This article is part of the operation script for grafting an abdominal aortic aneurysm. The article can be used on its own, or to go to the next part of the operation, click on NEXT PART OF THE OPERATION at the bottom of this page.
AORTIC ANEURYSM 130 - SECTION 1.00 WORK UP AND WHO SAFE SURGERY CHECKLISTS SIGN IN AND TIME OUT
WORK UP FOR AN ELECTIVE PATIENT
- A full clinical work up is needed.
- i.e.History and Examination.
- To assess the effects of the aortic aneurysm
- To detect other aneurysmal and occlusive vascular disease
- To detect past and intercurrent disease
- Ultrasound or CT scan
- To exclude a suprarenal aneurysm.
- To identify other aneurysms and occlusive disease of vessels distal to the aorta.
- ECG.
- Hb + Full blood count.
- Clotting screen
- Group and save serum.
- Urea and electrolytes.
- Blood glucose.
- Urine culture
- Nasal and groin swabs for MRSA
- Chest X-ray.
- Referral for an echocardiogram and a cardiological opinion.
- Admit 24 hours before operation for intravenous administration of 2 litres dextrose/ saline.
WORK UP FOR AN URGENT PATIENT
- Ie Need to operate within the next 3 hours.
- Assess in the Emergency Area, where there is access to resuscitation and imaging.
- Do not admit the ward. This will cause unnecessary delays.
- Take a history and examine the patient.
- Inform the consultant surgeon or the surgeon who will be doing the operation.
- Warn the anaesthetic team.
- Warn the operating theatre team.
- The patient has some pain and an expansile selling.
- The diagnosis is in doubt.
- About 25% of patients with aneurysms have other causes for abdominal pain.
- e.g. peptic ulcer, ischaemic bowel.
- There have been no hypotensive episodes.
- The systolic blood pressure is above 100mm. of mercury.
- The pulse rate is less than 100 per minute.
- The same investigations should be done as for an elective patient.
- Cross match 4 units of blood.
- The ultrasound or CT scan will indicate whether there is any leakage around the aneurysm or into the peritoneal cavity.
- Some dilatation of the suprarenal aorta up to 25mm. is acceptable for grafting.
- Dilatation greater than 25mm.or thrombus in a suprarenal aneurysm makes a successful operation unlikely.::
- NB There is a danger of underestimating the urgency of operation.
- Patients can deteriorate within minutes.
- Aneurysms wait for nobody.
WORK UP FOR A RAPIDLY DETERIORATING PATIENT
- ie. Need to operate as soon as possible.
- The patient has pain and an expansile selling.
- The diagnosis is clear.
- There is no serious intercurrent disease.
- Patients over 80 years have less than 20% chance of surviving emergency surgery for aneurysms.
- There have been hypotensive episodes.
- The systolic blood pressure is below 100mm. of mercury.
- The pulse rate is more than 100 per minute.
- Call the anaesthetic and scrub team.
- Take blood for:
- Cross matching 6 units of blood
- Hb + full blood count + clotting screen.
- Urea and electrolytes.
- Use a femoral vein stab if the arm veins are not accessible or are too vasoconstricted.
- Nasal and groin swabs for MRSA
- Do ECG.
- Insert two intravenous lines in the upper limbs.
- Use 14 swg. diameter cannulas eg Venflon.
- Use the most peripheral sites possible in the upper limbs.
- Scan if immediately available.
- Do not shave.
- Obtain written consent the patient if there is time.
- Do not hesitate.
- Transfer the patient to the anaesthetic room for resuscitation.
