1.30 Preoperative Assessment

Question 1

Aims of pre op assessment

Nursing staff

Answer 1

Nurses

Relevant standard Invx

Nurse assessment + info
falls
standard qs

Information time off sick notes
wounds stitch

Question 2

Aims of preop assessment

Doctors

Answer 2

1. Focused medical hx and exam
   ID pre exiting or new comorbs
2. ID potential anaesthetic difficulties
3. Refer advanced Invx where appropriate
   eho / pfts / cpet
4. Referrals to relevant specialties
   cardiologist / resp physicians
   preop optimization of comorbs
5. Overall assessment of risks faced
   surg and anaes
   present to patient
   allow patient make informed decision proceed
6. Highlight any potential issues w/ consent

Question 3

Aims of preop assessment

Doctors

Answer 3

7. Facilitate periop planning:

a - admission night before surgery insulin sliding scale
b plan appropriate thromboproph management in high risk
c post op HDU / ICU care

8. Provide opportunity to discuss anaesthetic techniques
   fasting
   risks / side affect
   reduce fear anxiety
9. Lifestyle advice
   weight loss diet smoking alcohol

Overall aim
improve periop outcomes
reduce risk of adverse events

Question 4

Role of anaesthetist in preoperative assessment

Answer 4

Uniquely placed strcture to preop process

knowledge of anaesthetitsing patient w/ comorbs
- know what can be achieved by pre op optimisation

Physiological + pharmacological knowledge used to assess and provide sensible and accurate advice patients
premed
techniques - RA
Postop analgesia method

Continuity morning surgery

further pre-assess
diff anaesthetist

discussion precision technique regimens of anaes and analgesia

check the result of invx / tests

Question 5

Benefits

Answer 5

1. Reduced rates cancellations
   and no show on day from anxiety
2. Reduce risk cancellation d/t suboptimal comorb control
   lack beds
   tests not complete
3. Increased theatre efficiency time
   pre-assess much smoother
   list start on time
   less delay waiting results before send
4. financial benefits from above

5. Patient outcomes
recommended lifestyle change
weight loss exercise smoking
improve periop outcome
benefit patient long term