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The prevalence of obesity has tripled worldwide over the past four decades. The United States has the highest rates of obesity, with 88% of the population being overweight and 36% obese. The UK has the sixth highest prevalence of obesity. The problem of obesity is not isolated to the developed world and has increasingly become an issue in the developing world as well. Obesity carries an increased risk of many serious diseases and health conditions, including type 2 diabetes, heart disease, stroke, sleep apnea, and certain cancers. Our ability to take care of this population safely throughout the perioperative period begins with a thorough and in-depth preoperative assessment and meticulous preparation. The preoperative assessment begins with being able to identify patients who suffer from obesity by using diagnostic criteria and, furthermore, being able to identify patients whose obesity is causing pathologic and physiologic changes. A detailed and thorough anesthesia assessment should be performed, and the anesthesia plan individualized and tailored to the specific patient's risk factors and comorbidities. The important components of the preoperative anesthesia assessment and patient preparation in the patient suffering from obesity include history and physical examination, airway assessment, medical comorbidities evaluation, functional status determination, risk assessment, preoperative testing, current weight loss medication, and review of any prior weight loss surgeries and their implications on the upcoming anesthetic. The preoperative evaluation of this population should occur with sufficient time before the planned operation to allow for modifications of the preoperative management without needing to delay surgery as the perioperative management of patients suffering from obesity presents significant practical and organizational challenges.

Some drugs should be discontinued preoperatively. The monoamine oxidase inhibitors should be withdrawn 2-3 weeks before surgery because of the risk of interactions with drugs used during anesthesia. The oral contraceptive pill should be discontinued at least 6 weeks before elective surgery because of the increased risk of venous thrombosis.

Preoperative Preparation Ppt Download

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Surgical complications occur frequently. One large study17 documented at least one complication in 17% of surgical patients. Surgery-related morbidity and mortality generally fall into one of three categories: cardiac, respiratory and infectious complications17. The overall risk for surgery-related complications depends on individual factors and the type of surgical procedure. For example, advanced age places a patient at increased risk for surgical morbidity and mortality. The reason for an age-related increase in surgical complications appears to correlate with an increased likelihood of underlying disease states in older persons18. Diseases associated with an increased risk for surgical complications include respiratory and cardiac disease, malnutrition and diabetes mellitus7. With respect to the type of surgery, major vascular, intraabdominal and intrathroracic surgical procedures, as well as intracranial neurosurgical procedures are frequently associated with increased perioperative morbidity and mortality19, 20. In addition, urgent and emergency procedures constitute higher risk situations than elective, nonurgent surgery and present a limited opportunity for preoperative evaluation and treatment.

Patients with poor functional status should undergo noninvasive cardiac testing unless low-risk surgery is planned. Patients with good or excellent functional status require noninvasive testing only if they are having high-risk surgery. Finally, patients with minor risk predictors or no risk predictors should have noninvasive testing if they have poor functional status and are about to undergo high-risk surgery. Importantly, no preoperative cardiovascular testing should be performed if the results will not change perioperative management.

The most significant of these risk factors is the site of surgery, with abdominal and thoracic surgery having pulmonary complication rates ranging from 10 to 40 percent25. As a rule, the closer the surgery is to the diaphragm, the higher the risk of pulmonary complications. The most important modifiable risk factor is smoking. The relative risk of pulmonary complications among smokers as compared with nonsmokers ranges from 1.4 to 4.3. Unfortunately, the risk declines only after eight weeks of preoperative cessation26. This interval allow the mucociliary transport mechanism to recover, the secretions to decrease and the carbon monoxide levels in the blood to drop.

Adequate control of blood glucose concentration (< 180 mg/dL) must be established preoperatively and maintained until oral feeding is resumed after operation. Oral hypoglycemic agents are withheld the day of surgery for an agent with a short half-life and up to 48 h preoperatively for a long acting agent such as chlorpropamide. A combination of glucose and insulin is the most satisfactory method of overcoming the deleterious metabolic consequences of starvation and surgical stress in the diabetic patient. Generally, there is no need for insulin infusion in diabetics who are diet-controlled regardless of type of surgery, or in diabetics who are on oral agents only and are undergoing minor surgeries.

We sought to determine whether an extensive behavioral preparation program for children undergoing surgery is more effective than a limited behavioral program. The primary end point was child and parent anxiety during the preoperative period. Secondary end points included behavior of the child during the induction of anesthesia and the postoperative recovery period. Several days before surgery, children (n = 75) aged 2-12 yr randomly received either an information-based program (OR tour), an information + modeling-based program (OR tour + videotape), or an information + modeling + coping-based program (OR tour + videotape + child-life preparation). Using behavioral and physiological measures of anxiety, we found that children who received the extensive program exhibited less anxiety immediately after the intervention, in the holding area on the day of surgery, and on separation to the operating room. These findings, however, achieved statistical significance only in the holding area on the day of surgery (44[10-72] vs 32[8-50] vs 9[6-33]; P = 0.02). Similarly, parents in the extensive program were significantly less anxious on the day of surgery in the preoperative holding area, as assessed by behavioral (P = 0.015) and physiological measures (P = 0.01). In contrast, no differences were found among the groups during the induction of anesthesia, recovery room period, or 2 wk postoperatively. We conclude that children and parents who received the extensive preoperative preparation program exhibited lower levels of anxiety during the preoperative period, but not during the intraoperative or postoperative periods.

Implications: The extensive behavioral preoperative program that we undertook had limited anxiolytic effects. These effects were localized to the preoperative period and did not extended to the induction of anesthesia or the postoperative recovery period.

Children undergoing surgery can experience significant preoperative anxiety and fear, which has been linked to regressive postoperative behaviors. Psychological preparation has been shown to reduce anxiety at time of anesthesia induction as well as negative behavioral changes after surgery. The current study seeks to provide insight into the impact of a video modeling intervention on preoperative anxiety and postoperative behavior changes.

This study found that an informational video designed by a child life specialist is an effective tool for reducing preoperative anxiety and postoperative behavior changes in children ages 5 to 10 years old undergoing ambulatory surgery.

The video intervention benefitted patients when added to the provision of standard child life specialist services. Video modeling interventions, particularly when informed by the expertise of a child life specialist, are a useful modality for preoperative preparation of pediatric patients.

Research into which preparation techniques are most beneficial is limited and warrants further study. No standard of preparation technique exists, although there is some evidence for the use of specific approaches. Informational videos based on modeling reduce anxiety at time of anesthesia induction, as well as negative post-surgery behavioral changes (Batuman et al., 2016).

The current study, a double-blind, pretest-posttest randomized controlled trial provides insight into the impact of a particular preparation technique (video modeling) on preoperative anxiety and postoperative behavior changes in children ages 5 to 10 years old. Study findings inform how preoperative preparation for children should be undertaken by healthcare providers. The research questions for the study include:

Certain demographic characteristics may increase the likelihood of preoperative anxiety in children. Quiles and colleagues (2000) found a higher incidence of preoperative worry among female patients. Additionally, pre-surgery worries increased with age. As cognition develops, children become more aware of the risks of surgery (Quiles et al., 2000). In contrast, other studies have found an inverse relationship between age and preoperative anxiety (Getahun et al., 2020; Liu et al., 2022). It may be that the source of anxiety differs by age, with older children showing concern for different factors than younger patients (Liu et al., 2022). Preoperative anxiety has also been linked to negative postoperative behavior changes (Batuman et al., 2016; Kain et al., 2006).

Brewer and colleagues (2006) conducted a double-blind study to determine if surgery patients prepared by a child life specialist demonstrated less anxiety than those who did not receive preparation. Children receiving preparation from a child life specialist had less anxiety than the control group. Furthermore, children in the control group experienced a significant increase in anxiety levels from the preoperative to postoperative period whereas the intervention group had a nonsignificant decrease in anxiety. 2351a5e196