Surgery

Preoperative Evaluations

ASA Physical Status Classification

Class Definition
1 Normal healthy
2 Mild systemic disease
3 Severe systemic disease
4 Life-threatening systemic disease
5 Moribund
6 Brain-dead

Metabolic Equivalent (MET)

Mallampati Classification

EuroSCORE

Score Level Mortality
0 ~ 2 Low 1.3%
3 ~ 5 Medium 2.9%
≥ 6 High 10.9 ~ 11.5%

Revised Cardiac Risk Index (RCRI)

  • High-risk surgery :: vascular & thoracic
  • Ischemic heart disease
  • History of congestive heart failure (CHF)
  • History of cerebrovascular disesase
  • Insulin-dependent diabetes mellitus
  • Preoperative creatinine > 2 mg/dL
Score Level Cardiac Risk
< 2 Low < 1%
≥ 2 High > 1%

Minimal Fasting Time

Product Time
Clear liquid 2 hours
Human milk 4 hours
Light meal 6 hours
Regular meal 8 hours

Therapeutic Intervention Scoring System (TISS)

Acute Physiology and Chronic Health Evaluation (APACHE) II

  • Temperature :: rectum
  • Heart rate (HR)
  • Mean arterial pressure (MAP)
  • Respiratory rate (RR)
  • Oxygenation: PaO2/FiO2 (PF) ratio
  • Arterial pH
  • Sodium
  • Potassium
  • Creatinine
  • Hematocrit
  • White blood cell count
  • Glasgow Coma Scale (GCS)

Etiology of Postoperative Fever {5W}

Mnemonic Etiology Time (days)
Wind Pneumonia & Atelectasis 1 ~ 3
Water Sepsis & UTI 3 ~ 5
Wound Surgical site infection (SSI) 5 ~ 7
Walking DVT & PE > 5
Wonder Drugs -

Surgical Wound Classification

Wound Flora Spillage Inflammation Pus
Clean - - - -
Clean-contaminated + -   -
Contaminated + + + -
Dirty + + + +

Types of Wound Healing

Types of Suture Materials

  • Non-absorbable
    • Natural
      • Cotton
      • Silk
      • Steel
    • Synthetic
      • Nylon
      • Polypropylene
      • Polyester
  • Absorbable
    • Natural
      • Collagen [Catgut]
    • Synthetic
      • Vicryl
      • Monocryl
      • Dexon
      • Polydioxanone (PDS)

Types of Wound Closure

  • 1° closure [1° intent]
  • 2° closure [2° intent]
  • Delayed 1° closure [3° intent]

Tissue Reactions to Suture Materials

  • Non-absorbable < Absorbable
  • Natural > Synthetic
  • Monofilament < Braided