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Neurologic Preoperative Risks
- Increased ICP
- Coma
- Seizures
- Contaminated or open wound
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Preoperative management of increased ICP
- CSF drainage via ventricular or lumbar catheter
- Steroids: dexamethasone, prednisone, hydrocortisone
- Controlled anesthesia induction:hyperventilation, narcotics
-
Preoperative management of of Coma
- early intubation, assessment, and systemic stabilization
- ICP management
- Treatment of urinary retention: bladder catheter
-
Preoperative management of contaminated or open wound
antibiotics to cover skin contaminants and prompt debridement and secondary closure
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Systemic Peroperative Risks include areas
- CV
- Respiratory
- Endocrine
- Hematologic
- Gastrointestinal
- Genitourinary
- Renal
- Fluids and electrolytes
- Infection
-
Cardiovascular Risks
Control of hypertension, hypotension, and arrhythmias
-
Respiratory Risk Factors
- Pulmonary function test
- Chest x-ray - complacation lesion and need for bronchodilation
-
Endocrine risk factors
- diabetes management
- pituitary assessment
- steroid coverage for stress management
-
Hematologic risk factors
- coagulation disorders and plts
- anemia evaluation
-
Gastrointestinal risk factors
- Risk of aspiration
- General nutrition for healing
-
Genitourinary risk factors
Management of urinary infections and drainage
-
Renal risk factors
dialysis
-
Fluid and electrolyte risk factors
- Metabolic balance
- Control of electrolytes
-
Infection risk factors
identification of source, treatment with antibiotics
-
Preoperative preparation and consent
- Nature of condition
- Proposed tx and possible complications
- Alternative forms of treatment
- Customary and usual treatment schemes
- Expected benefit of proposed tx not guaranteed
-
Perioperative Medications
- Perioperative antibiotics
- Perioperative steroids
- Hypertonic solutions
- Antihypertensives
- Anticonvulsants
-
Periooperative antibiotics
- 1st dose prior to anesthesia
- continue through sx until closure unless infx demonstrated
-
Perioperative steroids
- spinal cord injury
- brain tumor edema
- increased ICP
- dexamethasone 10-29 mg loading, 4 to 6 gm Q6
-
hypertonic solutions
- mannitol 1g/kg for increased ICP to assist retraction
- 3% saline for persistent hyponatremia
-
antihypertensives
prevent immediated postoperative bleeding for management of SAH
-
anticonvulsants
full preoperative load when risk of seizure exceeds 5-10% or after seizure occurs
-
intraoperative medications
- IV narcotics
- Inhalation agents
- Hyperventilation
- NO
- muscle paralysis agents
- local anesthetics
- hypertensives
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