Topics:
Abdominal Trauma, Abdominal Tuberculosis, Ascitis,
Burns,
Ca Colon,
Chemotherapy for Colorectal Ca, Colonoscopy,
Constipation,
Esophageal varices, Evidence based surgery, Gall Bladder,
GERD,
GI Bleed,
GI Endoscopy,
GI Malignancy,
Hernia,
Inflammatory Bowel Disease(1),
Inflammatory Bowel Disease (2),
Intestinal Obstruction, Laparoscopy Diagnostic,
Laparoscoy FAQs
Laparoscopy Operative, Liver function,
Obstructive Jaundice, Pancreatitis,
Peptic Ulcer, Piles/Fissure/Fistula,
Portal Hypertension,
PR (per rectal examination), Serum tumor markers,
Shock
Lectures:
Ano-rectal abscess
Anti-biotics in coloproctology
Applied anatomy of the Ischio-Rectal Fossa
Bowel Preparation
Diverticulosis
Fissure in Ano
GERD
Hiatal Herniae(1)
Hiatal Herniae(2)
Irritable Bowel Syndrome
Laparoscopy History
Laparoscopy Anaesthesia
Onco Surgery
Pilonidal sinus
PR - Per-rectal examination
Pre-Operative Preparation

PRE OPERATIVE PREPERATION

 

You loose any battle if fought without preperation.

We know you're your role. Unfortunately you do not realise the importance of your job.

Neglegiance is because one does not understand the implications of his carelessness.

Accomplishment of successful surgery is a team work.

Reception is like an Air hostess for a plane. They give you warm welcome and guide you in.

Pre op preperation is like maintainace ground staff working at 2 AM in midnight in hangers, checking every thing minutely for the flight due to take off at 8 AM in morning.

Surgeon is a Pilot, Assistant co pilot and the anaesthetist is navigator. Take off is smooth if pre flight check up wasthourough.

Post op care is post op maintainace again by the ground staff.

Any airliner is a hospital which gains good reputation if the accident rate is zero.

Will it be possible if there is lacuna or carelessness at any point?

The strength of any chain is it's weakest link. Don't become a weak link for any organisation.

Realise your importance, do your job sincerely and enjoy your job wherever you are posted. At times you will be rewarded without any efforts, like in labour room. The lady inside will be taking pains for you and you will be greeted outside by grand parents when you hand them over the cute baby. Where as when you will be posted in OT doing steralisation, your sincerity will bring down the infection rate, but no body will know you. So enjoy your work.

Knowledge brings fear. Once you know the importance of each pre op order, you will do it by heart. If you know that the BP falls immediately after spinal anaesthesia , you will like to start the drip 2 hrs before surgery. If you know that wound gets infected in diabetes, you will get a Blood sugar done. If a person doing shaving knows it's importance, he will do it carefully.

The main lesson for today is become knowledgeble, teach to your juniors, sincerity will automatically follow.

PRE OPERATIVE ORDERS

Purpose :

It is to reduce the infection rate and make the patient fit to undergo Anaesthesia and Surgery.

Why not suggestions??

Why not request??

Because it has to be followed without any alterations, without applying any brains, like that followed in army.

Routine Pre Op orders

Take written consent.

It is written, not verbal.
Explaination is necessary in his own language.
Wittnessess should be other than his own family.
You should explain and take the permission for mutilation, like an amputation, hysterectomy, Oopherectomy, Mastectomy or removal of the Testes etc. It is his body and he has full right to take the decision, may it be wrong according to you.
Now we also offer the choice of anaesthesia to the patient and try to make it possible.
Consent should be taken a day before, so he has time to think over finally, not on the way to OT or after shifting in the OT. It is a serious matter, not formality.

Do Xylocaine ST

It is a risky drug, hence we do a sensitivity test. It is not mere an elevation of a bleb intradermally, making a roung circle all around and going away without even telling your friend in over.
Do it in presence of a duty doctor, keep the emergency drug tray fore hand. Write Xylocaine on the spot so others know about what is this bleb.
Take history of previous allergies before you inject.
Do not do it if no relative is around.

Prepare the parts

Preperation of the operative area and around needs the knowledge of procedure planned. Ask the surgeon if you do not know it. It is necessary to reduce infection and makes easy for adhesive tape.

Do not forget back. It is for the hygeine of spinal anaesthesia. Shaving of pubic hair makes catheterisation clean. Trimming of scalp hair is also good.

Cuts and abrasions make patient more prone for infections and the whole purpose is defeated.

A good bath with hot water and soap, cleaning of feet, specially in villagers, and thorough cleaning of operation area will reduce infection rate and keep OT clean. It is a good practice to make them purchase a new pair of socks. Similarly do not forget to clip the nails and remove all bangles, ornaments and nail polish. It affects pulse oxymeter and makes difficult to apply the leads.

All above is nothing but making the patient more and more clean, in turn reducing the bacterial load wihich he is carrying with him.

An enema to be give previous night should be planned in such a way that he has eased fully before you give him a shot of sedation.

Sedation should not be give to a sleeping patient. Don't make him sleepless whole night due to a harshly given Inj Calmpose.

First shot of antibiotic should be given in presence of a duty doctor.

Blood tests

Are advised to screen the organs. Apart from blood sugar, Serum creatinine is to know about the functioning of kidneys, LFT is for liver.

ECG

To know about heart

X Ray chest

Tells a lot about lungs.

Please attach all investigations in chronological order. If any investigation is before more than one month please inform your consultant. At times we miss it and we appreciate if you point out.

May be a lady informs you about the date of menstruation and has the hesitation to tell a male consultant. Your information could alter the date of surgery.

Your active participation is expected.

Blood which is arranged a night ago should be properly labelled and stored.
Wraping in cotton never makes it warm. Best way is to hold it against the body. Again, it is a wrong practice to make the patient do this and drain her body heat.

Pre op loading of fluids

Cannot be done in haste. When it is written to start before 2 hrs, you have no choice.

Shift the patient to OT when called.
Please do not do it early and do it fast when called.

 

 

Don't hesitate to ask that you do not know.

This is a game of life and death. Your one lie could kill the patient and we rely on you.

Either
it is Yes,
it is NO
or
it is I DON'T KNOW Sir.
There should not be any fourth reply like Jahan tak yaa shayad blood sugar ho gaya hai.

Remember….

You are dealing with a patient, who is a living thing with all feelings like you, for you he may be one of the case in your list of 6 or 8 operations, but for him, his life is at stake, may be he has come to the hospital ar for that matter to any city for the first time. Imagine his anxiety, fear and apprehension and behave accordingly.

All of us are employed by God and given the opportunity to serve the humanity and we are doing it with skills bestowed by him.
Don't loose it !

 

With all good wishes

Dr D.U.Pathak
Jabalpur Hospital.

Dec 14th 2005

JABALPUR HOSPITAL AND RESEARCH CENTRE , RUSSEL CHOWK, JABALPUR (MP)

Dept of General Surgery and Laparoscopy

Dr D.U.Pathak
MS FICS FACRSI
Reg No - 3091.
Dipl Lap Surgery
Gen/Colorectal/Laparoscopic Surgeon
GI Endoscopist

Ex Executive Menber & Vice President Asso of Colon & Rectal Sutgeons of India.
Trained in Lap Surgey Basic at Sir Gangaram Hosp New Delhi
Advance course at Gem hospital Coimbatore

Life member :
AMA, ASI, ACRSI, IAGES, AMASI, IASG, ISG, IASO, ICS.