xray
4. Ecg

6. American society of anaesthesiologist physical
status classification

7. Preoperative preparation of a surgical patient
1. Detailed written surgical consent
2. Patient preparation-
• Skin prep- bathing and hair clipping
• GIT prep- Npo for 8 hr for solids, 6 hr for liquids, dulcolax/charcoal or
cleansing enema.
• Clean gown/clothes .
• cover hairs, remove all ornaments and nail polish.
• adequate sleep for 6-8 hr.
3. Preoperative medications
Antibiotic, sedative, antacid, Dvt prophylaxis, analgesic, antiemetic.

8. Scrubbing up-

9. Intraoperative

10. Postoperative
Immediate postoperative care-
• Airway patency
• Effectiveness if respiration
• Presence of artificial airways
• Mechanical ventilation, or supplemental oxygen
• Circulatory status, vital signs
• Fluid balance – input/output from catheters, drains, ability to void.
• Level of consciousness.

11. • Ongoing assessment
1. General condition
2. Vitals
3. Fluid status
4. Respiratory ,cardiovascular function
5. Pain level
6. Bowel, bladder function
7. Wound condition
8. Tubes, drains, iv lines.

12. Enhance recovery after surgery -ERAS

13. For futher study
• bailey and love’s short practice of surgery 27 th edition
• Sabiston text book of surgery 21 st edition
• Treadwell JR, Lucas S, Tsou AY. Surgical checklists: a systematic review of impacts and implementation. BMJ
Qual Saf. 2014;23(4):299-318. doi:10.1136/bmjqs-2012-001797
• Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: Time to
change practice?. Can Urol Assoc J. 2011;5(5):342-348. doi:10.5489/cuaj.11002

14. THANK YOU