Preparation for surgery

Elective and emergency patients require different preparation.

Elective cases

• Consider pre admission clinic to address medical issues.
• Blood tests including FBC, U+E, LFTs, Clotting, Group and Save
• Urine analysis
• Pregnancy test
• Sickle cell test
• ECG/ Chest x-ray

Exact tests to be performed will depend upon the proposed procedure and patient fitness.

Risk factors for development of deep vein thrombosis should be assessed and a plan for thromboprophylaxis formulated.

Diabetes

Diabetic patients have greater risk of complications.

Poorly controlled diabetes carries high risk of wound infections.

Patients with diet or tablet controlled diabetes may be managed using a policy of omitting medication and checking blood glucose levels regularly. Diabetics who are poorly controlled or who take insulin will a require variable rate intravenous insulin infusion. Potassium supplementation should also be given.

Diabetic cases should be operated on first.

Emergency cases

Stabilise and resuscitate where needed.

Consider whether antibiotics are needed and when and how they should be administered.
Inform blood bank if major procedures planned particularly where coagulopathies are present at the outset or anticipated (e.g. Ruptured AAA repair)
Don't forget to consent and inform relatives.

Special preparation

Some procedures require special preparation:

• Thyroid surgery; vocal cord check.
• Parathyroid surgery; consider methylene blue to identify gland.
• Sentinel node biopsy; radioactive marker/ patent blue dye.
• Surgery involving the thoracic duct; consider administration of cream.
• Pheochromocytoma surgery; will need alpha and beta blockade.
• Surgery for carcinoid tumours; will need covering with octreotide.
• Colorectal cases; bowel preparation (especially left sided surgery)
• Thyrotoxicosis; lugols iodine/ medical therapy.