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PRE. & POSTOP.
EVALUATION
Dr Hamdi Al-ShenawiMB Ch. B, FRCSI
Consultant G. Surgeon
Assistant Professor of surgery , Medical college, AGU
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ASA Classification
ASA IA norm ally healthy individ ual: no organic, physiological,biochemical or psychiatric disturbance.
ASA IIA pat ient wi th mi ld -moderate systemic d isturbance: thismay or may not be related to the disorder requiring surgicaltreatment, eg diabetes mellitus, hypertension
ASA IIIA patient with in capacitat ing sy stemic d iseasewhich isnot incapacitating eg heart disease with limited exercise tolerance,uncontrolled hypertension or diabetes
ASA IVA patient w ith incapacitat ing sys temic dis ease that is aconst ant threat to l i fewith or without surgery, eg congestivecardiac failure, severe angina.
ASA VA moribund patient who is not expected to live and wheresurgery is performed as a last resort e.g. ruptured aortic aneurysm
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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
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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?
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PROBLEM 2
24-YEAR-OLD BAHRAINI FEMALE
K/ C: SICKLE CELL DISEASE
SYMPTOMATIC GALL STONES
FOR: LAP. CHOLECYSTECTOMY
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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 :
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PROBLEM 3
50 YEAR-OLD FEMALE
K/C OF RHEUMATOID ARTHRITIS
ON STEROIDS FOR MANY YEARS
DIAGNOSIS :LARGE P.U.HERNIA
FOR OPERATION
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On co rt icostero ids ? Imuno-compromised
Suprarenal suppression
Shift to IV - - - gradual
Anesthesia problem?
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PROBLEM 4
46-YEAR OLD FEMALE
K/C DYSFUNCTIONAL UTERINE BLEEDING
(FIBROIDS)
FOR: ABDOMINAL HYSTERECTOMY
BODY WEIGHT 150KG
PAST HISTORY OF DVT (LAST DELIVERY)
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DVT high r isk factors?
Virchow
How to p revent?
pre. , during, postop
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PROBLEM 5
70-YEAR-OLD MALE
K / C: CANCER HEAD OF
PANCREAS
OBSTRUCTIVE JAUNDICE FOR: LAPAROTOMY
TRIPLE BY-PASS
(WIPPLES OP)
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Infect ion
Bleeding
Hepato-renal
shutdown --- renal
fai lure
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PROBLEM 6
40-YEAR-OLD MALE
K / C: CHRONIC OBSTRUCTIVE AIRWAY
DIS./ASTHATIC
LEFT INGUINO HERNIA
FOR: REPAIR
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7
BOY 2 YEARS OLD
RIGHT INGUINO HERNIA
FOR HERNIOTOMY
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8
3-YEAR OLD MALE
RIGHT INGUINO HERNIA (RECURRENT)
FOR: OP (REPAIR - MESH)
H/O ALLERGY TO PENICILLIN
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PROBLEM 8
35 years old lady
Diagnosis : symptomatic thyrotxicosis
For subtotal thyrodectomy On medications for two years
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POSTOP. COMPLICATIONS
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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 andobstipation. X-rays show air fluid
levels in the small intestine.
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