1 / 25

Pre Operative tests in Cardiothoracic Surgery

Pre Operative tests in Cardiothoracic Surgery. Why. FBC. HB Anaemia ? Why Anticoagulation type of valve Polycythaemia WCC neutrophilia neutropaenia True or false Prosthetic valve endocarditis has ~50% mortality Leukaemia PLT Thrombocytosis Thrombocytopaenia

hallam
Download Presentation

Pre Operative tests in Cardiothoracic Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pre Operative tests in Cardiothoracic Surgery

  2. Why

  3. FBC • HB • Anaemia ? Why • Anticoagulation type of valve • Polycythaemia • WCC • neutrophilia • neutropaenia True or false • Prosthetic valve endocarditis has ~50% mortality • Leukaemia • PLT • Thrombocytosis • Thrombocytopaenia • Aspirin and clopidogrel have no effect

  4. U & E • Na • Paraneoplastic in Ca lung • Confusion in old grannies • Diuretics • K • Arrthymias • Paraneoplastic in Ca lung • Diuretics • Urea • GI bleed • Diuretic use • Dehydration • Creatinine • Major risk factor for dying post cardiac surgery

  5. LFTs and calcium • LFTs • Alcoholics major risk factor • Metastasis in lung cancer • Right heart failure • Drugs eg Statins • Ca2+ • Metastasis in lung cancer • Paraneoplastic

  6. Clotting • Pro coagulant • Protein C • Protein S • antithrombin III • VonLeiden • Lupus anticoagulant ONLY ONE WITH ABNORMAL LABS • Block the grafts • Bleed • Monitor heparin and warfarin therapy and reversal • Von Willibrands • Haemophilia A • Christmas disease (Haemophilia B)

  7. Glucose • 1ST OR 2ND on list • Diabetes is major risk factor for dying • Poorly controlled means metabolic problems post operatively • Newly diagnosed in CABG patients • HBA1c or Fructosamine

  8. ECG • Normal or not • Rate eg brady or tachy • SR / AF • PR interval • LV hypertrophy • Bundle branch block • ST levels in CABG • ST curvature in lung and oesophageal cancer • Pacemaker

  9. PFTs • Epidural use • Nebuliser use • Risk of thoracotomy • Valve patients different to CABG patients • DLCO / VA • Thoracic surgery • Rule of 19 for predicting post operative FEV1

  10. CXR - Cardiac • Size heart • Risk • Cardioplegia • Trauma • Aortic calcification CVA risk eg Cannulation ? Off pump • Lung cancer as most are ex or current smokers • #ribs ? #sternum in past • Wires / clips from previous sternotomy • Beware Ethibond or wire removal • Think LIMA • Valves and Warfarin

  11. CXR - Thoracic • Size heart • Risk • Trauma • Growth of tumour • Pleural effusion • Pulmonary mets • #ribs ? #sternum in past • Wires / clips from previous sternotomy • Beware Ethibond or wire removal • Think LIMA especially in Left upper lobectomy • Valves and Warfarin

  12. CXR - Oesophageal • Size heart • Pleural effusion • Pulmonary mets • ? see tumour • Wires / clips from previous sternotomy • Beware Ethibond or wire removal • Think LIMA • Valves and Warfarin

  13. CXRs

  14. Angiogram – Isolated CABG • Aortic calcification • Amount aortic regurgitation • LV function • What needs doing • Conduits to use • LIMA • RIMA • Radial • Vein

  15. Angiogram – Isolated Valve • ? needs CABG • LMS length • Circ size in mitral surgery • Aortic calcification • Amount aortic regurgitation • LV function • Aortic valve calcification ? CVA risk

  16. CT - Cardiac • Redo surgery ? RV and sternum separation • Aortic sizes ? Need root or arch • Follow up of descending aorta • Planning coarctation

  17. CT - Thoracic • Thoracic surgery • Tumour • Mediastinal LNs • Metastatic spread

  18. CT - Oesophageal • Oesophageal Surgery • Tumour ? Left or Right approach • Trachea • Mets

  19. Echo • All murmurs need evaluating • Always check “supposedly normal valves” • Pulmonary and tricuspid valves rarely commented on with mitral valve patients • PA pressure MAJOR risk factor • LV and RV function

  20. Weight • Tamponade • Leg wound healing • Breathless patients ? Need diuretics

  21. BP • Left and right arm for LIMA • Level that kidneys and brain expect • Aortic dissection

  22. Swabs • Sternal wound and valve infection • Prosthetic valve endocarditis mortality 30 to 50 %

  23. Carotid scans • Type of operation • Blood pressure on bypass • Risk of stroke • ? Combined procedure • Post operative medications

  24. Clinical ExaminationDON’T UNDERESTIMATE THE IMPORTANCE OF THIS

  25. Next week26th JanThoracic SurgeryLecture Theatre

More Related