preoperative preparation for thyroid surgery ppt

Scrub time (gentle, repeated back-and-forth strokes) for chlorhexidine-alcohol preparations should last for 2 minutes for moist sites (inguinal fold and vulva) and 30 seconds for dry sites (abdomen), and allowed to dry for 3 minutes 46. 135 182.e1 Early ambulation can be promoted by preoperative counseling of the patient, as well as effective stepwise, multimodal analgesia regimens that limit reliance on systemic opiates. Benefits of ERAS pathways include shorter length of stay, decreased postoperative pain and need for analgesia, more rapid return of bowel function, decreased complication and readmission rates, and increased patient satisfaction. . 2016 Am J Obstet Gynecol The starting point in assessing a patient's cardiac risk often involves a previous history of diagnosed coronary artery disease, any previous cardiovascular procedural interventions or testing, current therapies and any current symptoms suggestive of angina or congestive heart failure. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Agency for Healthcare Research and Quality 323 . : . , 22 Options include an SSKI 50 mg/drop 1 to 2 In summary, recommendations do not call for preoperative cardiac testing in all patients. . It is imperative to ensure the patient is euthyroid prior to surgery to avoid complications of a thyroid storm or myxoedema coma in the perioperative period. Shah PM Bell A , Implementation of ERAS protocols has not been shown to increase readmission, mortality, or reoperation rates. 9 Demartines N Anatomy Physiology Biochem Pathology Pharmacology Microbiology forensic Ophthalmology E N T Medicine Gynaecology Obstetrics surgery Paediatrics and many more subject's ready made power point presentations, Arterial Blood Gas InterpretationAcute Lung Injury and ARDSThe Surgical Approach to the Acute AbdomenThe AdrenalAdvanced Mechanical VentilationAirway Management in the Emergency Department and ICUAnesthesia ReviewAnorectal DiseaseAcute Respiratory Distress Syndrome and Trauma PatientsBariatric SurgeryBasic Mechanical VentilationBasic Wound Closure and Knot TyingBenign Breast DiseaseBenign Esophageal DisordersBlunt TraumaBreast CancerBurn ManagementCardiogenic ShockCarotid Artery DiseaseCentral Venous AccessChest TraumaCholelithiasisColon CancerCricothtroidotomyCultural CompetencyEsophageal DisordersEsophageal Motility DisordersExcellent HemostasisFluid and Electrolyte AbnormalitiesFoley Urethral CatherizationFull DisclosureGastric CarcinomaGastroesophageal Reflux DiseaseGlycemic Control in the Perioperative PeriodGroin HerniasHemostasisIncision and Drainage of AbscessInfectious Disease in the Critically IllLiver TraumaLiver ReviewLower Extremity Vascular DiseaseMalrotationMedical Care of the Surgical PatientMedical MalpracticeNecrotizing FasciitisNeoplasms of the Exocrine PancreasNeurosurgical EmergenciesNon-Invasive Breast CancerNutritionNutritional Support of the Trauma PatientOncology ReviewParathyroidsPathology of the PancreasPatient SafetyPediatric SurgeryPenetrating Neck TraumaPeriampullary CarcinomaPhysiology of Transfusion TherapyPortal HypertensionPrimary HemastasisPyogenic Hepatic AbscessesRoot Cause AnalysisSepsis and Septic ShockShockShock and HypoperfusionShort BowelSmall BowelSurgical NutritionSurgical Site Infections (SSI)Surgical Treatment of UlcersSurviving Sepsis, EBMSwan Ganz IntroThreatened Limb LossThyroid CancerTraumatic Brain InjuryTube Thoracostomy ModuleVenous InsufficiencyWhat is System Based Care?Wound Healing, Dear AllCan someone send me a powerpoint presentation on Bullous disease of the lung.Thanksor let me know where I can find it.Dr. Feldheiser A Fluid overload may lead to electrolyte abnormalities, peripheral edema and impaired mobility, delayed return of bowel function, and pulmonary congestion, whereas hypovolemia may result in decreased cardiac output and oxygen delivery. Javanmard-Emamghissi H It also highlights the elements of an informed consent that considers the use of new technology and/or approaches to secure excellent patient outcome and satisfaction. 55 In addition, patients often cannot eat for varying periods before and after surgery, further compromising nutritional status. . Crit Rev Oncol Hematol . Evidence-based surgical care and the evolution of fast-track surgery When ERAS pathways have been implemented for benign gynecologic and gynecologic oncology surgeries (using open and minimally invasive approaches), results have been encouraging 13 14 15 16 17 18 19. . Emergency surgery calls for expedited pre-operative cardiac assessment and management. . Yoong W ; , . It is well known that surgical stress induces a catabolic state that leads to increased cardiac demand, relative tissue hypoxia, increased insulin resistance, impaired coagulation profiles, and altered pulmonary and gastrointestinal function 3. London (UK) 2006 While ACOG makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. . . Rojansky N Hinds C The strategy of postoperative minimization of opioid use reduces nausea and vomiting, impairment of bowel function, delayed mobilization, and pulmonary morbidity 54. . , 262 , Patients sometimes asked to maintain body weight or lose weight prior to surgery. Integration of a multidisciplinary approach is important to ensure buy-in and compliance with these guidelines from all members of the surgical team. An estimated postoperative FEV1 of 800 mL or more is required before lung resection is performed. 6 Mena GE : Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: enhanced Recovery after Surgery (ERAS(R)) Society recommendationsPart I Tonnesen H Copyright 2018 by the American College of Obstetricians and Gynecologists. In this topic, we discuss various surgical aspects of thyroidectomy, including preoperative evaluation and preparation, operative management, postoperative care, and Barnett C Evidence that preoperative mechanical cleansing of the bowel improves surgical outcomes is limited. . : . , Wilmore DW , Int J Clin Exp Med 2015 Removal of the urinary catheter, if used, within 24 hours also shortens hospital length of stay by decreasing infection risk 30. . Chackmakchy SA Del Prete S, Russo D, Caraglia M, et al. We are just sharing them for helping medical education world wide, .If you find any copyrighted slides inform me i will take necessary actions.If any of of you have a good personal power point presentation, COLLECTION OF MEDICAL POWERPOINT PRESENTATIONS AND LECTURE NOTES FREE DOWNLOAD, The Surgical Approach to the Acute Abdomen, Airway Management in the Emergency Department and ICU, Acute Respiratory Distress Syndrome and Trauma Patients, Glycemic Control in the Perioperative Period, Nutritional Support of the Trauma Patient, Pathology Robbins chapters powerpoint files - set 4, Free Medicine PowerPoint Templates collection, Physiology Lecture Notes- ppt and pdf - set 4, SNAKE BITE MANAGEMENT POWERPOINT LECTURES, PHarmacy ( Pharm D , B - Pharm ,M-Pharm , D Pharm) Lecture Notes. Systemic hormone therapy and oral contraceptive use have been associated with increased risk of VTE; however, the overall risk remains quite low. , . Patients with cardiopulmonary disease may warrant a second examination just before hospitalization. For example, a patient who is scheduled for hip replacement surgery and has limited assistance available at home may require home services or temporary placement in a rehabilitation facility. Any potential conflicts have been considered and managed in accordance with ACOGs Conflict of Interest Disclosure Policy. . Goldman's cardiac risk index16 was one of the first attempts to systematically evaluate a patient's risk of cardiac complications with surgery. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Colorectal Dis , , 562 Pre-operative impairment in ADLs and IADLs have been shown to be strong predictors of sustained post-operative functional impairment following major abdominal surgery in older adults, 31 in addition to being important risk factors for post , . 2007 , Le Maitre B 1999 Thiele RH . ; Formally speaking, consultants generate suggestions only and Ellington DR Chlorhexidine gluconatetopical Plans for such assistance can be made before hospitalization. Preoperative preparation includes the following areas: 1.Nutrition and fluids2.Elimination3.Hygiene4.Medications5.Sleep6.Care of valuables7. Tong Y 71 5. J Am Coll Surg Am J Obstet Gynecol Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization 7 This treatment has been shown to decrease thyroid blood flow, vascularity, and intraoperative blood loss. 179 www.acog.org Davison B J Am Coll Surg Anderson AD 842 , Renal and liver function studies are not routinely needed but may be indicated for patients who have a medical condition or medication use that would serve as indications for these tests. An albumin level of less than 3.2 mg per dL (32 g per L) suggests an increased risk of complications. Nick AM - Patients with pheocromocytoma may require admission a week before surgery to evaluate & block the alpha & beta adrenergic effects of catecholamines. Intravenous antibiotics should be administered within 60 minutes before skin incision. Hendry PO 465 , or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 WebPreoperative Nursing Care. Prevention of infection after gynecologic procedures. Implementation of ERAS protocols has not been shown to increase readmission, mortality, or reoperation rates 20 21. different from that of heart surgery in the perspective of postoperative care. For patients at risk of VTE, the Caprini score or Rogers score may be used to provide further risk stratification Table 2. Unstable angina, myocardial infarction within six weeks and aortic or peripheral vascular surgery place a patient into a high-risk category for perioperative cardiac complications. For example, advanced age places a patient at increased risk for surgical morbidity and mortality.3,4 The reason for an age-related increase in surgical complications appears to correlate with an increased likelihood of underlying disease states in older persons, because studies have found that healthy elderly patients have surgical complication rates comparable to those of healthy younger patients.5,6 Diseases associated with an increased risk for surgical complications include respiratory and cardiac disease, malnutrition and diabetes mellitus.7 With respect to the type of surgery, urgent and emergency procedures constitute higher risk situations than elective, nonurgent surgery and present a limited opportunity for preoperative evaluation and treatment. World J Gastroenterol Chung P : Royal College of Obstetricians and Gynaecologists Take off all jewellery and piercings. Enhanced Recovery After Surgery is a comprehensive program, and data demonstrate success when multiple components of the ERAS pathway are implemented together. . 303 3598 Pulmonary complications may be prevented by providing patients with instructions on how to perform incentive spirometry and deep-breathing exercises. 126 Previous pre-operative ultrasound findings and which patients received SSKI were collected. et al Opioid use is associated with postoperative nausea and vomiting, impairment of bowel function, delayed mobilization, and increased pulmonary morbidity, all of which can delay recovery and negatively affect patients perception of the surgical experience. , Ochana A In one randomized controlled trial of women undergoing gynecologic laparoscopy, transversus abdominis plane block did not provide statistically significant differences in mean postoperative pain scores 53. For vaginal hysterectomy, paracervical nerve blocks or intrathecal morphine may be useful. 36 128 : Jankowski CJ . , Social isolation, limited financial resources, poor dentition, weight loss and chronic disorders such as pulmonary disease, congestive heart failure, depression, diarrhea and constipation are commonly associated with malnutrition. Guthrie T A meta-analysis of six randomized controlled trials demonstrated that implementation of at least 4 of the 17 possible components of the ERAS pathway in patients undergoing colorectal surgery resulted in reductions in length of hospital stay (by more than 2 days) and complication rates (by nearly 50%) 6 7 8 9 10 11 12. , 2009 Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS[R]) society recommendationsPart II . 36 Johnston B The goal of this article is to outline the preoperative information that all patients should know prior to thyroid surgery. Additionally, mechanical bowel preparation is time-consuming, expensive, and unpleasant for patients. I like it very much. . Chewing gum reduces the incidence of postoperative ileus and its use should be considered 54. Colorectal surgery was the first subspecialty to implement ERAS programs. . Art. Preoperative alcohol cessation prior to elective surgery The goals of decreasing surgical stress and helping the body mitigate the consequences of such stress with ERAS pathways is achieved by the implementation of a combination of multiple elements, which when bundled together, form a comprehensive perioperative management program. 245 Preemptive medication strategies (eg, medications given to the patient before surgery), including paracetamol and acetaminophen, gabapentin, nonsteroidal antiinflammatory drugs, and COX-2 inhibitors, have been shown to decrease total narcotic requirements and improve postoperative pain and satisfaction scores in women undergoing total abdominal hysterectomy 49. As an alternative to the administration of opioids, ketorolac is effective in controlling postoperative pain and does not increase postoperative bleeding 48. Cosio S Popping DM In order for an ERAS program to be sustainable, it should be embedded as a standard model of care in a healthcare delivery system. PA work up & Premedication.ppt. ; Alcohol ablation. ; : Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials - Active Patients' satisfaction with fast-track surgery in gynaecological oncology . I definitely want to read more on that blog soon. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Achtari C WebDefinitions. Ann Surg Oncol Enhanced recovery pathway in gynecologic surgery: improving outcomes through evidence-based medicine : Meyer LA : The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials ; , . : ; , For laparoscopic surgeries that do not involve genitourinary or digestive contamination, no antibiotic prophylaxis is necessary 23. et al 2016 , . Bhinder R The traditional fasting requirements of surgery deplete liver glycogen and are associated with impaired glucose metabolism and increased insulin resistance, which have been shown to adversely affect perioperative outcomes. : 2014 Pre-operative outpatient medical evaluation can decrease the length of hospital stay as well as minimize postponed or cancelled surgeries.1 To effectively provide this consultative service, the physician should understand the risk associated with the particular type of surgery planned and relate this risk to the patient's underlying acute and chronic medical problems. , ; . . . Initial studies have shown a decrease in perioperative cardiac mortality, with few side effects.41 Revisions in current guidelines are inevitable and may include a recommendation for beta blockers in patients with coronary artery disease. , Mller AM Ren H Ann Surg Wolters Kluwer If preoperative assessment has increased concerns regarding the airway, the following options should be considered: 1. Monson JR ; Gynecol Oncol That assessment may incorporate blood tests, an electrocardiogram (EKG), X-Rays, or other imaging reports. Web*Reproduced with permission of the American College of Surgeons and the American Geriatrics Society. Gynecol Oncol Dr.Aslam (Specialist Pulmonologist International Modern Hospital Dubai ) Alumnus -calicut medical college & Pariyaram Medical College, www.medicalppt.blogspot.com only collects and share links from other websites ,"Everything under one umbrella " .We do not host or modify the presentations.These lecture notes are sole property of original uploaders.

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