1.5. Anaesthesia - Pre-Op Assessment

Question 1

What is the role of Anaethetists in Pre-Op?

Answer 1

1. Assess
2. Identify High Risk
3. Optimise
4. Minimise Risk
5. Inform and Support Patients Decisions
6. Consent

Question 2

What is involved in General Anaesthesia?

Answer 2

1. Drug induced reversible coma
2. CNS / Cardiac / Respiratory Depression
3. Drug interactions

Question 3

What is involved in Regional Anaesthesia?

Answer 3

1. Profound Sympathectomy

2. Neurological Sequelae

Question 4

What are the Considerations which need to be made with all Anesthetics?

Answer 4

1. Patient Co-morbidities
2. Patient Unknown Pathologies
3. Nature of the Surgery
4. Anaesthetic Techniques
5. Post-op Care

Question 5

What is done in a Pre-Op assessment?

Answer 5

1. History
2. Examination
3. Investigations

Question 6

What aspects of History are covered in a Pre-op assessment?

Answer 6

1. Known Co-Morbidities - Severity / Control
2. Unknown Co-Morbidities - Systemic Enquiry / Clinical Examination
3. Ability to Withstand Stress - Exercise Tolerance / Reason for Limitation / Cardio-Respiratory Disease
4. Drug and Allergy
5. Previous Surgery and Anaesthesia
6. Potential Anaesthetic Problems - Airway / Spine / Reflux / Obesity

Question 7

What are the Measurements of Exercise Tolerance (MET’s)?

Answer 7

2 METs - Walk around the house
3 METs - Do light housework
4 METs - Walk 100-200m on the Flat
5 METs - Climb a flight of Stairs / Walk up Hill
6 METs - Walk on the Flat at a Brisk Pace
7 METs - Play Golf / Mountain Walk / Dance
8 METs - Run a Short Distance
9 METs - Strenuous Exercise / Heavy Physical Work

Question 8

What are the ASA gradings?

Answer 8

ASA1 - Otherwise Healthy Patient
ASA2 - Mild-Moderate Systemic Disturbance
ASA3 - Severe Systemic Disturbance
ASA4 - Life Threatening Disease
ASA5 - Moribund Patient
ASA6 - Organ Retrieval

Question 9

What is the Cardiac Risk Index?

Answer 9

1. High Risk Surgery
2. Ischemic Heart Disease
3. Congestive Heart Failure
4. Cerebrovascular Disease
5. Diabetes
6. Renal Failure

Question 10

What Cardiovascular Investigations can be performed in a Pre-Op?

Answer 10

1. ECG
2. Exercise Tolerance Test
3. Echocardiogram
4. Myocardial Perfusion Scan
5. Stress Echo
6. Cardiac Catheterisation
7. CT Coronary Angiogram

Question 11

What Respiratory Investigations can be performed in a Pre-Op?

Answer 11

1. Saturations
2. Arterial Blood Gas
3. Chest X-Ray
4. Peak Flow Measurements
5. FVC / FEV
6. Gas Transfer
7. CT Chest

Question 12

What is involved in Optimising?

Answer 12

Optimal Medical Control of Long-Term Conditions:

1. Hypertension
2. Ischaemic Heart Disease
3. Heart Failure
4. Asthma / COPD
5. Diabetes
6. Epilepsy