Anaesthetic pre-assessment

Question 1

What is the ASA score?

Answer 1

This is an American society of anesthetists score that stratifies risk in pre-operative patients.

1. Normal healthy patient
2. Mild systemic disease (asthma)
3. Severe systemic disease
4. Severe systemic disease that is a constant threat to life
5. Moribund patient, not expected to survive without the operation
6. Declared brain-dead patient - organ removal for donor purposes

Question 2

What is the surgical severity score?

Answer 2

This grades the surgery being undertaken for risk for the patient.

1. Diagnostic endoscopy, laparoscopy, and breast biopsy
2. Inguinal hernia, varicose veins, adenotonsillectomy, and knee arthroscopy
3. Total abdominal hysterectomy, TURP, and thyroidectomy
4. Total joint replacement, artery reconstruction, colonic resection, and neck dissection

Question 3

What are the key questions in a pre-operative assessment for anesthetics?

Answer 3

1. Previous anaesthetic exposure and were there any complications? (anaphylaxis, malignant hypothermia or difficult airway)
2. Post-operative nausea and vomiting? Travel sickness? Non-smoker? Female? Opoids? (Apfel score)
3. Allergies (ask specifically about penicillin and NSAIDs)
4. Medication history (specifically for anticoagulants, antiplatelets, antihypertensives, analgesics, antihistamines and herbal medication) and when they last took them
5. Presenting complaint and past medical history. Are conditions well managed?
6. Fasting period? No water for 2 hours and no food for 6 hours?
7. Airway assessment? This is done by Wilson’s score involving weight, head and neck movement, jaw movement, receding mandible, and buck teeth. This score suggests whether there will be a difficult airway

Question 4

What additional investigations might an anesthetist do before an operation?

Answer 4

These may be done if there are concerns about surgical severity or specific conditions in the past medical history. These can include:

FBC/U&Es/pregnancy test, ECG, Baseline CXR, or cardiopulmonary exercise testing

Question 5

What must be checked in a pre-operative assessment?

Answer 5

CONSENT