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Pre-Op

Pre-Op Procedures and Expectations: Your Complete Guide

A thorough preoperative evaluation is essential for successful surgical outcomes, emphasizing medical history and physical exams. Prehabilitation prepares patients for surgery, focusing on physical and emotional well-being to reduce post-surgery complications.
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By Steve Birnhak
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Medically reviewed by
Dr. Mark Aranson
Comprehensive physical examination
Comprehensive pre-op physical examination

Imagine walking into the operating room feeling confident that you're well-prepared for your upcoming surgery. This level of confidence stems from a thorough preoperative evaluation, which plays a vital role in ensuring a successful surgical outcome. A comprehensive pre-op assessment is the foundation of a smooth surgical experience and a speedy recovery.

In this blog post, we will take you on a journey through the various aspects of pre-op evaluation, from understanding the essentials to managing perioperative risks. Discover the importance of medical history, cardiac and pulmonary examinations, and the role of prehabilitation which  optimizes your health before surgery to deal with potential health issues in the recovery period. Let’s get started!

Key Takeaways

  • Pre-op procedures are necessary to assess a patient’s overall health and identify potential risks.

  • Comprehensive medical history, physical exam including cardiac and pulmonary evaluation, tailored pre-op tests provide an overview of health status prior to surgery.

  • Prehabilitation programs work to support patients before and after surgery with tools such as nutritional supplementation, medications, exercise and stress management.

Understanding Pre-Op: The Essentials

Pre-op procedures aim to assess a patient’s overall health, pinpoint potential risks, and verify physical and emotional readiness for surgery. Conditions such as respiratory, vascular, and cardiac diseases, malnutrition, and diabetes mellitus have been linked to an increased risk of surgical complications. Since surgery is a stressful event for the body, it's vital to have a proper preoperative risk assessment and preoperative cardiac and pulmonary evaluation to minimize the occurrence of surgical complications.

The patient’s medical history is the main element of preoperative evaluation. It helps identify potential risks and complications such as allergies, prior reactions to anesthesia, and existing health conditions like coronary artery disease. The pre-op physical exam is another essential aspect of the evaluation, where physicians assess the patient’s heart, lungs, and overall health. This extensive evaluation aids in customizing the pre-op assessment to the patient’s specific needs, promoting the best surgical outcomes.

The Role of Medical History in Pre-Op Assessment

Medical history assessment
Medical history assessment

An extensive medical history offers important information that can greatly influence the preoperative evaluation process. The patient’s medical record includes:

  • Past and current medical history

  • Surgical history

  • Family history

  • Social history

  • History of allergies

  • Current and recent drug therapy

  • Unusual reactions or responses to drugs

  • Any problems or complications associated with previous anesthesia

Such information helps healthcare practitioners get an overview of a patient’s medical status in order to provide better care, such as allowing healthcare providers to assess the potential risk of pulmonary complication rates ranging from mild to severe.

In addition to a thorough history, a clinical examination is also crucial in determining the presence of a disease. Routine laboratory tests, however, may not present a benefit or cost-effectiveness for apparently healthy patients. Merging medical history with physical examination allows healthcare providers to better recognize patients with a higher risk for perioperative complications and make well-founded decisions about their anesthesia and surgical care.

Physical Exam: A Closer Look at Your Health

During the pre-op physical examination, healthcare providers evaluate the patient’s airway, lungs, and heart, along with recording vital signs. This comprehensive physical examination helps identify potential cardiac and pulmonary complications and ascertain the patient’s functional heart and lung capacity.

We'll discuss in more detail the cardiac and pulmonary evaluations and their importance in pre-op assessment.

Cardiac Evaluation

Evaluating potential cardiovascular risk is necessary to assess the patient’s ability to withstand surgery and anesthesia. Perioperative cardiovascular evaluation plays a crucial role in identifying potential cardiac events, including myocardial infarction, pulmonary edema, ventricular and atrial fibrillation, primary cardiac arrest, and complete heart block, which can have a major impact on the results of a surgical procedure. Ignoring these issues can put the success or failure of operations at risk. A comprehensive cardiac evaluation aids in recognizing these risks, which can be handled through suitable interventions like unblocking cardiac arteries with angioplasty, preventing the blood from dangerous clotting with use of non-steroidal meds like aspirin, and slowing the heart rate and lowering the blood pressure with beta-blockade, and angiotensin-converting enzyme inhibitor therapy.

A cardiac evaluation typically involves a thorough history and physical examination, focusing on risk factors for cardiac complications. Additional tests such as cardiac stress tests or coronary computed tomography angiography (CCTA) which may be ordered based on the patient’s clinical history, comorbidities, and physical examination findings. This comprehensive cardiac assessment helps ensure that the patient is well-prepared for surgery and anesthesia.

Pulmonary Examination

Evaluating pulmonary function is crucial for identifying potential respiratory complications that may occur during surgery, and ensuring the patient’s lungs can handle the stress of surgery. During a pulmonary examination, physicians assess specific signs such as:

  • adventitious lung sounds - any sounds that are out of the ordinary

  • wheezing - whistling or rattling sound in the chest

  • rales - small bubbling, rattling or clicking sounds in the lungs

  • rhonchi - low-pitches noises made when exhaling

  • or other signs of active narrowing of the airway caused by spasm, infection, or tumor

Preoperative pulmonary function testing, including:

  • spirometry, which measures lung air capacity

  • diffusion capacity test, which measures how well the lungs exchange gases, and

  • arterial blood gas analysis, which measures the amount of gases dissolved in arterial blood

can also help assess the patient’s lung function and risk of complications.

Certain risk factors, such as chronic obstructive pulmonary disease, abdominal and thoracic surgery, and emergency surgery, may be associated with perioperative respiratory complications. Recognizing these risk factors and conducting a comprehensive pulmonary examination allows healthcare providers to plan perioperative interventions effectively and improve the patient’s respiratory health before surgery. As surgical and anesthesia complications appear to be more common in these cases, it is crucial to be vigilant and proactive in addressing them.

Pre-Op Testing: What to Expect

Pre-operative assessment
Pre-operative assessment

Pre-op tests are a key part of the preoperative evaluation process, aiding in securing the best possible outcomes for surgical patients. These tests are tailored to the individual patient’s medical history and needs, taking into account factors such as the type of surgery, anesthesia, and any underlying health conditions. Pre-op tests may include blood work, imaging studies, and other diagnostic tests to provide a comprehensive overview of the patient’s health status.

To avoid delays in surgery, patients should ensure that the physicians responsible for their pre-operative tests submit the results to their surgeon and anesthesiologist. Appropriate pre-op testing aids healthcare providers in making well-founded decisions about anesthesia and perioperative care, eventually resulting in better surgical outcomes and a quicker recovery. This is especially crucial for urgent and emergency procedures, where time is of the essence.

Special Considerations for Patients with Specific Conditions

Patients with certain conditions, such as diabetes, heart disease, or those taking anticoagulant medications, require thorough pre-operative management to reduce perioperative risks. For instance, patients on anticoagulant therapy should have their coagulation status optimized before undergoing regional anesthesia to avoid excessive bleeding.

Corticosteroid-treated asthmatics, for example, may need to adjust their medication regimen prior to surgery to minimize the risk of perioperative complications. Consulting with healthcare providers is necessary to determine the required adjustments to medications and any special precautions needed before surgery.

Surgical Procedures and Anesthesia Types

An anesthesiologist monitoring vital signs
An anesthesiologist monitoring vital signs

The type of surgery and anesthesia used can impact perioperative risk, and should be considered during pre-op evaluation. For example, patients undergoing vascular surgery may require intraoperative anticoagulation with heparin; however, in combination with spinal surgery, this potentially might cause abnormal bleeding complications.

Keep in mind that certain medications taken for arthritis and pain like COX-1 & COX-2 inhibitors and NSAIDs, medicines to prevent platelets from sticking together like thienopyridines, and platelet glycoprotein (GP) IIb/IIIa antagonists, are known to increase the risk of bleeding during spinal/epidural anesthesia. Proper management of these medications and anesthesia techniques is crucial in minimizing perioperative risks.

The Day Before Surgery: Final Preparations

Perioperative review
Perioperative review

The day before surgery, patients should follow specific guidelines to ensure they are ready for the procedure. Here are some important steps to take:

  1. Fasting is crucial to decrease the volume and acidity of stomach contents, reducing the likelihood of regurgitation and aspiration during surgery.

  2. Typically, patients are advised not to consume any solid food for a certain period of time.

  3. Clear liquids may be permitted up to a few hours before the surgery.

  4. Any sudden change noted in the immediate pre-op period such as a fever, nausea, cough or “cold”-type symptoms should be immediately reported to the pre-op department where the planned operation is to take place.

Besides fasting, patients may need to modify their medication intake before surgery. For example, abrupt discontinuation of drugs such as clonidine should be avoided to prevent rebound hypertension. Smoking cessation and abstaining from alcohol consumption for at least 24 hours before surgery are also recommended. By adhering to these guidelines, patients can optimize their physical and mental preparedness for surgery.

Getting Help

Prepping for surgery
Prepping for surgery

Seeking additional support and resources can help patients better prepare for surgery and optimize their recovery process. Prehabilitation programs, such as those focusing on exercise, nutrition, and stress management, can significantly improve post-surgical outcomes.

We'll further discuss the role of prehabilitation and useful resources for additional assistance.

The Role of Prehabilitation

Prehabilitation, or physical and emotional preparation before surgery, can have a noticeable impact on post-surgical outcomes and overall recovery. Research has shown that prehabilitation improves various outcome domains preoperatively, including:

  • Nutritional supplementation

  • Smoking cessation

  • Physical and cognitive exercise

  • Stress management

Patients can improve their physical status, reduce functional decline, and optimize their recovery process by participating in prehabilitation exercises such as:

  • Aerobic exercises

  • Resistance exercises

  • Flexibility exercises

  • Balance exercises

  • Strength exercises

  • Inspiratory muscle training

Psychological interventions may also prove beneficial in certain prehabilitation programs.

Valuable Resources for Additional Assistance

Programs like Ready Set Recover offer guidance and support for patients preparing for surgery. Covering topics such as sleep, stress management, and goal setting, this program aims to optimize recovery and overall well-being. Created by health and wellness professionals and approved by physicians, Ready Set Recover provides a comprehensive approach to pre-surgical preparation.

Summary

In conclusion, a comprehensive pre-operative evaluation is crucial in ensuring a successful surgical outcome and a smooth recovery process. By understanding the essentials of pre-op assessment, taking into account medical history, and conducting thorough cardiac and pulmonary evaluations, patients and healthcare providers can work together to minimize perioperative risks.

By seeking additional support and resources, such as prehabilitation programs and organizations like Ready Set Recover, patients can take control of their pre-op journey and optimize their recovery process. With the right preparation and guidance, patients can face surgery with confidence, knowing they have taken every possible step to ensure the best possible outcome.

Frequently Asked Questions

What does pre-op mean?

Pre-op is the time before an operation, meaning "before operation." During this time, you will meet with one of your doctors and/or representatives from surgery and anesthesia, and typically need to have a checkup within the month before surgery.

How long does pre-op take before surgery?

Pre-op may take up to 4 hours, so it is important to bring your packet and personal reading material for the duration of the appointments.

What is a pre-op order for surgery?

A pre-op order for surgery is a process involving a member of the surgery/anesthesia departments who obtains basic information about you and your health, and it may include pre-operative testing such as blood and urine tests.

What is pre-op vs post op?

Pre-operative care involves preparing a patient for surgery, while post-operative care refers to the care patients receive after a surgical procedure.

How does medical history play a role in pre-op assessment?

A thorough medical history is vital for a successful pre-op assessment as it allows medical staff to identify any potential risks and complications, such as allergies, previous reactions to anesthesia, and existing health conditions.

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