The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) has published guidelines and recommendations for the standardization and improvement of surgical care. The guidelines contain a number of measures developed by the “Surgical Care Improvement Project (SCIP),” called SCIP guidelines. The SCIP guidelines are constantly released as part of an evolving manual which is intended to unify standard quality measures to document and track standards of care. The SCIP guidelines aim to complications that are responsible for a substantial proportion of preventable diseases as well as costs. Seven SCIP initiatives related to the perioperative area. Among the general recommendations are: Keep an almost normal blood sugar levels maintained (eg <80 mg / dl.) During the first 2 postoperative days, v. a. in cardiac surgery patients. Use scissors or depilatories, no blade to remove hair from the surgical site immediately prior to surgery. Remove urinary catheter within the first 2 postoperative day, as was required to make this specific clinical circumstances. Standardize the choice of antibiotic based on the type of surgery and the patient factors (antibiotic prophylaxis for surgical procedures). The perioperative area is based on both individual and general recommendations. Many drugs can interact with anesthetics or have adverse effects during or after surgery. Therefore, usually before surgery the medication to the patient and be set fst which are to be taken on the day of surgery. Anticoagulants and antiplatelet agents antiplatelet drugs (eg. Aspirin) are usually discontinued 5-7 days before the procedure. Warfarin is stopped 5 days before surgery; INR should be the time of surgery ? 1.5. Patients who have a significant risk of an embolism (z. B. patients with back lying pulmonary embolism or atrial fibrillation with stroke), a short-acting anti-coagulant, such as low molecular weight heparin, optionally after discontinuation of warfarin (known is. Überbrückungsanticoagulation- Deep vein thrombosis (DVT )). Because it takes up to 5 days until warfarin therapeutic anticoagulation is achieved, the gift of the day or after an operation can begin, unless the risk of postoperative bleeding is high. Patients should receive a Überbrückungsantikoagulation until INR has reached the therapeutic goal. Corticosteroids patients may require additional corticosteroids to prevent inadequate responses to perioperative stress, have taken if they daily> 5 mg prednisone (or equivalent dose of another corticosteroid) for> weeks within the past year. Corticosteroids are unnecessary for minor operations. Diabetes I nsulinpflichtige diabetics get the day of surgery usually morning a third of their usual insulin dose. Patients with oral medication to take half of it. The intervention should be possible in the morning. The anesthetist to monitor the level of glucose during the operation and are required additional insulin or dextrose. Close monitoring blood glucose meter (finger test) is required throughout the perioperative period. In the immediate postoperative period, insulin is staggered given the usual insulin therapy at home will not be resumed until patients receive their normal diet. Substance dependence patients with a drug or alcohol addiction can get into a withdrawal in the perioperative period. In alcoholics recommended by the admission to the hospital, the prophylactic use of benzodiazepines such as chlordiazepoxide, diazepam or lorazepam. Opiate addicts can be administered to prevent withdrawal of opioid analgesics; for pain relief they need then possibly larger doses than usual. In rare cases the use of methadone to prevent perioperative withdrawal is required. Heart disease patients with known coronary artery disease or heart failure should undergo a preoperative examination and risk stratification in her cardiologist. If patients are not medically optimized, they should undergo before elective surgery additional investigations. Other medications that control chronic diseases Most drugs used to treat chronic disorders, especially cardiovascular effective including antihypertensives should be shared throughout the perioperative period. Most of the orally administered medication can be given with a small sip of water or on the day of surgery itself. Other Medikamemnte must be administered parenterally or postponed taking to the postoperative period. Anticonvulsant levels should be measured preoperatively in patients with seizure disorders. Preoperative checklist in the operating room will be briefly discussed the most important thing in the team before the process begins. To confirm the identity of the patient the optimal method and the richtigigen surgical site was one of (if applicable) on the availability of all necessary equipment for the finished indexed prophylaxis (eg., Antibiotics, anticoagulants) Smoking Smokers should quit smoking before an operation on chest or abdomen give up as soon as possible. It takes several weeks for the ciliary mechanisms have returned to their normal function. Pre- and postoperatively is recommended breathing exercises. Upper respiratory tract Before anesthesia dentures must be removed best so that they will be given to a family member before the lock. In patients with Nasenseptumdeviation or other disabilities airway is recommended before each surgery and anesthesia prior examination by an anesthesiologist.


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