Anaesthetics 5 -Pre-op assessment Flashcards
What is the pro-operative role of the anaesthetist?
- Assess
- Identify high risk patients
- Optimise
- Minimise risk
- Inform and support patients decisions
- Consent
Why does the anaesthetist carry out pre-op planning?
Reduces
- Anxiety
- Delays
- Cancellations
- Complications
- Length of stay
- Mortality
When is pre-operative planning carried out?
Elective planned system
- Primary care
- Pre-assessment clinic
Urgent and emergency surgery too
What is the “trauma of surgery”?
- Stress response
- Fluid shifts
- Blood loss
- CVS, Resp., Renal and Metabolic Shift
SLIDE 12?????
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What condiersations must be made by the anaesthetist in pre-op?
Patient-specific
- Known co-morbidities
- Unknown pathologies
Nature of Surgery
Anaesthetic Techniques
Post-op Care
What three aspects are used in terms of the patient pre-op?
- History
- Examination
- Investigation
What are the important aspects of patient history pre-op for the anaesthetist?
Known co-morbidities
- Severity
- Control
Unknown co-morbidities
- Systemic enquiry
- Clinical examination
Ability to withstand stress
- Exercise tolerance
- Reason for limitation
- Cardio-respiratory disease
How is exercise tolerance of a patient assesed?
METs - (Metabolic Equivalent): The ratio of the work metabolic rate to the resting metabolic rate.
Can you do the following activities without getting breathless;
- Walk around the house 2 METS
- Do light housework 3 METS
- Walk 100-200 metres on the flat 4 METS
- Climb a flight of stairs or walk up a hill 5 METS
- Walk on the flat at a brisk pace 6 METS
- Play golf, mountain walk dance, or any form of exercise 7 METS
- Run a short distance 8 METS
- Do either strenuous exercise or heavy physical work 9 METS
What anaesthetic specific issues must be asked of the patient prior to surgery?
- Drugs and Allergies
- Previous surgery and anasthesia
- Potential anaesthetic problems
- Airway
- Spine
- Reflux
- Obesity
- Rarities in FH
- Malignant hyperpyrexia
- Cholinesterase deficiency
What is ASA grading?
- ASA1 Otherwise healthy patient
- ASA2 Mild to moderate systemic disturbance
- ASA3 Severe systemic disturbance
- ASA4 Life threatening disease
- ASA5 Moribund patient
- (ASA6 Organ retrieval)
What morbidities are important to asses in the Cardiac Risk Index?
- High-risk surgery
- Ischaemic heart disease
- Congestive heart failure
- Cerebrovascular disease
- Diabetes
- Renal failure
Why are investigations undertaken prior to surgery?
- Detect unknown conditions
- Diagnose suspected conditions
- Severity of known disease
- Establishing a baseline
- Detecting complications
- Assessing risk
- Guiding management
- Documenting improvement
What are the specific Cardiovascular and Respiratory investigations undertaken prior to surgery (in at risk patients??)
CVS
- ECG
- ETT (Exercise Tolerance Test)
- Echo
- Myocardial perfusion
- Stress echo
- Cardiac catheterisation
- CT coronary angiogram
Resp
- Saturations
- ABG
- CXR
- Peak flow
- FVC/FEV
- Gas transfer
- CT Chest
WIth what condition is it important to optomises medical control (assum prior to surgery)?
- Hypertension
- Ischaemic heart disease
- Heart failure
- Asthma
- COPD
- Diabetes
- Epilepsy
