Perioperative Care, Critical Care and Surgical Ethics
Core Concepts
Master preoperative risk assessment (cardiac, pulmonary), prophylaxis (antibiotics, DVT), and management of common postoperative complications (wound infection, dehiscence, ileus). Understand critical care principles: sepsis management, mechanical ventilation, and hemodynamic monitoring. Ethical concepts: informed consent, capacity, confidentiality, and end-of-life care.
Traps in Questions
A common trap is the timing of antibiotic prophylaxis: within 60 minutes before incision. Another trap is the management of postoperative fever: workup based on timing (day 1–2: atelectasis; day 3–5: UTI, pneumonia; day 5–7: wound infection, DVT). For ethics, beware of the “ Jehovah’s Witness” scenario: respect refusal of blood products. Also, know that DNR orders are suspended in the operating room unless explicitly discussed.
Worked Example
A 70-year-old man with COPD scheduled for elective hernia repair. What preoperative evaluation is needed? Answer: Optimize pulmonary status, consider regional anesthesia, and ensure smoking cessation if possible.
Rule of Thumb
In sepsis, “time is tissue” – antibiotics within 1 hour of recognition and fluid resuscitation 30 mL/kg for hypotension.