PRE. & POSTOP.

EVALUATION
Dr Hamdi Al-Shenawi
MB Ch. B, FRCSI Consultant G. Surgeon Assistant Professor of surgery , Medical college, AGU

ASA Classification
ASA I A normally healthy individual: no organic, physiological, biochemical or psychiatric disturbance. ASA II A patient with mild -moderate systemic disturbance: this may or may not be related to the disorder requiring surgical treatment, eg diabetes mellitus, hypertension ASA III A patient with incapacitating systemic disease which is not incapacitating eg heart disease with limited exercise tolerance, uncontrolled hypertension or diabetes ASA IV A patient with incapacitating systemic disease that is a constant threat to life with or without surgery, eg congestive cardiac failure, severe angina. ASA V A moribund patient who is not expected to live and where surgery is performed as a last resort e.g. ruptured aortic aneurysm

PROBLEM I 65-YEAR-OLD MALE DIAGNOSIS: CANCER SIGMOID COLON FOR: SIGMOID COLECTOMY K/C: H.T.N I.H.D D.M

ON ASPIRIN B Blockers ORAL HYPOGLYCEMIC

 Aspirin ?when to withhold before op,? Bl . Investigations?(CBC, U&E, Bl sugar, coagulation profile, cross mach) C XR, ECG, Echo. Cardiac consultation/Control DM Bowel preparation? D/C oral hypoglyceamicsc insulin(sliding scale) B blockers?? IHD & OP, when?

PROBLEM 2 24-YEAR-OLD BAHRAINI FEMALE

K/ C: SICKLE CELL DISEASE

SYMPTOMATIC GALL STONES FOR: LAP. CHOLECYSTECTOMY

Bl investigations?
CBC, LFTs , U&E, HB Electrophoresis, coagulation profile, G& cross mach.

SCD problems? How to avoid it?

Exchange transfusion, Hydration , Oxygenation , Warming, Antibiotics. Consent :

PROBLEM 3
50 YEAR-OLD FEMALE

K/C OF RHEUMATOID ARTHRITIS

ON STEROIDS FOR MANY YEARS DIAGNOSIS :LARGE P.U.HERNIA FOR OPERATION

On corticosteroids ? Imuno-compromised Suprarenal suppression Shift to IV - - - gradual Anesthesia problem?

PROBLEM 4 46-YEAR OLD FEMALE K/C DYSFUNCTIONAL UTERINE BLEEDING (FIBROIDS) FOR: ABDOMINAL HYSTERECTOMY

BODY WEIGHT 150KG

PAST HISTORY OF DVT (LAST DELIVERY)

DVT high risk factors? Virchow

How to prevent?
pre. , during, postop

PROBLEM 5
70-YEAR-OLD MALE K / C: CANCER HEAD OF PANCREAS OBSTRUCTIVE JAUNDICE FOR: LAPAROTOMY TRIPLE BY-PASS (WIPPLES OP)

 Infection Bleeding Hepato-renal shutdown --- renal failure

PROBLEM 6 40-YEAR-OLD MALE K / C: CHRONIC OBSTRUCTIVE AIRWAY DIS./ASTHATIC LEFT INGUINO HERNIA

FOR: REPAIR

7 BOY 2 YEARS OLD RIGHT INGUINO HERNIA FOR HERNIOTOMY

8 3-YEAR OLD MALE RIGHT INGUINO HERNIA (RECURRENT) FOR: OP (REPAIR - MESH) H/O ALLERGY TO PENICILLIN

PROBLEM 8

35 years old lady Diagnosis : symptomatic thyrotxicosis For subtotal thyrodectomy On medications for two years

POSTOP. COMPLICATIONS

A 36-year-old male has been

recovering from an appendectomy. On the seventh post-operative day he develops crampy abdominal pain, vomiting, abdominal distention and obstipation. X-rays show air fluid levels in the small intestine.