PREOPERATIVE PREPARATION PREOPERATIVE ❏ informed consent ❏ consults - anesthesia, medicine, cardiology, etc. ❏ blood components: group and screen or crossmatch depending on procedure ❏ diet - NPO after midnight ❏ AAT, vital signs routine ❏ IV - balanced crystalloid at maintenance rate (4:2:1 rule) • Ringer's lactate or normal saline ❏ investigations • CBC, lytes, BUN, creatinine, urine analysis • INR/PT, PTT with history of bleeding disorder • ABGs if predisposed to respiratory insufficiency • CXR (PA and lateral) if > 35 years old or previously abnormal within past 6 months • ECG > 35 years old or as indicated by past cardiac history drugs (including oxygen) • patient's regular meds including prednisone - consider pre-op boost • prophylactic antibiotics (on call to OR) (e.g. cefazolin) if • clean/contaminated cases (i.e. GI/GU/respiratory tracts are entered) • contaminated cases - trauma • insertion of foreign material (e.g. vascular grafts) • high risk patients (e.g. prosthetic heart valves, rheumatic heart disease) • bowel prep (decreases bacterial population e.g. Ancef, Cipro, Flagyl) ❏ drains • nasogastric (NG) tube • indications: gastric decompression, analysis of gastric contents, irrigation/dilution of gastric contents, feeding (only if necessary ––> due to risk of aspiration, naso-jejunal tube preferable) • contraindications: absolute - obstruction of nasal passages due to trauma, suspected basilar skull fracture, relative - maxillofacial fractures; for these may use oral-gastric tube • Foley catheter • indications: to accurately monitor urine output, decompression of bladder, relieve obstruction • contraindications: suspected disruption of the urethra, difficult insertion of catheter
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