Preparation of patients prior to emergency surgery

Surgery, especially emergency surgery, is a physiological insult. In some cases surgery takes precedence over full resuscitation (for example, in ruptured aortic aneurysm), but in most cases there is time to resuscitate the patient. General and spinal anaesthesia sometimes involve a drop in blood pressure owing to vasodilatation, and this is exaggerated if the patient is volume-depleted prior to induction. Hypovolaemia before emergency surgery is common and is due to:

• vomiting and diarrhoea

• fluid loss in to an obstructed bowel

As stated throughout this book, proper resuscitation makes a big difference to outcome - not only in terms of perioperative mortality but also in terms of postoperative morbidity. In terms of simple physiology (A, B, C) one should aim to restore the observations as far towards the patient's normal as possible before surgery. This is so that they can mount a successful compensatory response during the perioperative period. Preoperative aims are:

• airway secure

• respiratory rate 10-30

• well perfused with good cardiac output

• normal electrolytes (especially K+ and Mg2+)

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