Anaesthesia for Emergency Surgical Procedures
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Optimization of patients for anaesthesia is a dynamic process. In extreme emergencies it may not be possible to stabilize a patient fully before theater but the process must be instigated immediately on admission, to allow the best chance of a good outcome for the patient. This is multidisplinary decision of weighing risk vs benefit and managing clinicians and anaesthetists must work together
Septic hypotensive patients must be resuscitated and source isolation surgery commenced within 12 hours of admission.
ALL patients requiring resuscitation should have 2 wide bore (18G or larger for adults) placed and rapid infusion of isotonic fluids commenced immediately. A urinary catheter must also be placed. Close monitoring of these patients is paramount.
Uncontrolled haemmorhage is an indication for surgery with or without the availability of blood. All efforts should be made to make blood available.
If patient requires referral, ensure patient is stable to survive transfer. LIFE SAVING SURGERY (eg stopping bleeding/ delivery of eclamptic) SHOULD BE PERFORMED PRIOR TO REFFERAL.
INVESTIGATIONS PRIOR TO SURGERY
Minor Surgery (Excision, biopsy, suturing, MUA, I & D)
|
ASA1 |
ASA2 |
ASA3 |
FBC |
N/A |
N/A |
N/A |
Clotting |
N/A |
N/A |
|
U&E/kidney function |
N/A |
N/A |
|
ECG |
N/A |
N/A |
Consider if no ECG in past 12 months |
CXR |
N/A |
N/A |
|
Intermediate (hernia, knee arthroscopy, tonsillectomy, adenoidectomy)
|
ASA1 |
ASA2 |
ASA3 |
FBC |
N/A |
N/A |
Yes |
Clotting |
N/A |
|
Consider in patients with chronic liver dzz and taking anticoagulants |
U&E/kidney function |
N/A |
Consider in patients at risk of AKI |
Yes |
ECG |
N/A |
Consider for people with cardiovascular, renal or diabetes comorbidities |
Yes |
CXR |
N/A |
N/A |
Consult |
Major (laparatomy, c/s, thoracotomy)
|
ASA1 |
ASA2 |
ASA3 |
FBC |
Yes |
Yes |
Yes |
Clotting |
N/A |
Consider in patients with Chronic liver disease |
Consider in patients with chronic liver disease |
U&E and CR (Renal function) |
Consider in patients at risk of AKI |
Yes |
Yes |
ECG |
N/A |
Consider in patients with heart disease and HTN |
Consider in patients with heart disease and HTN |
CXR |
|
Yes |
Yes (pt with heart disease, htn chest disease) |