Pre-Op Care

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Questions Received:

  1. What specific pre-operative preparation is needed with someone suffering from COAD and needing a general anaesthetic? What impact would the surgery have on the COAD?

  2. 72 year old male with COAD. Uses nebuliser four times daily and frequent chest infections. What investigations will be needed prior to and following surgery to monitor his COAD?

  3. Why can't a patient eat before an operation?

Responses:

What specific pre-operative preparation is needed with someone suffering from COAD and needing a general anaesthetic? What impact would the surgery have on the COAD?

23rd July 2000

NB: The term COPD (Chronic Obstructive Pulmonary Disease) is now preferred to Chronic Obstructive Airways Disease (COAD). COPD relates to people with asthma, chronic bronchitis and/or emphysema.

History-Taking and Assessing

Information will be required concerning:

Whilst gathering information an assessment will be taking place concerning the person's mental state. Hypoxia, if present, can impede mental performance. The degree of alertness and how well orientated the person is, and the degree of knowledge and understanding they have concerning their proposed operation, are important observations to make.

Objective Assessment

This includes:

(NB: The anaesthetist may request pulmonary function studies.)

Planning

A care plan will need to be developed which addresses needs uncovered during the assessment process and also incorporates specific instructions set down by the anaesthetist (eg: whether a conventional general anaesthetic is to be administered or whether a spinal or epidural procedure is to be performed). The policies of the surgical team will also need to be taken into account. An approach will be made to the physiotherapist, the respiratory nurse specialist, and the theatre nurse who is to be responsible for the person's care. These members of the care team will need to visit the person, introduce themselves and discuss the part they will each play during the preoperative intraoperative and post operative periods.

Implementing

Checking MedicationPsychological needs - preoperative information and education contributes greatly to the reduction of stress and anxiety that can accompany hospital admission and the need for surgery (Haywood, 1975; Boore; 1978; Johnson, 1983). For someone with underlying respiratory disease the degree of insecurity and anxiety experienced can be quite intense. Information will need to be given regarding procedures that will be performed during the preoperative and postoperative period. Chest physiotherapy coupled with exercises to be carried out postoperatively, will be instigated and the importance of these reinforced. Information concerning drugs to be given to maintain respiratory function and reduce the risk of operative complications developing. These will be those that are regularly taken together with newly prescribed preparations (eg: as a premedication, to reduce thrombo-embolic disease and to combat infection).

Specific physical needs relating to the person's respiratory disorder - prescribed drugs will be administered and the person's response to these monitored, for example by conducting peak flow recordings and measuring oxygen saturation levels at agreed intervals. Such monitoring will enable important decisions to be made: whether humidified oxygen needs to be administered and if so at what percentage, and if administration is to be by mask or via nasal cannulae. The point at which any bronchodilators are to be withheld prior to the induction of the anaesthetic will need to be ascertained.

Evaluating

Key components of the nursing evaluation include examining objective data that have been gathered and comparing them with previously agreed parameters, holding discussions with other members of the care team (subjective assessment), and remaining alert to sudden changes in the person's condition. The evaluation phase also becomes, or can be used as, an integral part of the assessment phase.

Additional Points to Consider

People with asthma, chronic bronchitis and emphysema tend to have irritable airways, and intubation may provoke coughing attacks. Inhaled anaesthetic gases can also act as irritants to the bronchial mucosa (Carrie et al, 1998).

References

72 year old male with COAD. Uses nebuliser four times daily and frequent chest infections. What investigations will be needed prior to and following surgery to monitor his COAD?

23rd July 2000

The investigations and observations most commonly conducted are:

Why can't a patient eat before an operation?

1st September 2001

For an operation involving a general anaesthetic it is essential that the stomach is empty of food and contains minimal fluid beforehand. Generally a person can eat up until six or indeed four hours before an operation is due to take place and drink up until between four to two hours beforehand. Local policies do however differ in this respect. The once prolonged pre-operative fasting rituals that people had to endure have now, thankfully, been replaced by shorter intervals based upon research evidence (see Walsh, 1989; Torrance, 1991).

A period of fasting is essential before a person is exposed to a general anaesthetic because, apart from bringing about a state of unconsciousness and analgesia, anaesthetics also produce a state of relaxation throughout the body. Relaxation of the physiological sphincter between the oesophagus and the stomach readily allows any food or fluid contained within the stomach to be regurgitated. Strong hydrochloric acid is a component of stomach fluid, and if stomach contents are regurgitated into the airways and lungs the consequences are disastrous. The aim of fasting therefore is to reduce this risk.

References

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